Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa street, n 1, Guamá, Belém, PA, 66075-110, Brazil.
Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
BMC Womens Health. 2021 Feb 1;21(1):48. doi: 10.1186/s12905-021-01180-0.
Previous studies indicated an impact of hormonal contraceptive use on oral health. This systematic review aimed to investigate the evidence supporting the impact of the use of hormonal contraceptives and periodontal diseases.
This study is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and based on the PECO acrostic. Inclusion criteria comprised observational studies including women (P), which evaluated hormonal contraceptive users (E) and hormonal contraceptive non-users (C), to verify the association between this hormonal therapy and the periodontal diseases (O). Searches were performed on 5 databases: PubMed, Scopus, Web of Science, Cochrane Library, LILACS and grey literature (OpenGrey and Google Scholar). After the selection process, the included studies were evaluated qualitatively. Moreover, quantitative data were analyzed in two meta-analyses for clinical attachment loss (CAL) and probing depth (PD). Finally, the level of certainty was measured with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool between periodontal clinical parameters.
18 articles were eligible for the qualitative synthesis and 7 of them were selected for quantitative analysis. Hence, 15 of the eligible articles reported an association between the use of hormonal contraceptives and severity of periodontal disease. However, 6 articles demonstrated high risk of bias and were excluded from quantitative synthesis. The meta-analysis showed a statistically significant difference for CAL (MD 0.24 [0.09, 0.40]; p = 0.002), but in PD (MD 0.05 [- 0.05, 0.15]; p = 0.33) such difference was not identified. A very low level of evidence was found between the clinical parameters.
The use of hormonal contraceptives may be associated to severity of periodontal diseases. However, the quantitative analysis points to an inconclusive outcome due to the high level of heterogeneity. The association is biologically plausible, however additional studies are warranted to better elucidate the clinical significance of this possible association.
先前的研究表明，激素避孕药的使用对口腔健康有影响。本系统评价旨在研究支持激素避孕药使用与牙周病之间关系的证据。
本研究基于系统评价和荟萃分析的首选报告项目（PRISMA），并基于 PECO 首字母缩略词。纳入标准包括观察性研究，纳入女性（P），评估激素避孕药使用者（E）和非激素避孕药使用者（C），以验证这种激素治疗与牙周病（O）之间的关系。在 5 个数据库（PubMed、Scopus、Web of Science、Cochrane 图书馆、LILACS 和灰色文献（OpenGrey 和 Google Scholar））上进行了检索。经过筛选过程，对纳入的研究进行了定性评估。此外，还对临床附着丧失（CAL）和探诊深度（PD）的两项荟萃分析进行了定量数据分析。最后，使用 GRADE（推荐评估、制定和评估分级）工具评估牙周临床参数之间的确定性水平。
有 18 篇文章符合定性综合标准，其中 7 篇文章被选入定量分析。因此，15 篇合格文章报告了激素避孕药的使用与牙周病严重程度之间的关系。然而，有 6 篇文章存在高偏倚风险，被排除在定量综合分析之外。荟萃分析显示 CAL（MD 0.24 [0.09, 0.40]；p=0.002）有统计学显著差异，但在 PD（MD 0.05 [-0.05, 0.15]；p=0.33）中则没有发现这种差异。在临床参数之间发现了非常低水平的证据。
使用激素避孕药可能与牙周病的严重程度有关。然而，由于高度异质性，定量分析得出的结果尚无定论。这种关联在生物学上是合理的，但需要更多的研究来更好地阐明这种可能关联的临床意义。
