|Year : 2021 | Volume
| Issue : 3 | Page : 194-199
Assessment of attitude and awareness of oral health changes in females during menstrual cycle: A questionnaire-based survey
Swetha Kardalkar1, Shruti B Kardalkar2, Harsha Bhayya3
1 Department of Dentistry, Bidar Institute of Medical Sciences, Bidar, Karnataka, India
2 Department of Community Medicine, ESIC Medical College and Hospital, Kalaburagi, Karnataka, India
3 Department of Oral Medicine and Radiology, H.K.D.E.T's Dental College, Hospital and Research Institute, Humnabad, Karnataka, India
|Date of Submission||07-May-2021|
|Date of Acceptance||01-Jul-2021|
|Date of Web Publication||24-Aug-2021|
Department of Oral Medicine and Radiology, H.K.D.E.T's Dental College, Hospital and Research Institute, Humnabad, Bidar, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Menstrual cycle is one of the phases in a woman's life wherein there are multiple physiological changes in the body. Various phases of menstrual cycle show a different physiological behavioral pattern of the body as well as hormonal changes which can lead to multiple changes in the oral cavity. Aims: The aim of this study is to assess the attitude and awareness of oral health changes in females during menstrual cycle. Materials and Methods: The present study was conducted as a cross-sectional study among the general population of Karnataka, India. A self-administered semi-structured questionnaire consisting of 19 questions was used to assess the attitude and awareness of oral health changes in females during menstruation. Data were entered in Excel and analyzed using IBM SPSS statistics version 22. Results: In the present study, a total of 300 females participated comprising different age groups, of which maximum participants were in the age group of 18–24 years. 57.7% of population had a duration of 28–30 days' menstrual cycle. About 44.3% of participants had experienced an overall health change. 18.3% of participants experienced oral changes, of which 15% of participants had developed aphthous ulcers. 7.3% of participants experienced bleeding gums. 81.3% of participants believed that the use of antimicrobial mouthwash reduces bad breath and 55.7% believed that brushing twice can reduce swelling of gums. Conclusion: This study gives an inference that participants were though aware of menstruation and related complaints, but they were not aware of oral changes occurring during the cycle.
Keywords: Attitude, awareness, female, oral changes, oral health
|How to cite this article:|
Kardalkar S, Kardalkar SB, Bhayya H. Assessment of attitude and awareness of oral health changes in females during menstrual cycle: A questionnaire-based survey. J Dent Res Rev 2021;8:194-9
|How to cite this URL:|
Kardalkar S, Kardalkar SB, Bhayya H. Assessment of attitude and awareness of oral health changes in females during menstrual cycle: A questionnaire-based survey. J Dent Res Rev [serial online] 2021 [cited 2022 Dec 9];8:194-9. Available from: https://www.jdrr.org/text.asp?2021/8/3/194/324421
| Introduction|| |
Oral cavity is a mirror to the overall well-being and health of patients. The oral mucosa which is formed by keratinized and nonkeratinized epithelium is influenced by various factors. Hormonal changes are one of the major factors which cause changes in the oral mucosa which could be during puberty, menstruation, pregnancy, or menopause. The oral changes seen can be gingivitis, oral ulcers, reddening of the attached mucosa, and burning of the mucosa.
Menstrual cycle is one of the phases in a woman's life wherein there are multiple physiological changes in the body. Various phases of menstrual cycle show a different physiological behavioral pattern of the body. It is always observed that there is a fluctuation in ovarian hormones during menstruation. These hormonal changes can lead to multiple changes in the oral cavity.
Intraoral changes like gingival bleeding, redness of mucosa, oral ulcer, recurrent herpetic lesions, rarely candidal infections are noted in few of the women, which are attributed due to sex hormonal changes during menstruation. These hormonal fluctuations are seen throughout a woman's life time which impacts the physiology and psychological well-being of women. Lack of awareness about these changes in women of the urban and rural population leads to ignorance of the changes noticed in the oral cavity. The presence of intraoral changes and poor oral hygiene practices can in-turn affect the overall health and well-being directly or indirectly. This study was taken up to assess attitude and create awareness about oral health and oral hygiene among healthy menstruating females of different age groups.
| Materials and Methods|| |
The present study was conducted as a cross-sectional study among the general population of Karnataka, India. Healthy menstruating females of different age groups who were willing to participate voluntarily were selected and included through convenient sampling in the present study. A self-administered semi-structured closed-end questionnaire was designed comprising 19 questions to assess the awareness and attitude of females about oral health and oral hygiene and its association with menstrual cycle by assessing their experiences during their menstrual cycle. All the participants were informed regarding the study, and informed consent was taken with detailed explanation in local language without harming the cultural and social values. The questionnaire was available in English and in Kannada (regional language).
n = 4pq/l2
Taking proportion P = 50%, q = (100 − p) =100 − 50 = 50, l% =10% of p
n = 400
A pilot study was done among thirty participants, and the changes in questionnaire were done as required.
