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ORIGINAL ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 19-23

Assessment of periodontal hygiene, health, and myths among menopausal and postmenopausal women visiting outpatient department: A cross-sectional study


1 Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Jammu, Jammu and Kashmir, India
2 Department of Law, University of Jammu, Jammu, Jammu and Kashmir, India

Date of Submission22-Mar-2021
Date of Decision13-Jun-2021
Date of Acceptance24-Jun-2021
Date of Web Publication7-Jul-2021

Correspondence Address:
Dr. Malvika Singh
Assistant Professor, Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Jammu, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/QAIJ.QAIJ_2_21

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  Abstract 


Context: Menopause and postmenopausal phase has often been linked to periodontitis. Aims: The aim of this study was to assess the periodontal health awareness, methods adopted to maintain hygiene and prevalent myths regarding periodontal health among menopause and postmenopause women. Settings and Design: A total of 1115 menopausal and postmenopausal females participated in the study. Subjects and Methods: After complete demographic assessment of participants, four questionnaires were provided to the participants in which they had to choose the option they felt was correct. Statistical analysis used mean and standard deviation for continuous variables and frequency and percentage for categorical variables were calculated and tabulated. Results: Majority of participants self-reported some form of periodontal health problems with burning sensation in the mouth and tongue as a chief complaint leading the survey. Very few participants had never visited a dentist and an abundant number of menopausal and postmenopausal females reported hesitation in getting periodontal treatment citing prevalence of certain myths regarding the same. Irrespective of the educational qualification, a highly significant number of participants were unaware of the importance of periodontal health during menopause and postmenopause and believed in age-old homemade treatment for the same. Conclusions: The oral health care still remains on the backseat in care provided to menopausal and postmenopausal females.

Keywords: Awareness, menopause, oral hygiene, periodontal health, periodontitis, postmenopause


How to cite this article:
Singh M, Jamwal M. Assessment of periodontal hygiene, health, and myths among menopausal and postmenopausal women visiting outpatient department: A cross-sectional study. QAI J Healthc Qual Patient Saf 2020;2:19-23

How to cite this URL:
Singh M, Jamwal M. Assessment of periodontal hygiene, health, and myths among menopausal and postmenopausal women visiting outpatient department: A cross-sectional study. QAI J Healthc Qual Patient Saf [serial online] 2020 [cited 2021 Aug 4];2:19-23. Available from: https://www.QAIJ.org/text.asp?2020/2/1/19/320808




  Introduction Top


Menopause is defined as the permanent cessation of menstruation due to loss of ovarian follicular function and usually takes place between 45 and 55 years of age[1] after which postmenopausal phase starts. Apart from causing changes in the entire body, significant periodontal changes are seen in the periodontium to the extent that postmenopausal status is considered as risk for periodontitis. Periodontal disease accounts for the greatest loss of teeth in India[2] and women during menopause often complain of dry mouth, concurrent senile atrophic gingivitis, and menopausal gingivostomatitis along with periodontitis.

Lack of general awareness and public concern about the consequences of the broad prevalence of periodontal disease can be attributed primarily due to the lack of awareness and public concern about the same and the only possible solution to reduce its prevalence rate among masses seems to be creating awareness for its prevention. The aim of this study was to assess the knowledge of menopause and premenopausal women about oral health and practices regarding the same. The survey also assessed and solved the common myths of menopause and postmenopausal women on maintaining and following oral hygiene practices during the same phase of their lives.


  Subjects and Methods Top


In the present, cross-sectional study, 1115 females belonging to the age group of 46–76 years who reported/visited the outpatient department of periodontics and oral implantology of our institute participated in the study. The study was approved by the Institutional Ethical Committee and was also registered with clinical trials under the Government of India. The patients who fulfilled following criteria were selected for the study.

Inclusion criteria

  1. Age 46 years onwards
  2. No periodontal therapy in the last 6 months
  3. Systemically healthy patients.


Exclusion criteria

  1. Acute oral disease.
  2. Any antimicrobial therapy in the last 1 month before the study
  3. Smokers, alcoholics, and tobacco chewers.


A detailed questionnaire containing common myths regarding oral implications of menopause was made in four languages, i.e., Hindi, English, Dogri, and Urdu according to the preference of the patient. Eligible patients were then explained about the study, and an informed written consent was taken before providing the questionnaire. A facilitator was provided to the participants who were illiterate and were not able to fill out the questionnaire on their own. Statistical indices such as mean and standard deviation for the continuous variables and frequency and percentage for categorical variables were applied and tabulated.


