Impact of Polycystic Ovary Syndrome on Periodontal Status of Women of Adolescent and Adult Age Groups: A Cross Sectional Study

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women, primarily affecting the reproductive system, with substantial collateral negative health effects on metabolic, psychologic, and cardiovascular functio ns.

It is a complex disease with characteristics of hyperandrogenism and chronic anovulation (CA) with global prevalence ranging from 2.2% to 26% in Western countries, 2% to 7.5% in China, 6.3% in Sri Lanka,and 9.13% to 36% in India.Patients with this syndrome are at higher risk of developing insulin resistance (IR), obesity, dyslipidemia, cardiovascular disease (CVD), and endometrial carcinoma IR and hyperinsulinemia are responsible for the low-grade chronic systemic inflammation. Periodontitis, an immunoinflammatory disease, is a result of interaction between bacterial attack and host inflammatory response, causing inflammation of supporting tissues of the teeth leading to tissue destruction and tooth loss. It has been suggested as a risk factor for many systemic diseases such as diabetes mellitus, dyslipidemia, obesity, CVDs, rheumatoid arthritis, and respiratory diseases. Chronic low-grade inflammation is emerging as a plausible etiologic mechanism linking periodontal disease and many systemic diseases. Increased concentrations of inflammatory biomarkers (CRP and interleukin -6) have been reported in periodontitis and periodontal treatment helps in decreasing these biomarkers. Timonen P et al. in their cross sectional study demonstrated association of insulin sensitivity with the periodontal infection but they could not draw definite conclusions about the role of reduced insulin sensitivity in the pathogenesis of periodontal infection. Furthermore, Periodontal intervention may improve glycemic control, insulin resistance and serum inflammatory cytokine levels in type II Diabetes patients having chronic periodontitis. Both PCOS and periodontitis has been linked to elevated CRP levels, therefore it is postulated that CRP might be a possible mediator of the association between periodontitis and PCOS As, periodontitis and PCOS are associated with systemic inflammation and insulin resistance, these two disorders may be linked through a common pathophysiologic pathway. Previously conducted cross-sectional studies described a possible relationship between PCOS and periodontitis and the impact of PCOS on gingival inflammation and vice-versa in terms of increased inflammatory markers (hsCRP, IL-6, IL-17 and TNF-α). However, they have not evaluated the effect of periodontal therapy on systemic inflammation and insulin resistance in PCOS women suffering with periodontitis. It was hypothesized that periodontitis and insulin resistance may add to the systemic inflammatory burden and may consequently contribute to progression of PCOS and vice -versa. So, controlling systemic inflammatory burden by scaling and root planing and medical treatment may have an effect in the management of PCOS women ha ving periodontitis. Therefore, the study was attempted to evaluate the effect of non-surgical periodontal therapy along with medical treatment on hsCRP, Homeostatic Model Assessment (HOMA) and periodontal parameters in PCOS women having periodontitis. Available evidence suggests that oxidative stress may be a common link for the association between periodontitis and components of the metabolic syndrome, diabetes, and CVD. Both nitrites and nitrates, which appear in nitric oxide (NO) metabolism, and myeloperoxidase (MPO) are considered to reflect the strength of oxidative stress.

AIM - assessment of impact of polycystic ovary syndrome on periodontal status of women of adolescent and adult age groups. A cross-sectional study PRIMARY OBJECTIVES Comparative evaluation of periodontal parameters like Bleeding on probing(BOP), probing pocket depth(PPD), clinical attachment level(CAL)in both groups. Comparative evaluation of serum hsCRP levels( high sensitivity C reactive proteins) in both the groups. SECONDARY OBJECTIVES Assessment of Plaque index, Gingival index, Gingival phenotype, Gingival recession, Education status, Socio-economic status, Anthropometric parameters. Objectives Outcome Method of measurement of outcome Comparative evaluation of periodontal parameters( BOP, PD, CAL,PI, GI) in both the groups.

The present cross-sectional study will be conducted in the Department of periodontology, Post Graduate Institute of Dental Sciences, Rohtak in collaboration with Department of Obstetrics and Gynaecology Post Graduate Institute of Medical Sciences, Rohtak

1.PLAQUE INDEX(PI)- Plaque index by Silness and Loe 43(1964) will be used for assessment of plaque. For the scoring, a mouth mirror, an explorer and a light source will be used on air dried teeth and gingiva. GINGIVAL INDEX (GI) : Lӧe and Silness-Gingival Index by Loe and Silness (1963) will be used. 3.BLEEDING ON PROBING (BOP):BOP will be recorded as 1 (present) if it occurred within 15 sec of probing and 0 (absent) if no bleeding occurred. It will be calculated in %.