|Year : 2019 | Volume
| Issue : 1 | Page : 28-32
Awareness of Oral Health Changes during Menstruation: A Questionnaire-Based Survey among Adolescent Girls
Sheiba R Gomes1, Sandhya Tamgadge2, Siddharth S Acharya3, Prem R Thapar4, Rutika R Patil4, Sneha C Khanapure3
1 Department of Public Health Dentistry and Periodontology, DY Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
2 Department of Oral and Maxillofacial Pathology and Microbiology, DY Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
3 Department of Public Health Dentistry, DY Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
4 Intern, Public Health Dentistry, School of Dentistry, DY Patil Dental College, Navi Mumbai, Maharashtra, India
|Date of Web Publication||12-Apr-2019|
Department of Oral Maxillofacial Pathology, DY Patil University School of Dentistry, Sector 7, Nerul, Navi Mumbai - 400 706, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Periodontal health in women is affected by sex hormones. Puberty, menstruation, use of oral contraceptives, pregnancy, and menopause influence the periodontal health in women. Aim: This study was conducted to assess the awareness of oral health changes during menstruation in adolescent girls. Materials and Methods: A self-administered cross-sectional survey was conducted at a node in Navi Mumbai to assess the awareness of adolescent school-going girls on the subject of menstruation and the oral changes associated with the same. Results: Majority of the participants were aware of menstruation and associated problems, but only 4% of participants were aware that oral health changes can occur during menstruation. Conclusion: There is a definite lacuna in the awareness of adolescents about menstruation and the oral health changes associated with the same, and creating awareness on this association is necessary to prevent periodontal disease in adulthood.
Keywords: Adolescence, awareness, female sex hormones, gingival bleeding, menstruation
|How to cite this article:|
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
|How to cite this URL:|
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 [serial online] 2019 [cited 2019 Oct 19];7:28-32. Available from: http://www.dmrjournal.org/text.asp?2019/7/1/28/256025
| Introduction|| |
Hormonal changes during puberty, menstruation, and pregnancy affect a woman's oral health. These fluctuations occur throughout a woman's life, resulting in changes in the gingival and periodontal tissues, and these hormonal changes affect therapeutic decision-making in periodontics. During puberty, an increased level of sex hormones, such as progesterone and estrogen, increases blood circulation in the gingiva, leading to a greater susceptibility to irritation from food particles, plaque bacteria, and calculus. Epidemiologic and immunologic data suggest that irreversible tissue damage from periodontal disease begins in late adolescence and early adulthood.
Oral health education and promotion can be delivered at primary health-care centers, hospitals, private dental clinics, and schools. Schools are a preferred place for promoting oral health because one billion children worldwide spend most of their daytime life there, of which many are female. Physical and psychological changes occurring in adolescent girls make them vulnerable and in need of preventive programs to ensure positive health and hygiene. School adolescents who suffer from poor oral health are more likely to have restricted activity as compared to those with good oral health., A lack of health education and insufficient preventive measures in developing countries leads to high prevalence of morbidity among them.
There is a dearth of published literature on awareness of involvement of oral tissues during menstruation. This has been neglected in the field of public health. Keeping this in mind, the present questionnaire-based survey was undertaken on school-going adolescent girls to find out their awareness on this subject.
| Materials and Methods|| |
The study was based on a self-developed prevalidated closed-ended questionnaire. This self-administered, structured, cross-sectional questionnaire-based survey was administered to 320 school-going girl students to assess their awareness on oral health and its association with menstrual cycle by assessing their experiences during their menstrual cycle. Fifteen students refused to participate in the survey; therefore, a total of 305 students had participated. It was conducted during March 2017. Girls between the ages of 13 and 17 years were selected from 7th to 10th grade. The questionnaire was in English and had 20 closed-ended mostly dichotomous answer questions [Table 1]. Required permission from the school and parental consent for those participating in the study were obtained before doing the survey. Confidentiality and anonymity of the participants were assured. The students answered the questionnaire in the classroom, and the teachers and school personnel were not present during the same. Before the start of the study, the nature of the study was explained to the students and the procedure for completing the questionnaire was explained, and certain terms related to the questionnaire were explained to them. Students were asked to respond to each item in the questionnaire according to the response format provided. The principal investigator and the team were available to clarify doubts raised by the students. They were encouraged not to discuss the questionnaire with each other. Ethical approval was obtained from the institute's ethical committee. To check the reliability, validity, and repeatability, a pilot study was done on thirty students with Cronbach's alpha value at 0.8. The data were statistically analyzed using descriptive analysis using SPSS 20 (IBM Corp. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp).