Sampling frame and setting
A web-based online survey was planned using Google Forms which consisted of predesigned and pretested questionnaires. A Google Forms link was circulated by networks and colleagues through WhatsApp private messages and groups during the research period to female participants of reproductive age.
Thorough recording of oral discomforts during various phases of the cycle was done during the study period. Participants in the present study ranged from 18 to 45 years of age group. The demographic data collected included age, educational level, marital status, and occupation. Data were entered in Excel and analyzed using IBM SPSS statistics version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, version 22.0 Armonk, NY, USA: IBM Corp.). The analysis of answers involved descriptive quantitative statistics, for example, frequency and percentage.
| Results|| |
In the present study, a Google Forms was circulated among 400 female participants comprising different age groups ranging from 18 to 45 years, out of which 100 females participated did not fill the form completely or complete the questionnaire. Hence, forms of 300 participants were considered for the statistical analysis. Maximum participants were in the age group of 18–24 years, i.e., 189 participants followed by 107 participants in the age group of 25–34 years. Only four participants participated in the age group of 35–45 years. All the participants belong to different marital status, educational background, and occupation as given in [Table 1].
57.7% of participants had a duration of 28–30 days' menstrual cycle, 30.3% of participants had <28 days' menstrual cycle, and only 12% had >30 days' menstrual cycle. About 44.3% of participants had experienced an overall health change during cycle and 65.3% had experienced psychological discomfort. When asked about experience of any oral changes during cycle, only 18.3% experienced oral changes and 9.3% were not aware of it. When participants were asked about how many days prior to the cycle they noticed the changes, 50.3% said <7 days prior to cycle and 28% noticed during the cycle and about 19.3% said more than 7 days prior to cycle.
In the present study, awareness of participants was assessed regarding oral health, which showed that only 15% of participants had developed oral ulcers while 68% of participants did not experience any ulcer formation and 17% were not aware of it. About 92.7% of participants did not experience bleeding of gums, while only 7.3% of participants had bleeding of gums; whereas none of the participants experienced any swelling of gums, only 6.3% of participants were not sure about swelling of gums. Twenty-nine percent of participants had altered taste sensation with bad breadth experience in 11.3% and burning sensation in oral cavity in 12% of participants. Only 13.7% of participants had recurrent complaints in the past and 16.3% of participants took additional supplements to tackle the changes [Table 2].
44% of the participants considered intraoral changes during menstruation as normal, while other 35% were not sure and aware of any such intraoral changes during menstruation. Seventeen percent of participants consulted a doctor in this regard, in that 8.6% of participants consulted a dentist. Only 5.3% of participants took treatment for oral-related changes [Table 2].
Participants' attitude was assessed, 55.7% of participants agreed that brushing twice can reduce the swelling of gums, while 34% were not sure. When asked about use of antimicrobial mouthwash in reducing the bad breath, 81.3% of participants believed that it helps in reducing bad breath. Ninety-four percent of participants believed that we should get checked once in 6 months for the better oral health [Table 2].
| Discussion|| |
In developing nations, there is a variation in individual health. The concept of social life is also an emphasis on the concept of health which also has shown interest in oral health to certain extent. A female goes through multiple phases in life such as menstruation, pregnancy, and menopause which cause changes in estrogen and progesterone, which affects gingival health and periodontal health in oral cavity. Due to fluctuation in the hormones, women report multiple oral discomforts which could be burning sensation,, bleeding of mucosa with minor irritation,, redness of gums, recurrent oral ulcers,, and sometimes, herpes labialis,, candidal infections, increased mobility of teeth,, and emotional upsets., However, till date, there is no established and proven study to state changes in oral epithelium and hormonal fluctuation.
In the present study, there were multiple general physical discomforts reported such as depression, backache, abdominal pain, headache, tiredness, bloating, and myalgia which are most commonly reported in most of the women. Few of them also complained of having mood swings and depression with psychological discomfort. Depression is said to be associated with changing concentration of gonadal hormones in adults and adolescents. Estrogen levels in menstrual cycle could cause mood changes. Few authors have correlated depression/drowsiness due to psychological stress during premenstrual period., In our study, whether this change was due to stress or hormonal level could not be attributed.
The oral changes encountered and reported in the present study were only about 18.3%, of which aphthous ulcers contributed to 15% of them, whereas a study conducted by Balan et al. showed thirty of patients with aphthous ulcers. Cellular immune system affects the mechanism of ulceration. During menstrual cycle, there is an alteration in immune response which is due to fluctuation of steroid hormone.
Few researchers have given an inference about a direct relationship between aphthous ulcer and menstrual cycle., During luteal phase between ovulation and menstruation, ulceration is most troublesome. These ulcerations during every menstrual cycle are due to fluctuating levels of progesterone.
