Hormonal influences on gingival tissue: relationship to periodontal disease.

It is the purpose of this review to survey the influence of corticosteroids, androgens, oestrogens and progesterone on gingival tissues and to show the relationship of such influences to periodontal disease. The clinical changes seen in plaque-induced gingivitis are accentuated by circulating levels of the above hormones via mechanisms such as partial immune suppression, increased fluid exudation, stimulation of bone resorption and stimulation of fibroblast synthetic activity. High counts of Bacteroides intermedius have been observed in users of oral contraceptives and also in the second trimester of pregnancy, in the absence of overt gingival inflammation. This is due to competition for binding between progesterone and naphthaquinone, which have a structural similarity; and the latter is an essential nutrient for the microbe. Hence high counts of Bacteroides intermedius may be a more sensitive indicator of an altered systemic hormonal condition than the usual clinical parameters. The main hormonal effect accentuates false pocketing, rather than initiating a change in attachment levels, except in cases of progressive periodontal disease associated with plaque induced inflammation and bone loss.