time during which adolescent and young adult female patients become sexually active and are exposed to exogenous Eating disorders Eating disorders in patients are a particular challenge to oral health professionals, given the psychological component of these disorders. Anorexia nervosa, bulimia nervosa, binge eating, and pica are all characterized by serious disturbances to both nutritional and mental health (National Institute of Mental Health, 2018; Psychology Today, 2018). The prevalence of eating disorders is disturbingly high in industrialized countries, especially in young women, possibly due to messages promoted in the media or conveyed by social media, peer pressures and by societal and personal expectations of an ideal body form (Jones, et al., 2018; Gividen, 2020; Riva & Dakanalis, 2018). Patients afflicted with eating disorders may use any combination of severe caloric restrictions, excessive use of exercise regimens, self-induced vomiting and laxative use in an effort to attain their ideal of a proper form of their body (Pocket Dentistry 2020; CDHO, 2019). The eating disorders anorexia and bulimia are typically characterized by times of extreme starvation (anorexia) followed by eating binges and forced vomiting (bulimia). The results of the largest national sample of 36,309 adults indicated that 0.80 of US adults will be affected by anorexia nervosa in their lifetime while 0.28 percent will be affected by bulimia nervosa and 0.85 % will be affected by the binge eating disorder (Biological Psychiatry, 2018). Each eating disorder presents with distinct patterns of psychological, medical, and dental characteristics. One study of bulimia nervosa found that the principal dental manifestations include erosion of the dental enamel, dental caries, and dental sensitivity (CDHO, 2019). A significant alteration in oral tissue also occurs, having an adverse impact on oral health. Specific oral manifestations in patients with eating disorders include: Oral contraceptives Oral contraceptives are synthetic hormones taken to prevent ovulation by hormonally mimicking pregnancy. Historic evidence suggests that use of high-dose combined oral contraceptives (containing more than 50 mcg of estrogen and 1 mg or more of progestin) places women at increased risk for periodontal diseases (Cleveland Clinic, 2018; Lugo, et al., 2021; Prachi et. al., 2019). Some reports indicate that women taking oral contraceptives experience an increased incidence of localized osteitis following extraction of mandibular third molars (Almeida, Pierce, Klar, & Sherman, 2016; Prachi, et al., 2019). Other studies have not confirmed the relationship between the use of oral contraceptives and alveolitis (inflammation in the tooth socket post-surgically), but they have noted a higher risk of postoperative alveolitis and infection among women after tooth extraction which may be caused by the fibrinolytic effect which oral contraceptives have upon blood clotting (Patton and Glick, 2016). Pregnancy hormonal changes During pregnancy, a woman is exposed to significant hormonal changes. The placenta produces high levels of estrogen and progesterone, which affect the oral tissues. Changes in hormone levels like those that occur during pregnancy have long been Subgingival microbiota changes during pregnancy Some researchers have speculated that the accumulation of progesterone and estrogen in gingival tissues during pregnancy may enhance bacterial growth by providing bacterial growth factors. Species such as P. melaninogenica and P. Intermedia can use these factors rather than Vitamin K for their growth (Kshirsagar and Balamurugan, 2018). Longitudinal changes in subgingival microbiota during pregnancy have been documented, but study populations are small; determining
sex hormones in oral contraceptives as well as changes in endogenous sex hormones associated with pregnancy.
● Smooth erosion of enamel (perimylolysis). ● Dental caries. ● Traumatized oral mucosal membranes and pharynx. ● Variations in the periodontium. ● Xerostomia. ● Enlargement of the parotid glands. (Antonelli and Seltzer, 2016; Gividen, 2020; Forney, Buchman- Schmitt, Keel, & Frank, G. K. W., 2016; Patton and Glick, 2016; CDHO, 2019). The most serious oral problems arise from self-induced vomiting. Perimylolysis is the most common and dramatic dental effect of chronic regurgitation. Its clinical manifestations include loss of enamel and dentin on the lingual tooth surfaces due to chemical erosion by the acidic stomach contents, aided by mechanical effects. The eroded tooth surfaces are usually smooth and glossy in appearance. It is common for the occlusal surfaces to be lost in the posterior teeth (Dentagama, 2019; Pocket Dentistry, 2020). Restoring teeth with the substantial loss of tooth structure via perimylolysis will require full-coverage crowns which may be preceded by endodontic treatment for hypersensitive teeth. The aforementioned oral manifestations of eating disorders places dentists and dental hygienists in a pivotal role for initiating a non-judgemental discussion about their origin (Gividen, 2020). Regurgitation and common vomiting cause enamel and dentin to erode and acid-resistant restorations to appear to emerge from their preparations. This is important to note because margins may open, leading to microleakage. Salivary gland enlargement may also be present because salivary stimulation occurs prior to vomiting.
REPRODUCTION-RELATED ORAL HEALTH ISSUES
Some studies have not found a statistically significant difference in the risk of the development of gingival disease parameters such as increased probing depths and bleeding upon probing among those who use oral contraceptives and those who do not (Smadi and Zakaryia, 2018). However, Ali and colleagues (2016) point out that women who have been taking oral contraceptives for some time show the same features of gingiva-periodontitis that are seen in pregnant women, and that the mechanism is either an increase in certain local microorganisms or an altered host response. In any case, it is important when taking a medical health history to ascertain if female patients are taking oral contraceptives, in part because the efficacy of contraceptives may be decreased when women receive an antibiotic (American Family Physician 2019). If antibiotic coverage is required as part of dental treatment, the dentist should consider advising female patients to use additional methods of birth control.
associated with the development of gingivitis (Kshirsagar and Balamurugan, 2018; González-Jaranay, Téllez, Roa-López, Gómez-Moreno, & Moreu, 2017; Nirola, 2018, et al., 2018).
the clinical significance of microbiotic changes requires further investigation. For example, a study of 20 pregnant women aged 18 or older found that although the subgingival levels of bacteria associated with periodontitis do not change over time, the number of individual bacterial species do. The qualitative microbiota changes during pregnancy feature a shift from aerobic or facultative gram-positive species towards an anaerobic gram-negative species (Kshirsagar and Balamurugan,
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