Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study

Surekha Ramrao Rathod; Ashwini Narendra Jadhav; Abhay Pandurang Kolte; Devdatt Laxman Pitale

doi:10.4103/srmjrds.srmjrds_106_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 14 | Issue : 1 | Page : 17-22

Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study

Surekha Ramrao Rathod¹, Ashwini Narendra Jadhav¹, Abhay Pandurang Kolte¹, Devdatt Laxman Pitale²
¹ Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
² Department of Obstetrics and Gynaecology, INHS Asvini, Mumbai, Maharashtra, India

Date of Submission	17-Aug-2022
Date of Decision	19-Jan-2023
Date of Acceptance	23-Jan-2023
Date of Web Publication	18-Mar-2023

Correspondence Address:
Dr. Surekha Ramrao Rathod
Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/srmjrds.srmjrds_106_22

Abstract

Background: Literature evidence on periodontal disease-associated microorganism in pre-and postmenopausal women suggest a complicated relationship between steroid hormones, periodontal tissues, and microorganism. Aim: The objective of the study was to assess and contrast the periodontal health condition and quality of life (QoL) of pre-and postmenopausal women. Materials and Methods: 100 patients were divided into four groups, i.e., healthy pre-menopausal, periodontitis pre-menopausal, healthy post-menopausal, and periodontitis post-menopausal. Periodontal parameters such as Gingival Index (GI), Plaque Index (PI), Probing Pocket Depth, Clinical attachment levels, Simplified Oral hygiene index, and a Utian QoL questionnaire were filled by the patients. The differences between three groups were analyzed using a one-way ANOVA test at baseline and 3 months, followed by a post hoc Tukey test. Results: The PI, GI, and Simplified Oral Hygiene Index levels were significantly different between healthy premenopausal and postmenopausal subjects. QoL scores were compared between the healthy premenopausal and healthy postmenopausal subjects, among which no statistically significant difference was found with P = 0.705 when compared between the positive questions score and P = 0.730 when compared between the negative questions score of the two groups. Conclusion: This study shows that there is no relation between menopause and QoL in women with periodontitis before and after menopause.

Keywords: Periodontitis, post-menopause, pre-menopause, quality of life

How to cite this article:
Rathod SR, Jadhav AN, Kolte AP, Pitale DL. Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study. SRM J Res Dent Sci 2023;14:17-22

How to cite this URL:
Rathod SR, Jadhav AN, Kolte AP, Pitale DL. Assessment of clinical and psychological parameters in pre- and post-menopausal women: A cross-sectional study. SRM J Res Dent Sci [serial online] 2023 [cited 2023 May 28];14:17-22. Available from: https://www.srmjrds.in/text.asp?2023/14/1/17/371996

Introduction

The menopause transition for women may be a significant health milestone with effects that go well beyond reproduction. Women's midlife and future health are influenced by concurrent biological, psychological, behavioral, and social changes in addition to menopause symptoms.^[1]

Ovarian function gradually deteriorates beyond the age of 30 years.^[2] The menopause transition starts around the age of 40 years, with reduced menorrhea because of fewer functional follicles, a drop in estrogen levels, and also a scarcity of response to pituitary Gonadotrophin-Releasing hormone, gonadotrophin, and follicular-stimulating hormone, missing periods are next.^[3] Menopause, which typically happens between the ages of 45 and 55 years, is the irreversible stop to menstruation brought on by a drop in ovarian follicular activity.^[4] In research of periodontal disease-associated microorganisms in pre-and postmenopausal women, Tarkkila et al. discovered an advanced relationship between steroid hormones, periodontal tissues, and microorganisms. Steroid hormones reduce the quantity of positive periodontal pathogens such as Porphyromonas gingivalis and Tannerella forsythia, which encompasses a positive impact on periodontal diseases.^[5] Gingivitis and periodontitis are the two most typical varieties of periodontal diseases. Periodontitis is brought on by inflammatory changes in the alveolar bone and periodontal ligament that are irreversible and harmful, eventually leading to tooth loss,^[6] disease is caused by the host's immunological response to an area biofilm. The host reaction is influenced by a range of behaviors such as smoking, poor oral hygiene, female hormone fluctuations, stress, and diabetes.^[7]

