How Does Menopause Affect Oral Health?

Some friends of ours Dr Rosie Ross and Jo Vines have recently released their book Approaching the Pause. We  recommend this book to anyone interested in a unique, entertaining and informative perspective on menopause and perimenopause.  In the interest of bringing oral health into the conversation about menopause, we hope you find the following short article useful. 

Why Does Menopause and Perimenopause Affect Oral Health?

Why does menopause and perimenopause affect oral health? The main reason is that during menopause, sex steroid hormone production changes. Oral mucosa contains estrogen receptors and has some distinct similarities to vaginal mucosa.In general, the links between hormonal changes and oral health are not crystal clear. However, some oral conditions have been reported more frequently in menopausal and perimenopausal women.These include:

• Oral discomfort and psychological symptoms (1)

• Burning mouth syndrome (2)

• Dry mouth (xerostomia) (3)

• Altered saliva composition (4)

 One of the most obvious effects with a broad implication for dental health is reduced saliva flow. Reduction in salivary flow can cause discomfort associated with the sensation of having a dry mouth and can increase the risk of dental issues such as decay.(5) Post-menopausal women have been demonstrated to have a higher frequency and severity of periodontal disease (gum disease).(6) Osteopenia in menopause has also been linked as a risk indicator for periodontal disease.(7)

Does Hormone Replace Therapy Help When Menopause is Affected?

There is some evidence to indicate that Hormone Replacement Therapy (HRT) may help in improving the oral subjective and objective symptoms for some patients.(8) Some research indicates that HRT in combination with alendronate and calcium has demonstrated an improved saliva flow rate in women experiencing oral symptoms.(9) Other research presents greater questions about the link between salivary gland function, menopause and HRT(10). HRT appears to reduce some of the micro-organisms associated with periodontal disease (such as Porphyromonas gingivalis). However, it does not appear to be correlated with overall periodontal health.(11) 

Interestingly, a very large study on 42171 post-menopausal women found that tooth loss was 24% less for women currently on HRT than non-users.(12) Women on HRT have also been shown to present more regularly for dental appointments. (13) This may explain some of the variations currently observed. 

Unfortunately, there are currently no guidelines available for best-practice dental treatment of menopausal women and a small amount of studies are available in this area.

For now, what we can recommend is:

• It is important to consider possible oral effects of menopause and perimenopause for the individual including dry mouth and increased risk of some dental and periodontal issues.

• Management of oral health symptoms associated with this period are likely to be best managed by an interdisciplinary GP and dental team with good communication between the two to develop a plan tailored to individual risk factors.(14)

Watch this space.

We hope that books like Approaching the Pause help to prompt a more open conversation about menopause and perimenopause, and that as this conversation emerges, improved evidence in this area will follow. 

To book an appointment with our team at Ethical Dental call 6652 3185 or book online.

References

1. Wardrop RW, Hailes J, Burger H, Reade PC. Oral discomfort at menopause. Oral Surg Oral Med Oral Pathol. 1989;67:535–40.

2. Merskey H, Bogduk N.  Classification of Chronic Pain. Seattle, WA: IASP Press; 1994. pp. 59–71.

3. Guggenheimer J, Moore PA. Xerostomia: Etiology, recognition and treatment. J Am Dent Assoc. 2003;134:61–9.

4. Ben Aryeh H, Gottlieb I, Ish-Shalom S, David A, Szargel H, Laufer D. Oral complaints related to menopause. 1996;24:185–9.

5. Minicucci EM, Pires RB, Vieira RA, Miot HA, Sposto MR. Assessing the impact of menopause on salivary flow and xerostomia. Aust Dent J. 2013;58:230–4.

6. Yalcin F, Gurgan S, Gul G. Oral health in postmenopausal Turkish women. Oral Health Prev Dent. 2006;4:227–33.

7. Sultan N, Rao J. Association between periodontal disease and bone mineral density in postmenopausal women: A cross sectional study. Med Oral Patol Oral Cir Bucal. 2011;16:e440–7.

8. Volpe A, Lucenti V, Forabosco A, Boselli F, Latessa AM, Pozzo P, et al. Oral discomfort and hormone replacement therapy in the post-menopause. 1991;13:1–5.

9. Sewón L, Laine M, Karjalainen S, Leimola-Virtanen R, Hiidenkari T, Helenius H. The effect of hormone replacement therapy on salivary calcium concentrations in menopausal women. Arch Oral Biol. 2000;45:201–6.

10. Ship JA, Patton LL, Tylenda CA. An assessment of salivary function in healthy premenopausal and postmenopausal females. J Gerontol. 1991;46:M11–5

11. Tarkkila L, Kari K, Furuholm J, Tiitinen A, Meurman JH. Periodontal disease-associated micro-organisms in peri-menopausal and post-menopausal women using or not using hormone replacement therapy. A 2-year follow-up study. BMC Oral Health. 2010;10:10.

12. Grodstein F, Colditz GA, Stampfer MJ. Tooth loss and hormone use in postmenopausal women. Compend Contin Educ Dent Suppl. 1998;22:S9–16.

13. Patil SN, Kalburgi NB, Koregol AC, Warad SB, Patil S, Ugale MS. Female sex hormones and periodontal health-awareness among gynecologists - A questionnaire survey. Saudi Dent J. 2012;24:99–104.

14. Suri, V, Suri V. Menopause and oral health. J Midlife Health. 2014;5:115-120.