Effect of Ethinylestradiol/Norethisterone Acetate With SRP on Periodontium and hsCRP in PCOS Women With Periodontitis

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    Postgraduate Institute of Dental Sciences Rohtak
Updated on 24 July 2022
testosterone level
root planing
oral hygiene instruction
Accepts healthy volunteers


As periodontitis is known to add to the systemic inflammatory burden and may consequently contribute to progression of PCOS and vice-versa, So, controlling local and systemic inflammatory burden by scaling and root planing and medical treatment may have an effect in the management of PCOS women having periodontitis.There is no data as yet, comparing the impact of COCs along with non surgical therapy and COCs along with just oral hygiene instructions on the periodontal health of PCOS patients. Therefore, there is need to study the effect of combined oral contraceptives (ethinylestradiol/norethisterone acetate) along with non-surgical periodontal therapy on periodontal status and high sensitivity C-Reactive Protein in polycystic ovary syndrome women having stage 1,2 periodontitis


Various studies have been conducted to assess the impact of oral contraceptives on periodontal status and mostly present conflicting results. However, none of these studies have been carried out on females diagnosed with PCOS. Such an assessment is significant keeping in mind the increasing prevalence of PCOS as well as introduction of low-dose oral contraceptives for the long-term management of these patients. Additionally, periodontitis is known to increase the systemic inflammatory burden and may possibly contribute to progression of PCOS and vice-versa. So, controlling both local and systemic inflammatory burden by scaling and root planing along with medical treatment may have a vital role in the management of PCOS women having periodontitis. There is no data as yet, evaluating the impact of COCs on the periodontal health of PCOS patients. Therefore, the effect of hormone based medical treatment on the periodontal status of these patients, whether protective or destructive, remains unclear till date. The present study, thus, aims to evaluate the effect of combined oral contraceptives (ethinylestradiol / norethisterone acetate) with and without non-surgical periodontal therapy on the periodontal status and the levels of serological marker of inflammation {high sensitivity-C Reactive Protein (hsCRP)} among polycystic ovarian syndrome (PCOS) women having periodontitis stage 1/2.

MATERIAL AND METHODOLOGY STUDY DESIGN AND SETTING- The present randomised controlled clinical trial will be conducted in the Department of Periodontology, Post Graduate Institute of Dental Sciences, Rohtak in collaboration with Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak.

STUDY PERIOD- 12-14 months STUDY SUBJECTS- PCOS patients having periodontitis,15-40 years of age and systemically healthy patients with periodontitis All the participants will be age and BMI matched. The present Randomized Controlled Trial will include 60 individuals of PCOS who will be divided into 2 groups using randomisation software. Generating randomization table.and allocation will be concealed in opaque envelops by another person not involved in the trial.30 systemically healthy females,age and BMI matched, will also be included.

Test group 1 , n=30, patients with PCOS on combined oral contraceptives (COCs) having stage 1/2 periodontitis will receive oral hygiene instructions (OHI) and SRP Test group 2, n=30, patients with PCOS on combined oral contraceptives (COCs) having stage 1/2 periodontitis will receive oral hygiene instructions only Control Group , n=30, Systemically Healthy (age and BMI matched) females with stage 1/2 periodontitis will receive with OHI and SRP.

Periodontal and anthropometric parameters will be measured and sampling will be done at baseline, 3months and 6 months. serum hsCRP levels will be assessed at baseline and at 6 months.

TEST GROUP AND CONTROL GROUPS - Periodontal parameters: -


7.GINGIVAL PHENOTYPE 8.GINGIVAL RECESSION 9. ANALYSES OF ANTHROPOMETRIC PARAMETERS- Waist circumference (WC) waist-to-hip ratio (WHR) BMI(Kg/m²) 10.hsCRP LEVELS Serum Testosterone levels (if required) 11.PCOSQ (Polycystic ovary syndrome questionnaire) 12.ORAL HEALTH RELATED QUALITY OF LIFE (OHRqol) questionnaire 13.Phenotype of PCOS

DATA MANAGEMENT AND STATISTICAL ANALYSIS Data recorded will be processed by standard statistical analysis.The normality of distribution of data will be examined by Shapiro Wilk test. Statistical analysis will be performed according to distribution of data. If it is in normal distribution inter group comparison will be done by using Independent T test and paired t test will be use for intragroup comparison and if non-normal distribution of data, inter group comparison will be done by Mann-Whitney U test and intragroup by signed rank test. The Chi square test will be applied to analyze categoric data. Correlation and association between predictors and dependent variables will be analyzed by correlation analysis and regression analysis.

Condition Periodontitis, PCOS
Treatment Scaling and root planing, Oral hygiene instruction
Clinical Study IdentifierNCT05129878
SponsorPostgraduate Institute of Dental Sciences Rohtak
Last Modified on24 July 2022


Yes No Not Sure

Inclusion Criteria

For test groups
females of reproductive age group (15-40 yrs)
BMI (18.5 - 24.9)
The diagnosis of PCOS according to Rotterdam criteria(37), when any two out of the following three abnormalities will be present
clinical (hirsutism, acne or acanthosis nigricans) and/or biochemical (raised testosterone)
hyperandrogenism chronic anovulation (oligomenorrhoea or amenorrhea) polycystic ovaries on
ultrasound (one or both ovaries demonstrate 12 or more follicles measuring 2 to 9 mm in
diameter or the ovarian volume exceeds 10 cubic cm on pelvic ultrasound)
presence of ≥20 natural teeth
Stage I/II periodontitis by using the criteria laid down by World Workshop 2017
For Test Group 2
Participants will receive professional oral hygiene instructions during the trial and
will be given cause related treatment after observation period of 6 months
Delaying treatment will not be considered unethical because of the low risk of disease
progression over 6 months (41) and because these individuals will be monitored
frequently and offered immediate (rescue) treatment if their disease progresses. Such
cases will be excluded from the study. Periodontitis progression will be defined as an
increase in CAL of 2 mm at any tooth site(42)
Participants will be enrolled in the present study after obtaining written informed
consent after explaining the details of the study design in their native language
Also, patients with grade C periodontitis or molar incisor pattern of periodontitis
(2017 criteria) will not be included in the study For control group Systemically
healthy females (age and BMI matched with PCOS women) diagnosed on the basis of
regular menstruation, no clinical or biochemical sign of hyperandrogenism and
ultrasound exclusion of PCOS, having stage 1/2 periodontitis

Exclusion Criteria

• history of androgen-secreting tumors, congenital adrenal hyperplasia and thyroid
nephrotic syndrome, chronic renal failure, significant cardiovascular disease
established type 1 or type 2 diabetes mellitus, active cancer within the last
past 5 yrs
smokers and alcoholics
history of systemic antibiotics or oral contraceptives usage within last 3 months
periapical pathology or oral inflammatory conditions other than periodontitis
any periodontal treatment within 6 months prior to study
incisor molar pattern/grade C periodontitis (2017 classification)
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