The oral health implications of oral contraceptives: It’s complicated

On Thursday, July 13, the FDA approved the first over-the-counter daily oral contraceptive approved for use in the US without a prescription. Expected to be available in early 2024, the progestin-only medication, called Opill, “provides an option for consumers to purchase oral contraceptive medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online,” according to the FDA’s release on the medication.¹ There will be no age-based purchasing restrictions.   

With the contraceptives’ effect on oral health long a topic in dentistry, what do dental professionals need to know in light of this development? 

Research limited, not yet conclusive

Elevated levels of ovarian hormones, either due to pregnancy or oral contraceptive use, can cause increased levels of gingival inflammation and increase bacterial growth, changing the oral environment. Both progesterone and estrogen increase the inflammatory response, and progesterone alters collagen production in the gingiva.²

Pregnancy gingivitis is very common, affecting 60% to 70% of people.² Reducing or eliminating plaque before beginning a pregnancy significantly improves this outcome.

Unlike a pregnancy, oral contraceptive use can last years or decades. A 1993 article in the journal Women & Health recommended that "women should practice good oral hygiene before beginning OC use and maintain it during OC usage."²

But research on the effect of oral contraceptives on oral health is limited and not yet conclusive. According to a 2021 article published in Dimensions of Dental Hygiene, “limited research indicates contraceptive pills and injectable agents raise the levels of estrogen and progesterone in the body. These elevated levels are linked to periodontal diseases, decreased bone mineral density, dry socket and temporomandibular disorders (TMD).”³

The article cites three published studies, including a 2019 study in African Health Sciences that concluded that “oral contraceptive pills had adverse effects on periodontal health.”⁴

But while there is a clear link between oral inflammation and hormones during pregnancy, the outcome of taking these hormones in contraceptives is still debated. Earlier versions of contraceptives contained very high doses of hormones compared to present-day formulations, leading some researchers to question if this logic still applies.  

A study published in Periodontology 2000 in 2012 says that “there have been far fewer studies to investigate whether modern oral contraceptives have any impact on the periodontium compared to studies of the early contraceptive formulations.”⁵

It notes ultimately that “following extensive review of the relevant literature and consideration of the historical perspective, the best available evidence strongly supports that oral contraceptives no longer place users at any increased risk for gingivitis or periodontitis. Oral contraceptives should not be viewed as a risk factor for gingival or periodontal disease.” 

Cleveland Clinic points to “when using oral contraceptives” as one of the stages of women’s lives during which hormonal changes can make them more susceptible to oral health problems, noting that “Women who take certain oral contraceptives that contain progesterone might experience inflamed gum tissues due to the body’s exaggerated reaction to the toxins produced from plaque.”⁶

But as with the Periodontology 2000 study, it also notes that the lower concentrations of hormones in newer birth control pills lessens the inflammatory response of the gums to dental plaque.  

Women may also experience changes in gum inflammation throughout their regular menstrual cycle due to the influence of hormones. 

Cleveland Clinic also notes that “the use of synthetic estrogens (birth control pills) can lead to decreased levels of natural estrogen. Decreased levels of natural estrogen are associated with another oral disorder, one affecting the temporomandibular joint (TMJ).”⁶ The FDA-approved Opill, however, does not contain estrogen. 

But whether or not oral contraceptives contribute to inflammation, there’s another reason for patients to tell their dentists if they’re taking them, and for dental professionals to seek the information: Certain medications that a dentist might prescribe, including antibiotics, can lower oral contraceptives’ effectiveness.

References 

1. FDA Approves First Nonprescription Daily Oral Contraceptive. US Food and Drug Administration. July 13, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive
2. Zachariasen RD. The effect of elevated ovarian hormones on periodontal health: oral contraceptives and pregnancy. Women Health. 1993;20(2):21-30. doi:10.1300/J013v20n02_02
   
3. Lugo K, Trinh I, Gonzalez G, et al. Oral health effects of contraceptive use. Dimensions of Dental Hygiene. February 26, 2021. https://dimensionsofdentalhygiene.com/article/oral-health-effects-contraceptive-use/
4. Prachi S, Jitender S, Rahul C, Jitendra K, Priyanka M, Disha S. Impact of oral contraceptives on periodontal health. Afr Health Sci. 2019;19:1795–1800.
5. Preshaw Oral contraceptives and the periodontium. Periodontol 2000. 2013;61(1):125-159. doi:10.1111/j.1600-0757.2011.00399.x
6. Hormones and oral health. Cleveland Clinic. Reviewed June 25, 2018. https://my.clevelandclinic.org/health/articles/11192-hormones-and-oral-health