Introduction
Materials and methods
Search strategy
Field 1 | (contraceptives OR contraception OR “oral contraceptives” OR “hormonal contraception” OR “hormonal contraceptive” OR “birth control implant” OR “contraceptive implant” OR “implantable contraceptives” OR “hormonal iud” OR iud OR “injectable birth control” OR “injectable contraceptive” OR “injectable contraception” OR “birth control pills” OR “contraceptive pills” OR “vaginal rings” OR “contraceptive ring” OR “birth control patch” OR “contraceptive patch” OR “emergency contraception”) | |
and | ||
Field 2 | (“oral health*” OR “oral manifestation*” OR “periodontal health*” OR “periodontal disease” OR “oral disease” OR "oral cavity”) |
Inclusion and exclusion criteria
Inclusion criteria | Exclusion criteria |
---|---|
Articles that studied oral alterations and included women of reproductive age using hormonal contraceptives. | Articles that did not include women of reproductive age using contraceptives or articles that did not study oral alterations in women of reproductive age using contraceptives. |
Articles in English or Spanish | Articles in a language other than English or Spanish |
Observational studies (case-control, cohort, cross-sectional, longitudinal) | Clinical cases, systematic reviews, and meta-analyses |
Studies conducted in humans | In vitro or animal studies |
Articles published within the last 21 years. | Articles published more than 21 years ago. |
Articles studying oral manifestations diagnosed by medical professionals. | Articles studying oral manifestations not diagnosed by medical professionals. |
Study selection
Study data
Quality analysis
Methods | ||
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Configuration | 1 | Describe the environment, locations, and relevant dates, including the periods of recruitment, exposure, follow-up, and data collection. |
Participants | 2 | Specify the eligibility criteria (inclusion and exclusion), including matched groups or control if applicable. |
3 | Provide the history of hormonal contraception. | |
Variables | 4 | Clearly define the oral manifestation and its diagnostic criteria. |
Data Sources / Measurement | 5 | Provide a detailed explanation of the evaluation methods (measurement) of the oral manifestation. |
Study Size | 6 | Explain how the study size was determined. |
Statistical Methods | 7 | Describe all statistical methods, including those used to control confounding factors. |
8 | Describe any method used to examine subgroups and interactions. | |
Descriptive Data | 9 | Provide the characteristics of the study participants (e.g., demographic, clinical, social), and report on exposures and potential confounding factors. |
10 | Indicate the number of participants with missing data and explain how it was addressed. | |
Outcome Data | 11 | Report the numbers in each exposure category or summary measures of exposure. |
Results
Study selection and flow diagram
Database | Search strategies | Results |
MEDLINE | #1 | |
#2 | 78,441 | |
#1 AND #2 | 98,310 | |
Web of Science | #1 | 96 |
#2 | 14,81,89,28,48,41,290 | |
#1 AND #2 | 80,674 | |
Scopus | #1 | 1,15,594 |
#2 | 140 | |
#1 AND #2 | 18,560 | |
Cochrane Library | #1 | 11,600 |
#2 | 46 | |
#1 AND #2 | 1,392 | |
SciELO | #1 | 1,950 |
#2 | 1 | |
#1 AND #2 |
Characteristics of the studies
Bibliometric analysis
Study design
Groups or sample
Age of participants
Type of hormonal contraceptive
Oral manifestations
Author and year | Study design | Sample or population | Age of participants/(years) | Type of HC | Oral manifestations | Key outcomes of interest | Conclusions | |
---|---|---|---|---|---|---|---|---|
