DEPOT MEDROXYPROGESTERONE ACETATE USE AND PERIODONTAL DISEASES

Veronika N. StilesUniversity of Michigan School of Dentistry

Department of Periodontics and Oral Medicine

SOME DEFINITIONS…

Depot Medroxyprogesterone Acetate (DMPA) (Depo Provera)=a progestin-only injectable contraceptive

administered every 3 months used by 10% of women ages 15-40 Periodontal diseases (PD) are a spectrum of

slow progressing chronic bacterial infections that can negatively affect the health of gingival tissues and periodontal supporting structures

WHY PERIODONTAL DISEASE PREVENTION SO IMPORTANT?

Association of gingival infections with progression of

StrokeCoronary heart disease

Low birthweight infants

! Link between oral and systemic health !

WHAT DOES DMPA USE HAVE TO DO WITH THIS?..

Bone mineral density at the hip and spine of DMPA users decreases 0.5%-3.5% after one year use

+ A 2012 cross-sectional preliminary study (using NHANES data) suggested that DMPA use may be associated with PD

Its main limitation is the cross-sectional nature of the data … therefore…

FIRST PROSPECTIVE COHORT STUDY

Therefore, we propose a pioneer prospective cohort study

Objective: to directly test the central hypothesis—>progestin-only contraceptive will increase the incidence of PD in women

STUDY DESIGN

Kent County Health Department Public Clinics 

189 Females ages 15-35 

New Depo Provera New Oral Contraceptive Diaphragm or condom user (exposed case) user (exposed

case) user (control) (n=63) (n=63) (n=63)

TIME Baseline 3mo 6mo 9mo 12mo 15mo 18mo 21mo

24moClinical examPlaque Index Gingival Index *SAME VARIABLES COLLECTED AT EACH TIME POINT*GCF-AST *

GCF-ALP* Questionnaire*

*Gingival Crevicular Fluid (GCF); Aspartate Aminotransferase (AST)*Gingival Crevicular Fluid (GCF); Alkaline Phosphatase (ALP)

SPECIFIC AIM 1

1. To evaluate potential periodontal disease-associated confounders associated with women who select DMPA contraception compared to controls. Working hypothesis: The majority of DMPA users may be females of lower socioeconomic status with already existent risks for increased levels of periodontal diseases.

SPECIFIC AIM 2

2. To determine the prevalence and severity of periodontal conditions in women before and after they initiate DMPA hormonal contraception within the first 24 months of use, while controlling for identified confounders (1).

Working hypotheses: Women who use DMPA: (a) will have the same baseline prevalence of PD as controls. If any differences are found, we hypothesize that they can be explained by known PD risk factors, and (b) have a greater risk of progression of periodontal disease than controls in the first 24 months of use who attend the Kent County Health Department in Grand Rapids, Michigan, after adjusting for other risk factors and confounding variables, including age, race, poverty income level, dental visit (<2 years), and smoking history.

 

SPECIFIC AIM 3

3. To estimate the prevalence of specific oral health behaviors, including dental care utilization patterns, among women who initiate DMPA use.

Working hypothesis: Poor practices of oral health care, dental utilization and detrimental behaviors (e.g., smoking, high alcohol consumption) have a direct negative impact on women’s periodontal health status.

SIGNIFICANCE

We propose to use prospective cohort study design that will establish proper temporal sequence.

This contribution is significant because it is the first step in a continuum of research that is expected to lead to the determination of the prevalence and severity of PD in women after initiation of DMPA contraception and identification of confounders, as well as specific oral health behaviors that might have a direct negative impact on women’s periodontal health status.

 

BACK TO THE PRELIMINARY STUDY…

2012 cross-sectional study using NHANES data

Study sample= 4,460 non-pregnant, pre-menopausal females

15-44 years old All statistical analyses were performed

taking into account: Complex sampling design Incorporation of sampling weights

MORE ON DEMOGRAPHICS

65.6% white; 51.4% well-educated; >57% not married; 27.2% never had a child; 4% DMPA users; 12.1% past users; 1/3-smokers; 59.5% -dental visit in the past 2 years

MORE ON DEMOGRAPHICS

All demographic factors differed significantly between the three DMPA user groups using a χ2 test for association (P ≤ 0.003).

Total sample weighted percents in column format.

Published in Journal of Periodontology 2012;83:1008-1017.DOI: 10.1902/jop.2012.110534© 2012 American Academy of Periodontology. All rights reserved.

Figure 1. Females, aged 15 to 44 years, who reported ever using DMPA by age and race/ethnicity: 1999 to 2004 NHANES.

SIMPLE UNADJUSTED LINEAR REGRESSION ANALYSIS (STRATIFIED BY DMPA USE)

LOGISTIC REGRESSION MODEL FOR GINGIVAL BLEEDING (GB)

CRITIQUE OF LOGISTIC REGRESSION MODEL (GINGIVAL BLEEDING)

P-values are not reported in Table 3

LOGISTIC REGRESSION MODEL (PERIODONTITIS)

CRITIQUE OF LOGISTIC REGRESSION MODEL (PERIODONTITIS)

P-values are not reported in Table 4 Once DMPA use and Smoking were

defined as ever (current/past) and never

DMPA use X smoking interaction – significant

Summary of interaction term odds- Table 5 (no p-value!)

DMPA USE X SMOKING INTERACTION

SUMMARY

This is the first cross-sectional study to examine DMPA use and PD using

multivariable modeling to control for potential confounders that provided additional evidence of an association

IN MY PROPOSAL…

To better answer the question of association,

prospective cohort study design will establish proper temporal sequence

using multivariable modeling to control for potential confounders

THTH

THANK YOU!

THANK YOU!