The most serious problem associated with menopause is osteoporosis. Osteoporosis also ends up in less crestal alveolar bone per unit volume, which might result in a faster bone loss when diseases such as periodontal infections are present.^[8] Postmenopausal women with osteoporosis, which reduces bone mass and density, had decreased lower jawbone, in step with Kribbs. Periodontal tissues and disease advancement have long been believed to be influenced by disease progression.^[9] In estrogen-deficient women, there has been an increase in gingivitis, periodontal disease, tooth loss, and xerostomia, and hormone replacement therapy appears to have associated with lower levels of several markers of oral disease severity as a comparison to estrogen-deficient women.^[10] Menopause may be a significant life transition period that has been linked to increased vulnerability in one's well-being.^[11] While some cross-sectional research has revealed no link between menopausal status and mental state, longitudinal investigations have found an increased incidence of depressive symptoms and bad mood throughout the menopause transition period.^[12]

Several studies have checked out the impact of “menopausal symptoms” on the Quality of life (QoL) of menopausal women at different stages of the menopause phase.^[13] QoL is defined by the “World Health Organization” (1993) as a sense of their position in life in regard to the aim, aspirations, standards, and concerns within their culture and value system.^[14] Periodontitis and menopause both have a bearing on QoL, so it's a necessity to seem at both periodontitis and therefore the QoL of menopausal women. As a result, the present research will compare and evaluate periodontal health and QoL in premenopausal and postmenopausal women.

Materials and Methods

Study design

This cross-sectional study was conducted after being approved by the Ethical Committee of VSPM DCRC on March 20, 2020 (no-IEC/VSPDCRC/70/2020).

Study setting

This study was conducted on pre and postmenopausal women requiring treatment at the department of periodontics and implantology. It lasted 3 months, from March 31, 2020, to July 2020. All the patients to be included within the study were explained about the study protocols, questionnaire, and about filling up the questionnaire.

Study size

The sample size was decided considering the mean difference in QoL scores because the main outcome measure, from the study by Williams et al.^[15] considering the quality deviation 22.35 and 25.85 of two groups using the formula:

Participants

One hundred patients were separated into four groups, each with 25 patients [Figure 1], i.e., Group I healthy premenopausal, Group II periodontitis premenopausal, Group III healthy postmenopausal, and Group IV Periodontitis postmenopausal. All the participants provided written consent for the participation within the study. All procedures performed within the study were conducted in accordance with the moral standards given in 1964 Declaration of Helsinki, as revised in 2013. All clinical parameters were measured by one examiner after the patients gave their written consent. The patients were instructed to top off the questionnaire as described. Patients with gingival inflammation, clinical attachment loss (CAL) of 5 mm, and probing pocket depth (PPD) of less than or equal to than 6 mm were diagnosed with periodontitis. The revised Classification for Periodontal and Peri-implant Diseases and Conditions published by the American Academy of Periodontology in 2017 was accustomed to diagnose periodontitis.^[16]

Figure 1: Flowchart showing the derivation of sample size

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Women who had an easy hysterectomy, diabetes, hypertension, cardiopathy, thyroid issues, or had periodontal surgery within the previous 6 months, and women who were taking hormone therapy were all excluded from the study.

Periodontal parameters such as the Gingival Index (GI) (Loe and Silness 1963),^[17] Plaque Index (PI) (Silness and Loe 1964),^[18] PPD, CAL (UNC-15, Hufriedy Chicago, IL), and the “Simplified Oral Hygiene Index” (OHIS) (Greene and Vermillion 1964)^[19] were assessed by both investigators. The Utian QoL questionnaire,^[20] which has 23 questions was modified to own 19 questions supported the occupational, health and emotion and validated by expert faculty. These questions were divided into positive and negative questions. The answers were presupposed to be marked using the 5 points scale within which point 1 stands for not true, point 3 stands for moderately true and point 5 stands for very true. Patients completed the questionnaire after the periodontal parameters were recorded [Table 1]. Data were coded and analyzed in STATA, version 10.1 (2011) (StataCorp, taxax, USA).

Table 1: Utian Quality of Life Scale

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Statistics analysis

The change between baseline to 3 months was measured using a paired t-test, while the difference between two groups was measured using an unpaired t-test. The differences between the three groups were analyzed using a one-way ANOVA test at baseline and 3 months, followed by a post hoc Tukey test.

Results

Between the healthy premenopausal and postmenopausal subjects, a significant difference was seen in the PI, GI, and OHIS values, i.e., the mean PI for healthy premenopausal was 0.303, and for healthy postmenopausal, it was 0.452 with a significant P = 0.017 similar results were seen with the GI and OHIS values for these 2 groups. No statistically significant difference was observed between the PPD and CAL values when compared between the healthy premenopausal and postmenopausal subjects [Table 2].

