Menopause causes changes and fluctuations in sex steroid hormone production. These changes can affect the health of women. Did you know it plays a big part in oral health? Read below to find out more.
During the menopause, women go through biological and hormonal changes, particularly in their sex steroid hormone production, affecting their health. Because the oral mucosa contains oestrogen receptors, these variations in hormone levels directly affect oral health. A few oral conditions and or diseases are seen more frequently during peri and post menopausal years.
Menopausal clinics should be aware of the oral changes that can occur during this period and the dental needs of these women. Oral mucosa resembles vaginal mucosa in its histology as well as its response to oestrogens, so should be considered in the same way we associate changes with menopause and reproductive/ sexual organs. Menopausal and peri menopausal women should be referred to dental experts accordingly. And on the other hand, the dental team should also be trained in the menopausal status of the woman, her HRT status and any special preventative/treatment needs.
Here is a few ways menopause can affect oral health:
Increased risk of Periodontitis – The periodontium is composed of the supporting structures of the teeth which includes the gums and bone/ligaments. There are oestrogen receptors in osteoblasts (that create bone) and fibroblasts (that create tissue) in the periodontium, which respond to the varying levels of hormones in different stages of reproductive life. Post menopausal women present with periodontal disease more frequently and in a more severe form. In a study conducted by Kribbs et al, it was found that women with advanced osteoporosis were 3x more susceptible to tooth loss than their counterparts. And Imirzalioglu et al concluded that osteopenia in menopause is a risk indicator for periodontal disease.
Dry mouth (xerostomia) – Function of oral salivary glands is hormone dependant. Depleting levels of oestrogen cause a reduction in salivary flow and saliva consistency. Just as post menopausal women experience vaginal dryness, they also experience dry mouth (also known as xerostomia). Saliva acts as a defence mechanism for the prevention of tooth decay and reduced salivary flow can encourage an increase in oral microbes thus affecting the oral and dental health. Yalcin et al investigated the saliva of a small group of menopausal women and the same number of premenopausal controls. They observed that salivary flow rate decreased with menopause and increased with HRT use. Agha-Hosseini et al observed a significant negative correlation between reduced bone mass density (BMD) and xerostomia. Xerosmtomia increases the risk of tooth decay and periodontal disease, as well as oral discomfort.
Burning mouth syndrome/oral pain – The burning sensation in normal oral mucosa is known as 'burning mouth syndrome' and is a common entity seen in post menopausal women. The symptoms vary from discomfort to intense pain. Various conditions like lichen planus, candidiasis and viral infections are seen more in post menopausal women and have similar presentation, but in burning mouth syndrome the mucosa appears essentially normal. Wardrop et al assessed the relationship between oral discomfort and menopause in women. The prevalence of oral discomfort was found to be significantly higher in perimenopausal and postmenopausal women (43%) than in premenopausal women (6%).
How can HRT help alleviate symptoms – In a study by Volpe et al, conjugated oestrogens were administered to one group of post menopausal women with oral discomfort. They observed that HRT improved subjective and objective symptoms in more than 50% of patients. In a Women's Health study on 42,171 post menopausal women in the USA, it was found that tooth loss was 24% lower in current HRT users than in nonusers. Allen et al published a systematic review on the cost of dental care in post menopausal women with osteoporosis with or without HRT use. They assessed 20 published studies involving 13,735 post menopausal women and it was discovered that post menopausal women with osteoporosis who did not receive HRT had a greater incidence of adverse dental outcomes and incurred higher dental care costs than those who received HRT.
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