title: The effect of menstrual cycle on periodontal health.
abstract: BACKGROUND
  Fluctuation in estrogen/progesterone levels has been shown to affect the periodontium. The effects of pregnancy, prepuberty, and oral contraceptives on gingival health has been studied extensively, with gingival scores reported to be higher, in most instances, than in controls. Fluctuation in steroid sex hormone is also noticeable through women's menstrual cycle. Many women report an increase in gingival inflammation and discomfort associated with their menstrual cycle, most commonly around the menses period. However, this well-known phenomenon has never been studied. The purpose of this longitudinal, prospective study was to compare the periodontal status of premenopausal women at different times during their menstrual cycle.
  
  
  METHODS
  Eighteen premenopausal women, enrolled in our maintenance program, were recruited. Clinical examination was performed before the recall visit at three different time points in their menstrual cycle: ovulation (OV), premenstruation (PM), and menstruation (M). Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were examined around the Ramfjord index teeth. Analysis of variance, with Scheffe modification, was used to determine differences between the menstrual time points.
  
  
  RESULTS
  Several women in this study reported appreciable oral symptoms just before or during menses. Mean PI (0.85 +/- 0.06) was almost identical at all time points. Despite this, GI was significantly higher (P = 0.0245) in OV (0.54 +/- 0.07) and in PM (0.5 +/- 0.08) than in M (0.38 +/- 0.07). Mean patient's PD (2.22 +/- 0.08 mm) and CAL (2.92 +/- 0.15 mm) was not significantly different between examinations.
  
  
  CONCLUSIONS
  We observed changes in gingival scores during the menstrual cycles of periodontally healthy women. These changes need to be addressed when analyzing data from epidemiological and treatment studies in premenopausal women.
authors.affiliation: Unit of Periodontology, Department of Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.
authors.forename: Eli E
authors.initials: EE
authors.lastname: Machtei
authors.forename: Dan
authors.initials: D
authors.lastname: Mahler
authors.forename: Hana
authors.initials: H
authors.lastname: Sanduri
authors.forename: Micha
authors.initials: M
authors.lastname: Peled
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008183:Luteal Phase / Q000502:physiology; D008597:Menstrual Cycle / Q000502:physiology*; D008598:Menstruation / Q000502:physiology; D008875:Middle Aged; D010060:Ovulation / Q000502:physiology; D017622:Periodontal Attachment Loss / Q000145:classification; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D010519:Periodontium / Q000502:physiology*; D017697:Premenopause / Q000502:physiology; D011446:Prospective Studies