Oral contraceptive use and periodontal diseases among United States women: An analysis of NHANES data.

Abstract

Periodontal diseases are common chronic diseases resulting in substantial cost to society and to individual members. There is evidence to suggest that high dose combined oral contraceptives (containing >50 mug of estrogen and progestin &ge;1 mg) place women at greater risk for periodontal diseases, but these data are over 20 years old. Since 1976, formulations of oral contraceptives have changed resulting in new oral contraceptive brands which contain <50 mug of estrogen and 1 mg or less of progestin. As a result, the findings of early studies may not be generalizable to today's preparations. The purpose of this cross-sectional study was to assess the association between contraceptive use and clinical indicators of periodontal disease among a representative sample of premenopausal U.S. women ages 17--50. This objective was achieved by analyzing data from the 1<super>st</super> and 3<super>rd</super> National Health and Nutrition Examination Survey (NHANES I 1971--74 and NHANES III, 1988--1994) data sets. Exposure was defined as oral contraceptives use. The outcomes in this study were gingival inflammation and moderate periodontitis. Multiple logistic regression models were used to assess the association between contraceptive use and measures of periodontal disease status while controlling for potential confounders. Weighted bivariate and multivariate analyses were conducted using SAS and STATA statistical packages. There was a statistically significant decline in the proportion of current oral contraceptive users between NHANES I and NHANES III (18.5% vs. 15.9%); (P < .05). Oral contraceptive users were younger, had higher education and income levels, had a higher perception of their own health and utilized dental care more frequently. Overall, oral contraceptive use was associated with a decreased prevalence of gingivitis and periodontitis in both data sets. In NHANES III, increased duration of oral contraceptive use was statistically associated with a decrease in moderate periodontitis, periodontal pocketing of 4 &ge; mm, and tooth loss among ever users, after adjusting for potential confounders. This study does not support the previous findings of increased risk of periodontal disease associated with oral contraceptive use. Further studies are necessary to confirm our results and to elucidate the association of oral contraceptives and periodontal diseases.