The most common oral manifestation of elevated levels of ovarian hormones, as seen in pregnancy or oral contraceptive usage, is an increase in gingival inflammation with an accompanying increase in gingival exudate. This gingivitis can be avoided or at least minimized by establishing low plaque levels at the beginning of pregnancy or the beginning of oral contraceptive therapy. It would appear that bacteria are not solely responsible for the gingivitis seen during these times, nor are the ovarian hormones solely responsible for the condition. Data from numerous studies suggest that the ovarian hormones alter the microenvironment of the oral bacteria so as to promote their growth and shifts in their populations. The present article reviews the current state of knowledge concerning the relationship of gingivitis to elevated levels of ovarian hormones, and describes the role that these hormones may play in the gingivitis associated with pregnancy or oral contraceptive usage.
PIP: A rise in the ovarian hormones, estrogen and progesterone, increases the risk of inflammation of the gingiva. Both pregnancy and use of oral contraceptives (OCs) increases the levels of these hormones. These levels stimulate bacterial growth in the mouth, resulting in a shift in bacteria flora. Progesterone and estrogen stimulate key factors involved in the inflammatory response. Progesterone changes the rate and pattern of collagen production in gingiva, thereby reducing the body's ability to repair and maintain the gingiva. Progesterone and estrogens cause folate deficiency which also prevents gingiva repair and they inhibit the immune system. Gingivitis generally occurs in 60-to-75% of pregnant women, but its incidence is only .03% if pregnant women are plaque-free at the beginning of pregnancy and practice good oral hygiene during pregnancy. Unlike pregnant women, OC users face the risk of chronic gingival inflammation with possible periodontal involvement. Women should practice good oral hygiene before beginning OC use and maintain it during OC usage. Good oral hygiene reduces the likelihood of developing gingivitis during pregnancy or OC use.