Effect of Menstrual Cycle Phase on Pain Perception and Anxiety During Non-Surgical Periodontal Treatment (MAPP)

Comparison of Pain Perception and Anxiety Levels During Non-Surgical Periodontal Treatment in Female Patients With Stage II and III Periodontitis at Different Phases of the Menstrual Cycle

This study evaluates the effect of menstrual cycle phases on pain perception and dental anxiety during non-surgical periodontal therapy in premenopausal women with Stage II and III periodontitis. Pain and anxiety levels were assessed using VAS and DAS scales in perimenstrual and postmenstrual phases. Periodontal treatment outcomes were also recorded before and after therapy.

Study Overview

• Status: Completed
• Conditions: Periodontitis
• Intervention / Treatment: Procedure: Non Surgical Periodontal Treatment

Detailed Description

This study investigated the influence of menstrual cycle phases on pain perception and anxiety levels during non-surgical periodontal therapy (NSPT) in systemically healthy premenopausal women diagnosed with Stage II and III periodontitis. A total of 36 participants were included. Clinical periodontal parameters, including probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), and bleeding on probing (BoP), were recorded before and after NSPT. Pain perception was assessed using the Visual Analog Scale (VAS), and dental anxiety was evaluated using the Corah Dental Anxiety Scale (DAS). NSPT was performed without local anesthesia using a split-mouth design. Outcomes were compared between perimenstrual and postmenstrual phases.

• Study Type: Observational
• Enrollment (Actual): 36

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Trabzon
    • Trabzon, Trabzon, Turkey (Türkiye), 61080
      • Karadeniz Technical University Faculty of Dentistry, Department of Periodontology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Systemically healthy premenopausal female patients diagnosed with Stage II and III periodontitis attending the Department of Periodontology were included in the study.

Description

Inclusion Criteria:

• Female patients aged 18 years and older diagnosed with Stage II and III periodontitis, systemically healthy, and not using medications affecting pain perception or hormonal status. Participants with regular menstrual cycles were included.

Exclusion Criteria:

• Patients with systemic diseases, pregnancy or lactation, use of analgesic, anti-inflammatory or hormonal medications, smokers (if excluded), and those with irregular menstrual cycles were excluded.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Perimenstrual Phase Group; Female patients with Stage II and III periodontitis who underwent non-surgical periodontal therapy during the perimenstrual phase.	Procedure: Non Surgical Periodontal Treatment; Standard non-surgical periodontal therapy including scaling and root planing performed without local anesthesia.
Postmenstrual Phase Group; Female patients with Stage II and III periodontitis who underwent non-surgical periodontal therapy during the postmenstrual phase.	Procedure: Non Surgical Periodontal Treatment; Standard non-surgical periodontal therapy including scaling and root planing performed without local anesthesia.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain perception	Pain perception during non-surgical periodontal therapy assessed using the Visual Analog Scale (VAS; score range: 0-10), where higher scores indicate greater pain intensity, across menstrual cycle phases.	Immediately after completion of each treatment session (session duration was not fixed and varied according to the extent of treatment required)
Dental Anxiety	Dental anxiety during non-surgical periodontal therapy was assessed using the Corah Dental Anxiety Scale (DAS; score range: 4-20). The scale consists of four questions related to different dental treatment situations, each with five response options of increasing intensity. Participants were asked to select the response that best reflected their level of anxiety. Higher scores indicate greater anxiety levels, across menstrual cycle phases.	Immediately after completion of each treatment session (session duration was not fixed and varied according to the extent of treatment required)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Probing Pocket Depth (PPD)	PPD was measured in millimeters at six sites per tooth using a periodontal probe, and mean values were calculated per participant.	Baseline (pre-treatment) and 6 weeks after completion of non-surgical periodontal therapy
Clinical Attachment Level (CAL)	CAL was measured in millimeters at six sites per tooth using a periodontal probe, and mean values were calculated per participant.	Baseline (pre-treatment) and 6 weeks after completion of non-surgical periodontal therapy
Gingival Index (GI)	GI was assessed at four sites per tooth to evaluate gingival inflammation, and mean scores were calculated per participant.	Baseline (pre-treatment) and 6 weeks after completion of non-surgical periodontal therapy
Plaque Index (PI)	PI was assessed at four sites per tooth to evaluate plaque accumulation, and mean scores were calculated per participant.	Baseline (pre-treatment) and 6 weeks after completion of non-surgical periodontal therapy
Bleeding on Probing (BoP)	BoP was recorded as the percentage of sites showing bleeding within 10 seconds after probing.	Baseline (pre-treatment) and 6 weeks after completion of non-surgical periodontal therapy

Collaborators and Investigators

• Sponsor: Karadeniz Technical University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2024
• Primary Completion (Actual): May 1, 2025
• Study Completion (Actual): May 1, 2025

Study Registration Dates

• First Submitted: July 2, 2026
• First Submitted That Met QC Criteria: July 20, 2026
• First Posted (Actual): July 22, 2026

Study Record Updates

• Last Update Posted (Actual): July 22, 2026
• Last Update Submitted That Met QC Criteria: July 20, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Menstrual cycle; Dental Anxiety; Non-surgical periodontal treatment; Pain Perception
• Additional Relevant MeSH Terms: Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Periodontitis
• Other Study ID Numbers: KTU-DENT-SK-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared due to patient confidentiality and privacy considerations. Data may contain sensitive clinical and personal health information. Therefore, access to the dataset will be restricted to the study investigators only.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No