Impact of hormonal phases on salivary characteristics and oral hygiene in women: a cross-sectional comparative study

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Abstract
Background: Hormonal fluctuations across a woman’s life stages can influence systemic and oral health. However, comparative data on salivary characteristics and oral hygiene across different hormonal phases remain limited. This study aimed to evaluate the salivary flow rate, salivary pH, and oral hygiene status among women in the menstruating, mid-cycle (ovulatory phase), pregnant-third trimester, and menopausal phases. Methods: In this cross-sectional study, 80 women ( n =20 per group: mid-cycle (ovulatory phase), menstruating, pregnant-third trimester, menopausal) were examined. Unstimulated salivary flow (mL/5 min) and pH were measured; oral hygiene was assessed with the OHI-S. Outcomes were analyzed by ANCOVAwith age as a covariate. When omnibus effects were significant, Tukey-adjusted pairwise comparisons of estimated marginal means (EMMs) were performed. Effect sizes are reported as partial eta-squared ( η²p ) values; salivary flow is reported as mL/min for interpretability. Results: After adjusting for age, salivary flow differed by group ( F =92.10, p η²p =0.787). The adjusted means (mL/min) were as follows: mid-cycle 0.831, menstruating 0.912, pregnant 0.427, and menopausal 0.460; menstruating and mid-cycle were greater than pregnant and menopausal (all p p =0.980). Salivary pH also differed ( F =16.55, p η²p =0.398): mid-cycle 7.65, menstruating 7.63, pregnant 6.93, menopausal 6.63; cycling groups exceeded pregnant and menopausal (most p p =0.931) or pH ( p =0.843). Oral hygiene categories differed by group (Fisher’s exact p <0.001), with poorer hygiene in pregnant and menopausal women. However, the cross-sectional design precludes causal inference, findings are restricted to third-trimester pregnancies, and unmeasured factors such as oral hygiene, diet, socioeconomic status, and medication use may have influenced outcomes. Conclusions: The study indicates that hormonal phases, particularly third-trimester pregnancy and menopause, are associated with reduced salivary flow, lower pH, and poorer oral hygiene, underscoring the need for stage-specific preventive strategies and collaboration between gynecologists and dental professionals.
Funding Information
  • Manipal Academy of Higher Education, Manipal

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