Menopause happens to all women
Menopause is a normal developmental stage in a woman’s life, marking the permanent cessation of menstruation and is the result of irreversible changes in the hormonal function of the ovaries. During the menopause all women will go through biological and hormonal changes, particularly in their sex steroid hormone production (such as oestrogen), which can ultimately affect their health. One overlooked area that is affected by these changes is the mouth.
Variations in hormone levels directly affect the oral cavity and there are a few oral conditions and/or diseases which are seen more frequently during peri and post menopausal years. This means that hormonal fluctuations affect more than a woman’s reproductive system. Let’s explore how the mouth may be affected by endocrine fluctuations and changes.
Menopause affects the oral tissues in the same way as it alters the other systems. Sex hormone receptors have been detected in the oral mucosa and salivary glands. Because of these receptors, salivary glands rely on oestrogen to be able to function. Therefore, reduced oestrogen causes reduced salivary gland function and the resulting reduction in saliva causes oral problems such as xerostomia (dry mouth), burning mouth syndrome, increase incidence of dental caries, dysesthesia (abnormal sensation), taste alterations, atrophic gingivitis (gum disease displaying thinning gum tissue), periodontitis and bone loss, and osteoporosis of the jaw.
Burning mouth syndrome
A burning sensation of the mouth, felt despite normal oral mucosa, is known as ‘burning mouth syndrome’ and is a common thing seen in postmenopausal women. One study found the prevalence of oral discomfort and burning mouth syndrome was significantly higher in perimenopausal and postmenopausal women (43%) than in premenopausal women (6%). Although considered idiopathic, it is thought to be possibly caused by neuronal inflammation in response to hormonal changes or altered production of neuroactive steroids in the mucosa and nervous system.
Xerostomia and increased biofilm
Xerostomia should be taken seriously. Saliva acts as a defence mechanism for the prevention of caries and a reduced salivary flow can encourage oral biofilm accumulation, thus affecting the dental health. Biofilm is the cause of an inflammatory and immune response by the body, the processes of which contribute to the tissue damage seen in periodontitis. If there is an increase of oral biofilm in a susceptible person, you increase the risk of periodontitis and bone loss.
Providing an environment for biofilm to flourish makes it a lot harder to control and accounts for why we often see advancing gum disease in peri and post menopausal women. It’s important that peri and post menopausal women see a hygienist/oral health expert regularly, to help manage their biofilm at this time and reduce the risk of this tissue damage and potential tooth loss. These are conditions that can be prevented.
Increased risk of periodontitis
Sex steroid hormones are also responsible for other mechanisms that are at play when it comes to periodontitis. They can lead to changes in inflammatory mediators, vascular permeability and growth/differentiation of fibroblasts (cells which contribute to the formation of connective tissue to maintain the structural framework of tissue).
There are oestrogen receptors in osteoblasts (cells which synthesise and mineralises bone) and fibroblast of the periodontal tissues. These respond to the varying levels of hormones during menopause, affecting the health of the periodontium and often causing women to present with periodontal disease more frequently and in a more severe form.
Increased risk of tooth loss
There is some correlation between systemic osteoporosis and alveolar bone loss (the bone of the jaw that houses teeth). Decreased bone mass density (BMD) of this alveolar bone can lead to attachment loss and tooth loss. A study showed that women with advanced osteoporosis (a condition which causes lower bone mass density and is associated with menopause) were 3x more likely to experience tooth loss.
Effects of HRT on dental risk factors
Studies have shown that HRT (hormone replacement therapy) may improve subjective and objective symptoms in more than 50% of patients. A Japanese study in 330 postmenopausal women showed that oestrogen may promote tooth retention by strengthening the periodontal attachment surrounding the teeth. There was a strong correlation between duration of oestrogen use and the number of remaining teeth.
Reduced pathogenic bacteria with HRT
In a 2 year open follow-up study it was observed that HRT led to decreasing numbers of positive samples of the bacterial species Porphyromonas gingivalis and Tannerella forsythia. These bacteria are identified as being among the most pathogenic in advancing forms of periodontal disease, causing the most tissue destruction and are found in the deepest pockets.
Oestrogen can influence interleukin levels in women with periodontitis and therefore may be a reason we see accelerated healing in women who are on HRT. (Interleukin factors regulate the immune response). In a famous Women’s health study on 42,171 postmenopausal women in the USA, it was found that tooth loss was 24% lower in HRT users than in nonusers.
A published systematic review on the cost of dental care in postmenopausal women with osteoporosis with or without HRT use assessed 20 published studies involving 13,735 postmenopausal women. It was discovered that postmenopausal 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.
HRT may not be for everyone, but for those who are able, it may help to reduce the risk of adverse dental outcomes of menopause and some subjective symptoms, possibly increasing quality of life. Dental professionals should strive to increase their knowledge around menopause and how it affects the oral health of women who are experiencing the effects. Oral health experts are the people to turn to for this preventative care.
Similarly, menopause educators and specialists should appreciate the role it plays on oral health and work with women to prevent issues arising by referring them to see an oral health expert.
Envisage Waiting Room TV
Being a healthcare environment, we have a responsibility to educate our patients about this and other topics. Envisage Dental TV makes this easy to do while they are waiting. It also allows us the opportunity to make women aware that there is a link, so that they may initiate the conversation with you about how to best maintain their mouth during menopause. Using Envisage Dental TV can spread this awareness and start these conversations.