Taichman and Eklund, 2005 [40] | cross-sectional | n = 9931 NHANES I = 4930 NHANES III = 5001 | 17–50/ NHANES I = 30 NHANES III = 32 | NHANES I = High-dose COC NHANES III = Low-dose COC | Periodontal disease | NHANES I: Protective association between OC users and gingivitis (NS; OR = 0.65). OC users have a lower probability of periodontitis (OR = 0.36). NHANES III: OC users have a lower prevalence of gingivitis (OR = 80). There is no protective effect between OC users and periodontitis (OR = 0.73). | The relationship between high-dose OC and gingivitis/periodontitis is ruled out. There is an association between low-dose OC and periodontal disease non-harmful. It is premature to determine a protective effect of OC. | |
Mullally et al., 2007 [42] | cross-sectional | n = 50 (with OC 21, without OC 29) | 20–35/ 29.7 ± 4.7 | COC (14 users with 30 mg of EE, 4 with 35 mg of EE, 3 others) | Periodontal disease | 95% of GAP diagnoses are made in individuals who take or had taken OC. OC users: higher PI and GI, but NS; higher and significant BOP (p = 0.017). OC users have greater mean PD (p = 0.006) and mean AL (p = 0.015). Users without a history of OC have significantly better periodontal health. | Common use of OC in women with aggressive periodontitis. High prevalence of OC use with GAP. OC users have worse periodontal health. | |
Brusca et al., 2010 [32] | case-control | n = 92 SG = 41 CG = 51 | 19–40/30 | SG = COC (0.015 mg EE and 0.06 mg gestodene/ 0.03 mg EE and 3 mg drospirenone/ 0.02 mg EE and 3 mg drospirenone) CG = no OC | Periodontal disease and presence of specific subgingival periodontopathogens | Severe periodontitis significantly higher in SG (p < 0.01). SG has higher presence of P. gingivalis (82.9%), P. intermedia (85.4%), and A. actinomycetemcomitans (14.6%). More Candida species (95.1%) in SG with significant difference (p < 0.05). SG (during + 3 years) has a higher presence of C. albicans, C. parapsilosis, C. krusei, C. tropicalis, and C. glabrata, except C. dubliniensis. | OC increase severe periodontitis and the presence of specific periodontopathogens in periodontal pockets. | |
Haerian-Ardakani et al., 2010 [33] | case-control | n = 70 SG = 35 CG = 35 | 17–35/24 | SG = COC Microgynon® (0.15 mg progestin and 0.03 mg EE) CG = without history | Periodontal disease | PI with no significant differences (p > 0.05). SG has significantly higher GI (p < 0.0001) and BOP (p < 0.001). PD and AL show no significant differences. | Users of low-dose OC for a minimum of 2 years have higher gingivitis and bleeding compared to the CG. | |
Parthasarathi et al., 2011 [44] | longitudinal | n = 284 [276 extractions in women; 14 (2.5%) in women with OC] | - | OC | Alveolar osteitis after extraction | Alveolar osteitis in 0 out of 14 extractions in women with OC. | No patient with OC developed alveolar osteitis. | |
Taichman et al., 2012 [41] | cross-sectional | n(NHANES) = 4460 [157 use DMPA, 553 used before, and 3750 never used] | 15–44 | DMPA | Periodontal disease | There is a significant association between gingivitis and current use of DMPA (OR = 1.7). The association between gingivitis and past use of DMPA is NS (p = 0.057). There is a modest association between periodontitis and DMPA use (OR = 1.49). DMPA users who are also smokers have a lower probability of periodontal disease (OR = 0.55). | The use of DMPA influences periodontal health. | |
Wu et al., 2013 [38] | cross-sectional | n = 754 | 20–39 | OC | Periodontal disease | Women using OC: PD ≥ 4 mm (p = 0.316), CAL ≥ 3 mm (p = 0.309), both NS, and > 25% of sites with BOP (p = 0.015), which is statistically significant (p < 0.05). | The use of OC exacerbates gum inflammation. | |
Aminzadeh et al., 2016 [35] | case-control | n = 40 SG = 20 CG = 20 | 18–45 | SG = COC CG = without history | Oral candidiasis | SG: significantly higher C. albicans (p = 0.04) and C. krusei (p = 0.03) but not C. tropicalis (p = 0.43). | OC increase the probability of growth of C. albicans and C. krusei. | |