  Results Top


A total of 1115 females belonging to the age group of 46–80 years with a mean of 63 ± 4.6 years participated in the study. Majority of the participants belonged to the age group of 46–56 years (53.90%) and rest belonged to the age group of 76 years onward (0.72%) [Table 1] and [Figure 1].When the educational qualification of the participants was taken into consideration, most of them had some form of formal education, the highest being graduates (43.33%); however, 0.18% of participants were completely illiterate [Table 1] and [Figure 2]. As far as the employment status of the participants was concerned, majority of the females pursued some form of clerical job (43.23%), while only some of them were unemployed (0.81%) [Table 1]. When the nature of chief complaints was taken in account, majority of participants had average two (62.06%) periodontal-related issues, with burning sensation in the mouth and tongue being the highest (23.94%) followed by food lodgement (16.86%) and tooth mobility (14.89%) [Table 2] and [Figure 3]. Majority of patients reported some gums-related problems while eating food (68.07%); however, in spite of having former complaints, majority of patients did not visit periodontist in the last 1 year (46.37%) and more astounding fact that surfaced over the time that some patients (02.06%) had never visited a periodontist before [Table 2] and [Figure 4]. However, after visiting the same, most (80%) of the participants showed willingness to re-visit periodontist.
Table 1: Sociodemographic characteristics of participants

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Table 2: Oral health status of participants

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Figure 1: Age wise distribution of participants

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Figure 2: Educational qualifications of participants

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Figure 3: Chief complaints of participants

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Figure 4: Participants visiting dentists

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As far as the oral hygiene habits of participants were concerned, a majority of the participants brushed teeth with tooth brush and paste (76.41%) once daily (62.06%) while using mouthwash (52.83%) once daily as well as (43.14%) [Table 3] and [Figure 5] and changed toothbrush quarterly (27.09%) while majority (60.85%) of them rinsed their oral cavity after meals [Table 4] and [Figure 6].
Table 3: Correct participant responses on survey items about common myths and importance of oral hygiene

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Table 4: Oral health practices among participants

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Figure 5: Methods of plaque control by participants

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Figure 6: Frequency of using a mouthwash by participants

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To assess the prevalent myths regarding the correlation of periodontal health and menopause and importance of maintaining periodontal health during the same, few questions were asked with yes, no, or don't know choices. The correct responses were assessed for their significance [Table 3]. For all the seven questions assessed, the number on participants giving correct responses were statistically significantly less than incorrect responses (P < 0.001%).


  Discussion Top


Periodontitis is a slow, progressive, chronic inflammatory disease, characterized by bursts of disease activity separated by the quiescent periods of varying duration.[3],[4] Menopause has been associated with destructive periodontal disease in elderly women.[5],[6] The aim of this study was to assess the oral hygiene habits and awareness of oral health among menopausal and postmenopausal females visiting the outpatient department of our institute. The survey also assessed the influence of common Indian myths about oral hygiene during the same phase on participants and along with assessing the awareness of menopausal and postmenopausal females about the effect of oral hygiene on same. The hormonal variations during menopause and postmenopause put females at a higher risk for developing various dental problems and another factor contributing to this fact remains that lesser number of females seek dental treatment after menopause and postmenopause even when there is an existing dental problem; thus, patient's chief complaints, her perception, reasons, and timing for seeking care can be valuable sources of information for the clinicians because these can significantly affect the patient's behavior, attitude, and willingness for the treatment.

According to the study, 0.18% of participants were completely illiterate, whereas 6.69% were qualified till high school. The relation between educational levels and periodontal health is a function of better oral hygiene among the better educated, more positive response toward oral hygiene, and a greater frequency of dental visits among the more dentally aware.[7],[8] Majority (62.06%) of participants had average two periodontal-related issues, with burning sensation in the mouth and tongue being the highest (23.94%) followed by food lodgement (16.86%) and tooth mobility (14.89%) which are the main findings of postmenopausal gingivostomatitis and postmenopausal osteoarthritis.[9] In our observation, 2.06% of participants never visited a periodontist and only 46.37% had visited the same in the past 1 year which also might have contributed to unhealthy dental practices like faulty tooth brushing.

A large number of the participants had a good knowledge about oral hygiene habits. The same was reflected in their practices where around 93.99% of participants used toothpaste and brush as oral hygiene aid and 62.06% of them brushed at least once daily. 83.77% of the participants changed their brush either at 3 months or 6 months, and 95.78% rinsed their mouth after meals. This awareness about oral hygiene could be because of the fact that merely 0.18% of the participants of survey were illiterate. The awareness could be increased further by organizing counseling sessions families of the same on a regular basis. This result was found to be contradictory to the result seen in a study conducted by Bhatia et al.[10] which showed a poor awareness among the study conducted among the North Indian population. This higher level of awareness might be due to the higher literacy level of the survey population at Jammu region. Postgraduates had higher awareness than the other two study groups. This increased awareness could be attributed to their higher education level. This result was in contrary to the results of other study, where the individuals with least educational qualification had higher knowledge on awareness.[11]