During menstrual cycle, women report increased gingival discomfort and inflammation due to fluctuation in steroid sex hormones. Estrogen is a factor responsible in formation of fibrous collagen and also causes cytodifferentiation of stratified squamous epithelium. Hormonal changes during puberty affect gums along with the subgingival microflora. The changes in microflora cause hyperplastic reaction and inflammation of interdental papilla. If local deposits like calculus are present, subgingivally, gingiva appears red, ballooned, and lobulated. Histologically, the gingiva resembles inflammatory hyperplasia. These inflammatory changes and erythematous changes of gingiva during menstrual cycles can easily provoke bleeding and exudation during mastication and brushing. Adolescents have a higher tendency for developing gingivitis when compared with prepubertal children and adults. In the present study, the maximum participants were adolescent, of which 7.3% of them reported bleeding gums while none had gingival swelling. In a study conducted by Gomes et al., only 4% of participants knew correlation between oral health and menstruation, 6% noticed bleeding gums, and 26% reported discomfort and tender gums, whereas in a study by Balan et al., 8% of participants had gingival bleeding. Shourie et al. in their study concluded that the preexisting gingivitis could be exaggerated by the sex hormones, however, these hormones have a very negligible effect on healthy periodontium and the significant effect of hormone and oral changes is uncertain.
In the present study, 29% of patients had altered taste sensation along with halitosis in 11.3% and burning sensation in oral cavity in 12%. Gomes et al. reported 4% altered taste sensation, whereas Balan et al. did not report any cases with altered taste sensation.
In our study, we found that 44% of patients were aware about menstruation and oral changes. Despite having complaints, only 16.3% took additional supplements to tackle changes and only 5.3% took treatment for any oral-related changes during menstruation which was very negligible.
Attitude of the participants toward oral hygiene and health was quite satisfactory. 55.7% agreed on brushing twice can reduce gingival inflammation and 81.3% believed brushing reduces bad breath. Ninety-four percent agreed on a regular checkup to a dentist once in 6 months for better oral health.
| Conclusion|| |
This study gives an inference that participants were aware of menstruation and related complaints, but they were not aware of the fact that menstruation and oral changes which cause discomfort are interrelated. For a better understanding of the correlation of female hormones and oral changes, it is recommended that a cross-sectional and longitudinal, clinical, and microbiological study should be done from adolescent to adulthood, correlating the oral findings during menstruation and the impact of same in adults.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Krejei CB, Bissada NF. Women health issues and their relationship to periodontitis. JADA 2002;133:323-8.
Balan U, Gonsalves N, Jose M, Girish KL. Symptomatic changes of oral mucosa during normal hormonal turnover in healthy young menstruating women. J Contemp Dent Pract 2012;13:178-81.
Prusty RK, Kumar A. Socioeconomic dynamics of gender disparity in childhood immunization in India, 1992-2006. PLoS One 2014;9:e104598.
Preckshot J. Oral health. Int J Pharm Compd 2004;8:11-4.
Mealey BL, Moritz AJ. Hormonal influences: Effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontol 2000 2003;32:59-81.
Carranza FA. Clinical Periodontology. 8th
ed. Philadelphia, USA: WB Saunders Comp.; 1996.
Dolby AE. Recurrent Mikulicz's oral apthae. Their relationship to the menstrual cycle. Br Dent J 1968;124:359-60.
Scully C, Porter S. Recurrent aphthous stomatitis: Current concepts of etiology, pathogenesis and management. J Oral Pathol Med 1989;18:21-7.
Segal AL, Katcher AH, Brightman VJ, Miller MF. Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle. J Dent Res 1974;53:797-803.
Dayal J, Pandya D, Dayal PK, Bhat A. Oral health amongst females during hormonal turnover: A clinical and cytological study. J Indian Acad Oral Med Radiol 2000;11:5-22.
Angold A, Costello EJ, Erkanli A, Worthman CM. Pubertal changes in hormone levels and depression in girls. Psychol Med 1999;29:1043-53.
Ferguson MM, McKay Hart D, Lindsay R, Stephen KW. Progeston therapy for menstrually related aphthae. Int J Oral Surg 1978;7:463-70.
Machtei EE, Mahler D, Sanduri H, Peled M. The effect of menstrualcycle on periodontal health. J Periodontol 2004;75:408-12.
Markou E, Eleana B, Lazaros T, Antonios K. The influence of sexsteroid hormones on gingiva of women. Open Dent J 2009;3:114-9.
Steinberg BJ, Minsk L, Gluch JI. Women's oral health issues. In: Clouse A, Sherif K, editors. Women's Health in Clinical Practice. Totowa, NJ: Humana Press; 2008. p. 273-93.
Gomes SR, Tamgadge S, Acharya SS, Thapar PR, Patil RR, Khanapure SC. Awareness of oral health changes during menstruation: A questionnaire-based survey among adolescent girls. Dent Med Res 2019;7:28-32. [Full text]
Shourie V, Dwarakanath CD, Prashanth GV, Alampalli RV, Padmanabhan S, Bali S, et al.
The effect of menstrual cycle on periodontal health – A clinical and microbiological study. Oral Health Prev Dent 2012;10:185-92.
[Table 1], [Table 2]