Oral manifestations of bulimia nervosa.

Bulimia nervosa is a psychological compulsive eating disorder that appears to be affecting a growing number of young women. It is characterized by repeated episodes of binge-eating followed by vomiting or some other purging behavior. Bulimia is accompanied by a number of physiological disturbances, some of which occur in the oral cavity. The present article reviews the major characteristics of bulimia nervosa, and describes the most significant oral manifestations of this disorder along with their reported incidences and etiologies.

Loss of oral contraceptive efficacy by concurrent antibiotic administration.

There are approximately 10 million women in the United States who are currently taking oral contraceptives on a daily basis. Although the actual number is not known, it is also estimated that a large number of these same women are on concomitant drug therapy. In recent years there have been a number of published reports linking a loss of contraceptive efficacy with the concurrent administration of other drugs, including antibiotics. Whereas the actual risk of drug interaction between antibiotics and oral contraceptives is yet unknown, it is important that women who are on oral contraceptive therapy be aware of possible contraceptive failure. This article reviews the published incidence of oral contraceptive/antibiotic interaction, along with a discussion of the possible mechanisms by which this interaction occurs. Recommendations are also presented for the health management of women taking oral contraceptives and other prescribed drugs.

Oral manifestations of menopause.

Menopause is a normal developmental stage in a woman's life, marking the permanent cessation of menstruation. It is the result of irreversible changes in the hormonal and reproductive functions of the ovaries. Menopause is accompanied by a number of characteristic physical changes; some of which occur in the oral cavity. The two most common oral manifestations of menopause are: oral discomfort, including pain, a burning sensation, dryness, and altered taste perception; and alveolar bone loss as a result of osteoporosis. Although menopause has been recognized for centuries, it has only been recently that the study of menopause has gained much attention. The purpose of this article is to review the basic physiology of menopause, and to present the etiology of the oral manifestations associated with menopause.

The effect of elevated ovarian hormones on periodontal health: oral contraceptives and pregnancy.

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.

Effect of antibiotics on oral contraceptive efficacy.

It is estimated that there are currently 10 million women in the United States who are taking oral contraceptives on a daily basis. Although the actual number is not known, it is also estimated that a large number of these same women are on concomitant drug therapy. In recent years, there has been a number of published reports linking a loss of contraceptive efficacy with the concurrent administration of other drugs, including antibiotics. Because of the common practice of prescribing antibiotics in dentistry, oral healthcare providers should be aware of the possibility of oral contraceptive failure with antibiotic treatment. Since it is often the dental hygienist who interviews patients and assists them in completing their health questionnaire, she or he can play an important role in educating and counseling these patients in possible drug interactions. This article reviews the published incidence of oral contraceptive/antibiotic interaction, along with a discussion of the possible mechanisms by which this interaction occurs. Recommendations are also presented for the oral health management of women taking oral contraceptives and other prescribed drugs.

Diabetes mellitus and periodontal disease.

One of the most commonly reported oral manifestations of diabetes mellitus is the increased prevalence and severity of periodontal disease. Whereas the periodontal disease of the diabetic patient is clinically similar to that found in nondiabetic individuals, the condition appears to be more severe and poses very serious health problems for the diabetic patient. This article will review the current state of knowledge concerning the relationship of diabetes mellitus to periodontal disease, and will examine the reported incidence and etiology of periodontal disease in the diabetic patient.

Ovarian hormones and gingivitis.

PIP: Elevated plasma concentrations of the ovarian hormones--estrogen and progestins--during pregnancy, puberty, the menstrual cycle, and oral contraceptive (OC) use are associated with an increased incidence of gingival inflammation and exudate. Gingivitis is induced by the micro- organisms that compose subgingival plaque, particularly anaerobic organisms. The ovarian hormones both stimulate bacterial growth and promote the inflammatory process. In the presence of sex hormones, the metabolic breakdown of folate is increased, leading to a folate deficiency that enhances the inflammatory destruction of oral tissue. Gingivitis occurs in an estimated 60-75% of pregnancy women, but the numbers of gingivitis-producing bacteria decrease toward the end of pregnancy and the gingival tissues return to their previous state. In OC users, on the other hand, inflammation of the gingiva is chronic and may increase over time. If gingivitis is already present at the onset of pregnancy or OC use, the inflammation will become progressively more severe. Although these effects cannot be avoided, ovarian hormone- induced gingivitis can be substantially minimized of low plaque levels exist at the beginning of pregnancy or pill initiation.^ieng

Ovarian hormones and oral health: pregnancy gingivitis.

The most common oral manifestation of increased levels of ovarian hormones is an increase in gingival inflammation with an accompanying increase in gingival exudate. Although plaque has been identified as the major etiologic agent of gingivitis, there are a number of known situations that exacerbate the condition. It is well-documented that pregnancy, puberty, menstrual cycle, and oral contraceptives all have been coupled with transient, self-limiting periods of gingivitis. A common feature these conditions share is an elevation in the plasma concentration of estrogens and progestins. This article will review the basic physiology of the estrogens and progestins and discuss the possible role these hormones play in the gingivitis occurring during pregnancy or oral contraceptive usage.