Smadi and Zakaryia, 2018 [34] | case-control | n = 281 SG = 139 CG = 142 | 18–39 | SG = COC (Yaz™, Marvelon™, Yasmin™, Microgynon30™, Dian™, others) CG = non-users | Periodontal disease | SG: OHI-S, SBI, CAL and GI significantly higher (p < 0.05). | COC increase the risk of gingival disease. This effect is potentiated by newer generations of COC. | |
Prachi et al., 2019 [39] | cross-sectional | n = 200 G1 = 100 G2 = 100 | ≥ 18 / G1 = 26,37 G2 = 27,08 | G1 = OC users G2 = without history | Worse periodontal health | Mean CPI for G1 (2.34 ± 0.81) and G2 (1.16 ± 0.89). Mean LOA for G1 (0.28 ± 0.45) and G2 (0.19 ± 0.50). Significant differences in mean CPI and LOA (p = 0.00). Significant association between CPI and OC duration (p = 0.000) (+ duration worse health). Significant association between LOA and OC duration (p = 0.000). | OC users have worse periodontal and gingival health. Longer duration of OC use is associated with higher PD, AL, and bleeding. | |
Altaee, 2020 [36] | case-control | n = 30 SG = 15 CG = 15 | 18–45/ 30,6 ± 5,6 | SG = OC users CG = without history | -Lesser orthodontic tooth movement. -Periodontal disease -Ulcerative lesion -Changes in mucosal color -Pyogenic granuloma | SG: significantly lower tooth movement (p < 0.05) and higher periodontal disease (p < 0.05), UL (20%), CCM (20%), PG (13.3%). | OC and FOA users show significantly less orthodontic tooth movement, significant increase in periodontal disease, and a higher percentage of CCM, PG and UL. | |
Bostanci et al., 2021 [43] | cohort | n = 103 G1 = 43 G2 = 41 G3 = 19 | G1 = 23 G2 = 23 G3 = 24 | G1 = does not use HC G2 = COC (20–35 µg of EE with progestins) G3 = LNG-IUD (Jaydess, Kyleena, and Mirena) | Salivary microbiome dysbiosis | Diversity and nº of species within the sample NS according to HC. HC has no notable effect on microbiome differentiation between samples. Microbiomes associated with periodontal health or disease show no notable differences between HC groups. | The use of HC is not responsible for significant changes in the salivary microbiome. | |
Rasheed and Ahmed, 2023 [37] | case-control | n = 51 SG = 30 CG = 21 | 16–45/ SG = 32,6 CG = 23,6 | SG = OC CG = non-users | -Changes in salivary flow, pH, and biochemical data (TSP, ALP, IgA) - Gingival inflammation -CCM, UL, PG | SG: pH value NS (P > 0.05), significantly lower flow rate (P < 0.0001), significantly higher ALP (P < 0.05), significantly lower IgA (P < 0.0001), significantly lower TSP (P < 0.0001), no changes in oral mucosa, positive association GI-duration of therapy. | OC affect salivary flow rates and other parameters (TSP, ALP, IgA). After prolonged use of OC, the main symptom is gingival inflammation. |
Quality analysis
Taichman and Eklund [40]. | Mullally et al. [42] | Brusca et al. [32] | Haerian-Ardakani et al. [33] | Parthasa-rathi et al. [44] | Taichman et al. [41] | Wu et al. [38] | Aminzadeh et al. [35] | Smadi and Zakaryia [34] | Prachi et al. [39] | Altaee [36] | Bostanci et al. [43] | Rasheed and Ahmed [37] | |||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | ✔ | × | ✔ | × | ✔ | ✔ | × | ✔ | ✔ | × | × | ✔ | × | ||
2 | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | × | ✔ | × | ||
3 | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||
4 | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | × | ✔ | × | ||
5 | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | × | ✔ | × | ✔ | × | ||
6 | ✔ | × | × | × | × | ✔ | × | ✔ | × | ✔ | × | × | × | ||
7 | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||
8 | ✔ | ✔ | ✔ | × | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | × | ✔ | × | ||
9 | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | × | ✔ | × | × | ✔ | × | ||
10 | ✔ | × | × | × | × | × | × | × | × | × | × | ✔ | × | ||
11 | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||
Total Score | 11 | 8 | 9 | 7 | 9 | 10 | 8 | 9 | 8 | 8 | 3 | 10 | 3 | ||
Risk of bias | Low | Low | Low | Moderate | Low | Low | Low | Low | Low | Low | High | Low | High |