| Observations And Results|| |
It was observed that all students had started with their mensuration cycles, which averagely lasted for 3–5 days. About 83% of students said that their cycle was regular. Sixty-six percent of students had discussed this with their friends, 60% of the total students had complaints, 38% about abdominal pain, 42% about cramps, 3% about headache, 85% about tiredness, 12% about backache, 3% had experienced nausea, 7% had experienced diarrhea, 2% experienced giddiness, and 1% experienced mood swings. Eleven percent of students had visited a gynecologist for associated problems, 7% had visited their family physician, but none had visited an endocrinologist or a dentist. Seven percent of students had taken medications. Three percent of students had undergone hormonal tests. Forty-three percent of students claimed that the members in their family had similar issues. Nineteen percent of students noticed irritability and agitation during the period, 28% agreed on changes in their hunger pattern, and 30% agreed that the period affected their day-to-day activity. Four percent of students claimed to be aware of the relationship between menstruation and oral health. None of the students experienced any changes in the color and texture of their gingiva. Six percent of students noticed bleeding from the gingiva. Twenty-six percent of students complained of tenderness and feeling of discomfort in the gingiva. Four percent of students complained of altered taste sensation. None of the participants had experienced aphthous ulcers, recurrent herpetic lesions. All students agreed that their school conducts awareness programs for them; however, oral health issues during menstruation were not discussed.
| Discussion|| |
India is a developing nation, a country of startling contrasts, and gender inequality with extreme poverty and wealth; this results in variation in health. There are 113 million adolescent girls, of which 68 million attend 1.4 million schools in the country. Menstrual hygiene management and existing cultural taboos have been extensively studied by researchers. Adolescence is the transition from childhood to adulthood characterized by physical emotions, endocrinal changes, and mental growth. Adolescence is a period where dramatic changes occur. Providing optimal health care to this age group requires in-depth understanding of biological, cognitive, and sociocultural changes that occur and its relationship and potential impact on the health of adolescence. Adolescence is associated with menarche and complaints such as irregular menstrual cycle, excess bleeding, and dysmenorrhea. Dysmenorrhea is a painful gynecological condition due to cramps of uterine origin and is of two types: primary which is pelvic pain without any pelvic pathology and secondary which is accompanied with pelvic inflammation. Primary dysmenorrhea is by far the most common gynecological problem in this age group. Inflammatory response mediated by prostaglandins and leukotrienes cause lower abdominal cramps and systemic symptoms. In our study, 60% of the students complained of complications during menstruation: 38% abdominal cramps, 12% backache, 3% nausea, 7% diarrhea, 1% feverish feeling, 2% giddiness, and 85% tiredness [Table 2]. Nag reported a dysmenorrhea in 33.5% population which is comparable with that experienced in our study. A Swedish study showed that more than 50% of all menstruating women experience some discomfort. George and Bhaduri concluded that dysmenorrhea is a common problem in India. Morbidity due to dysmenorrhea is a leading cause of absenteeism from school and a diminished quality of life. In our study, 30% of students agreed that mensuration affects their day-to-day activities. Dysmenorrhea seems to be a familial problem, and 43% of participants had a family history. These results are in accordance with previous studies. Despite having complaints, only a small proportion (11%) of girls had visited a gynecologist and 3% had done the hormonal tests recommended. None of the participants had visited an endocrinologist or a dentist and 7% had visited their family physician. Seven percent of participants had opted for pharmacological management. Female sex hormones such as estrogen and progesterone affect the periodontium. Pregnancy, mensuration, use of oral contraceptives, and menopause affect the gingival health in women. The premenstrual period and adolescence can be a critical period in a life of women marked by physical and physiologic changes in the body. During mensuration, fluctuations of steroid sex hormones occur, and women report an increase in gingival inflammation and increased associated discomfort. Estrogen influences cytodifferentiation of stratified squamous epithelium and the formation of fibrous collagen. Hormone progesterone exerts a direct effect on the periodontium and may play an important role in bone formation and bone resorption. Adolescence can be a critical period which could affect the periodontal status in later years. Hormonal level fluctuations during puberty affect both the gingival tissues and the subgingival microflora, causing hyperplastic reaction with inflammation of the