It is well established that routine dental procedures during menopause and postmenopause are completely safe. However, the most common barrier in seeking oral care during menopause and post menopause in our observation was the development of systemic conditions by women thus hampering them to pay attention toward their oral health. The participants however showed their willingness to visit periodontist after their treatment. The questionnaire to assess the understanding of menopause and postmenopausal a link between oral and systemic health was based on the common Indian myths and prevalent beliefs in the Indian society. In all the questions, the percentage of correct responses was significantly lower than incorrect responses. Only 16.23% of the participants of our study believed that bleeding gums were normal in menopause and postmenopause. The myth can be easily thwarted by explaining the individuals about the primary etiological agent which still remains dental plaque. With proper oral hygiene maintenance, gingival health can be maintained throughout menopause and postmenopause. In our survey, one of the essential beliefs was that menopause causes loosening of the teeth. This perception could be curbed if proper information is provided that if oral hygiene is maintained well, menopause per SE does not cause periodontal disease it is a cumulative effect of poor oral hygiene and systemic diseases. It is the already existing local factors which under the influence of increased circulating hormones lead to exaggerated periodontal disease progression.[12] 91.75% participants believed that burning sensation in the mouth was abnormal; however, it is due to the development of a syndrome known as burning mouth syndrome that occurs primarily in postmenopausal women. 80.89% of participants believed that visiting a periodontist and undergoing scaling further causes loosening of teeth. This is a very common myth and can be curbed by explaining the fact that procedures such as scaling prevents the progression of periodontal disease instead of making teeth loose.[13]

From the results obtained in our study, it was evident that the public had a less awareness about the link between menopause and periodontal disease. Hence, with due motivation of the patients, periodontal maintenance and attaining healthy oral hygiene would be easily achievable.


  Conclusions Top


Menopause has often been linked to periodontitis,[14] but irrespective of the educational qualification, the awareness among females regarding the same is very limited and often incorrect. Females especially the ones belonging to menopausal group should be made more aware regarding the effects of menopause on periodontium so severity of periodontitis can be reduced.



 
  References Top

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Nikolaou D, Gilling-Smith C. Early ovarian ageing: Are women with polycystic ovaries protected? Hum Reprod 2004;19:2175-9.  Back to cited text no. 1
    
2.
Mehta FS. Relative importance of various causes of teeth loss. J All India Dent Assoc 1958;30:211-21.  Back to cited text no. 2
    
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Albandar JM. A 6-year study on the pattern of periodontal disease progression. J Clin Periodontol 1990;17:467-71.  Back to cited text no. 3
    
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Flemmig TF. Periodontitis. Ann Periodontol 1999;4:32-8.  Back to cited text no. 4
    
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Payne JB, Reinhardt RA, Nummikoski PV, Patil KD. Longitudinal alveolar bone loss in postmenopausal osteoporotic/osteopenic women. Osteoporos Int 1999;10:34-40.  Back to cited text no. 5
    
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Geurs NC. Osteoporosis and periodontal disease. Periodontol 2000 2007;44:29-43.  Back to cited text no. 6
    
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Papapanou PN. Epidemiology of periodontal diseases: An update. J Int Acad Periodontol 1999;1:110-6.  Back to cited text no. 7
    
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Petersen PE, Ogawa H. Strengthening the prevention of periodontal disease: The WHO approach. J Periodontol 2005;76:2187-93.  Back to cited text no. 8
    
9.
Friedlander AH. The physiology, medical management and oral implications of menopause. J Am Dent Assoc 2002;133:73-81.  Back to cited text no. 9
    
10.
Bhatia A, Bains SK, Singh MP. To assess knowledge and awareness of North Indian Population towards periodontal therapy and oral-systemic disease link: A cross-sectional study. J Interdiscip Dent 2013;3:79-85.  Back to cited text no. 10
    
11.
Penmetsa GS, Gadde P, Begum Z, Mandalapu N, Ramaraju AV. Assessment of periodontal knowledge among residents of West Godavari district of Andra Pradesh, India: A descriptive epidemiological survey. J NTR Univ Health Sci 2018;7:39-43.  Back to cited text no. 11
  [Full text]  
12.
López-Marcos JF, García-Valle S, García-Iglesias AA. Periodontal aspects in menopausal women undergoing hormone replacement therapy. Med Oral Patol Oral Cir Bucal 2005;10:132-41.  Back to cited text no. 12
    
13.
Lamont T, Worthington HV, Clarkson JE, Beirne PV. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev 2018;12:CD004625.  Back to cited text no. 13
    
14.
Singh M, Singhal R, Negi R, Gupta R, Dahiya P, Kumar M, Bhardwaj R. Periodontal status in pre- and post-menopausal women: A review. Asian Pac J Health Sci 2018;5:136-41.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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