Table 2: Comparison between all clinical parameters (plaque index, gingiva index, simplified oral hygiene index, probing pocket depth, clinical attachment loss) healthy premenopausal and healthy postmenopausal

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The comparison between the clinical parameters between the periodonttis premenopausal and postmenopausal groups showed no statistically significant difference, however, the mean values of GI, OHIS, and CAL were slightly greater, i.e., 1.257, 2.493, 5.956, respectively, in the periodontitis postmenopausal group when compared with the periodontitis premenopausal group [Table 3].

Table 3: Comparison between all clinical parameters (plaque index, gingiva index, simplified oral hygiene index, probing pocket depth, clinical attachment loss) periodontitis premenopausal and periodontitis postmenopausal

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QoL scores were compared between the healthy premenopausal and healthy postmenopausal subjects, amongst which no statistically significant difference was found with P = 0.705 when compared between the positive questions score and P = 0.730 when compared between the negative questions score of the two groups [Table 4].

Table 4: Comparison of quality of life between healthy premenopausal and healthy postmenopausal

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When the QoL scores were compared between the periodontitis premenopausal and periodontitis postmenopausal subjects, among which no statistically significant difference was found with P = 0.4154 when compared between the positive questions score and P = 0.9107 when compared between the negative questions score of the two groups [Table 5].

Table 5: Comparison of quality of life between periodontitis premenopausal and periodontitis postmenopausal

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Discussion

The delicate and variable homeostasis of the periodontium is greatly influenced by the endocrine system. Due to endocrine problems (lower estrogen), vitamin and calcium deficiencies, as well as a number of psychological variables, women's oral symptoms appear to get worse throughout menopause. Dysesthesia, tooth decay, periodontitis, desquamative gingivitis, and an osteoporotic jawbone are contraindications for menopausal women. Traditional dental gadgets and implants are also not recommended for them.^[21]

Periodontal tissue and periodontal disease progression have been linked to sex hormones. The effect of menopause on periodontium was studied by Bhardwaj and colleagues, who discovered that female sex hormones are neither necessary nor sufficient to trigger gingiva changes. They can, however, influence periodontal tissue responses to microbial plaque, thereby contributing to periodontal disease.^[22]

In this study, the healthy pre-and post-menopausal groups differed statistically significantly in the PI, GI, and OHIS values. When compared between the periodontitis pre- and post-menopausal groups, there was found no significant difference between which was similar to the results of Wulandari et al. who discovered no variations in oral hygiene between perimenopausal and postmenopausal women.^[22] Between premenopausal and postmenopausal women, Qasim et al. discovered substantial changes in PI, salivary flow, calculus index, and pocket depth.^[23] The mean plaque, gingival, and bleeding scores were considerably higher among osteoporotic women in a study done by Richa et al. on osteoporotic and nonosteoporotic periodontitis post-menopausal women, indicating an association between osteoporosis and periodontal diseases in post-menopausal women.^[24],[25]

QoL indicators are used to evaluate the subjective impact of undesirable oral conditions and/or their consequences on everyday life. These metrics have emerged as a complement to clinical features, allowing for a much more thorough assessment of people's and populations' health. Ferreira et al.^[26] discovered in a systematic review on the influence of periodontal disease on QoL that periodontal illness can have a detrimental impact on adults' oral health-related QoL, with the severity of the disease having a bigger negative impact.

In the present study, the QoL was evaluated using the Utian QoL questionnaire a nonstatistically significant difference was found for the positive as well as negative questions when compared in the premenopausal and postmenopausal healthy as well as periodontitis women. These results were not similar to that of the study by Williams et al.^[15] were the QoL was compared between the postmenopausal women with poor oral health and Postmenopausal women with Good oral health and it was reported that the postmenopausal women with poor oral health showed a significantly poorer QoL. Elsabagh et al.^[14] found that postmenopausal women in the study had a significant prevalence of menopausal symptoms, which had a negative impact on their QoL. The limitations of this study could be that the questionnaire outcomes depend on the mental condition of the women answering the questions and also smaller sample size. Future studies with larger sample size are required to validate the results.

Conclusion

Premenopausal and postmenopausal women with periodontitis reported similar QoL scores, according to this study. Healthy postmenopausal however showed increased PI, GI, and OHIS when compared to the healthy premenopausal which indicates women should be aware of the consequences of menopause on periodontal health and take action to improve it.

Acknowledgments

The authors would like to thank Dr. Suresh Ughade, INCLEN Fellow and EX-Faculty in the Department of PSM Government Medical College and Hospital, Nagpur, for his contribution in carrying out the statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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