interdental papilla. If local deposits are present, gingiva appears red, ballooned, and lobulated. Histologically, it resembles inflammatory hyperplasia. This erythematous and edematous gingiva during the menstrual cycle results in easily provoked bleeding and exudation during day-to-day activities such as mastication and brushing. Adolescents have a higher prevalence of gingivitis than prepubertal children or adults. In this study, only 4% of participants knew that oral health and menstruation are related, 6% had noticed bleeding gums, and 26% had complained of had tenderness and discomfort in their gums. None of the participants noticed any changes in the color or texture of their gingivae probably due to the lack of awareness on the changes. In 1967, Holm Pedersen and Loe concluded that the menstrual cycle had no effect on clinically healthy gingiva, but aggravation of preexisting gingivitis was noticed during menstruation. In 2012, Shourie et al. concluded that the ovarian hormones have a negligible effect on clinically healthy periodontium though these hormones may exaggerate preexisting gingivitis and the clinical significance of the same is uncertain. Because our study was a questionnaire-based survey, these symptoms would have to be correlated based on clinical examination of the participants. Other studies suggest that circulating sex hormones may alter capillary permeability and increase fluid accumulation in the gingival tissues. This inflammatory gingivitis is believed to be transient as the body accommodates to the ongoing presence of the sex hormones. Studies suggest that the increase in sex hormones during puberty affects the composition of the subgingival microflora. Prevotella intermedia and Capnocytophaga emerge during puberty. It has been reported that increased sex hormone levels induce increases in the number of anaerobes, such as P. intermedia,,, and have an effect on onset and progression of periodontitis by decreasing the phagocytic capacity of polymorphonuclear leukocytes while increasing the release of interleukin-1 beta. In addition, sex hormones increase vascular permeability and enhance proteolytic enzyme interaction with interleukin-6, an inflammation mediator. Twenty-six percent of participants complained of tenderness and discomfort in the gingiva, 6% complained of bleeding gums, but none of the participants noticed any changes in the color or texture of the gingiva and none complained of ulcerations such as aphthae or recurrent herpes labialis. Balan et al. noticed that 30% of participants complained of aphthous ulcers, 5% had herpes labialis, and 8% of the normal healthy females showed gingival bleeding. Khosravisamani et al. demonstrated the effect of the menstrual cycle on the levels of interleukin 1 beta and tumor necrosis factor alpha in gingival crevicular fluid and on periodontal clinical parameters such as gingival bleeding in healthy females and concluded that changes occurring during the menstrual cycle influence the periodontium and can induce inflammatory conditions. In this study, it was concluded that only 4% of participants had the awareness that oral changes could occur during menstruation. The majority of the participants were aware of the issues associated with menstruation because programs were conducted for the same; however, none of these programs mentioned the changes in the oral cavity during menstruation and the impact of this during their adult life.
The limitation of our study is that it was conducted in a single node and therefore may not be representative of all school-going adolescents in Navi Mumbai. This study had self-reporting data and could have been reported by the participants based on their level of understanding of the questions.
The prevalence of oral changes during menstruation among adolescents has not been studied in the Indian population. It is recommended that both cross-sectional and longitudinal clinical and microbiologic studies should be done from adolescence to adulthood, correlating the oral findings during menstruation and the impact of the same in adulthood. There are various awareness programs for teenagers at school, but oral health changes and its relation to menstrual cycle should be emphasized.,
| Conclusion|| |
This study clearly indicates that young adolescent female students are aware of menstruation and its related complaints, but they are not aware of oral changes during menstruation and its relationship to oral health. It is recommended that all school-based programs related to menstrual health should create awareness related to the same, thereby improving the adolescents' ability to maintain their oral and general health.
We thank the school authorities and the participants of this questionnaire study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Corgel JO. Periodontal therapy in the female patient. In: Carranza FA, editors. Carranza's Clinical Periodontolgy. 12th
ed.. Canada: Saunders Elsevier; 2015. p. 436.
Ullah MS, Aleksejuniene J, Eriksen HM. Oral health of 12-year-old Bangladeshi children. Acta Odontol Scand 2002;60:117-22. Marshall TA, Levy SM, Broffitt B, Warren JJ, Eichenberger-Gilmore JM, Burns TL, et al.
Dental caries and beverage consumption in young children. Pediatrics 2003;112:e184-91.
World Health Organization WHO Information Series on School Health, Doc 11: Oral Health Promotion through Schools. Geneva: World Health Organization; 2003.
Shah P, Misra A, Gupta N, Hazra DK, Gupta R, Seth P, et al.
Improvement in nutrition-related knowledge and behaviour of urban Asian Indian school children: Findings from the 'medical education for children/Adolescents for realistic prevention of obesity and diabetes and for healthy aGeing' (MARG) intervention study. Br J Nutr 2010;104:427-36.
Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health 1992;82:1663-8.
Prusty RK, Kumar A. Socioeconomic dynamics of gender disparity in childhood immunization in India, 1992-2006. PLoS One 2014;9:e104598.
Mahon T, Fernandes M. Menstrual hygiene in South Asia: A neglected issue for WASH (water, sanitation and hygiene) programmes. Gend Dev 2010;18:99-113.
Joffe A. Why adolescent medicine? Med Clin North Am 2000;84:769-85, v.
Kural M, Noor NN, Pandit D, Joshi T, Patil A. Menstrual characteristics and prevalence of dysmenorrhea in college going girls. J Family Med Prim Care 2015;4:426-31.
] [Full text]
Morrow C, Naumburg EH. Dysmenorrhea. Prim Care 2009;36:19-32, vii.
Ziaei S, Faghihzadeh S, Sohrabvand F, Lamyian M, Emamgholy T. A randomised placebo-controlled trial to determine the effect of Vitamin E in treatment of primary dysmenorrhoea. BJOG 2001;108:1181-3.
Nag RM. Adolescent in India. Calcutta: Medical Allied Agency; 1982. p. 18-26.
Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982;144:655-60.
George A, Bhaduri A. Dysmenorrhea among adolescent girls – Symptoms experienced during menstruation. Health Promot Educ 2002;17:4.
Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecological conditions reported by US women: Findings from the national health interview survey, 1984 to 1992. Am J Public Health 1996;86:195-9.
Gagua T, Tkeshelashvili B, Gagua D. Primary dysmenorrhea: Prevalence in adolescent population of Tbilisi, Georgia and risk factors. J Turk Ger Gynecol Assoc 2012;13:162-8.
Machtei EE, Mahler D, Sanduri H, Peled M. The effect of menstrual cycle on periodontal health. J Periodontol 2004;75:408-12.
Markou E, Eleana B, Lazaros T, Antonios K. The influence of sex steroid hormones on gingiva of women. Open Dent J 2009;3:114-9.
Mascarenhas P, Gapski R, Al-Shammari K, Wang HL. Influence of sex hormones on the periodontium. J Clin Periodontol 2003;30:671-81.
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.
Holm-Pedersen P, Löe H. Flow of gingival exudate as related to menstruation and pregnancy. J Periodontal Res 1967;2:13-20.
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.
Yokoyama M, Hinode D, Masuda K, Yoshioka M, Grenier D. Effect of female sex hormones on campylobacter rectus and human gingival fibroblasts. Oral Microbiol Immunol 2005;20:239-43.
American Psychological Association. Developing Adolescents: A Reference for Professionals. Washington, DC: American Psychological Association; 2002.
Studen-Pavlovich D, Pinkham JR, Adair SM. The dynamics of change. In: Casamassimo PS, Fields HW Jr., McTigue DJ, Nowak AJ, editors. Pediatric Dentistry: Infancy through Adolescence. 5th
ed.. St. Louis, Mo.: Elsevier Saunders; 2012. p. 557-617.
US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General – Executive Summary. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
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.
Khosravisamani M, Maliji G, Seyfi S, Azadmehr A, Abd Nikfarjam B, Madadi S, et al.
Effect of the menstrual cycle on inflammatory cytokines in the periodontium. J Periodontal Res 2014;49:770-6.
Beck JD, Arbes SI Jr. Epidemiology of gingival and periodontal disease. In: Newman MG, Taki HH, Klokkevold PR, Carranza FA, editors. Carranza's Clinical Periodontology. 10th
ed.. St Louis, Mo: Saunders Elsevier; 2006. p. 117-9.
Baliga SM. Child oral health-care literacy in India: Can access to services be improved? J Indian Soc Pedod Prev Dent 2019;37:1-2.
] [Full text]
[Table 1], [Table 2]