What is Oral Health?
Healthy gums fit snugly around teeth and act to hold them securely in place. They are firm and have a colour ranging from pale pink to dark brown. Periodontitis is the formal name for gum disease, and it starts by damaging the soft tissues of the gum. Without treatment, periodontitis can go on to destroy the bone that supports your teeth, leading to loose or lost teeth. [1]
The oral mucosa, which is the soft tissue lining the mouth (including the insides of your cheeks and lips), and the salivary glands both contain estrogen receptors. This means that hormone fluctuations associated with the menopausal transition can affect the health of your mouth, gums, and teeth. Increasing age combined with decreasing estrogen levels disproportionately increases women’s risk of oral disease, among other conditions. [2] [3] However, some studies have concluded that the menopausal transition does not appear to significantly influence the severity of periodontal disease and tooth loss. [4]
Oral health problems overall are predominantly driven by a decrease in the production of saliva. This leads to an increase in tooth cavities, inflammation of the gums (atrophic gingivitis), gum disease (periodontitis), mouth sores (oral ulcerations) and bone loss in the jaw (osteoporotic jaws). [3] [5]
Other oral health problems include burning mouth syndrome, dry mouth (xerostomia), and bad tastes in the mouth (dysesthesia) are all discussed in the Burning Mouth Syndrome section.
Self-care & Natural Remedies for Oral Health
There is a lot that you can do to keep your mouth, gums, and teeth healthy on your own. Practice the following to maintain a healthy mouth and strong teeth:
- Brush teeth with a soft toothbrush thoroughly twice a day and floss daily between the teeth to remove dental plaque.
- Use mouthwashes containing chlorhexidine digluconate, which is an antiseptic agent with topical antibacterial activity. Your dentist, healthcare provider, or pharmacist can recommend an over-the-counter brand of mouthwash for you. Regular brushing and the use of chlorhexidine digluconate reduce the accumulation of dental plaque, and is known to prevent cavities, particularly root cavities that are common in older individuals.
- Drink fluoridated water.
- Brush your teeth with fluoride toothpaste.
- If you are able, visit your dentist at least once a year, even if you have no natural teeth or have dentures. At these visits ask your dentist to take a full clinical history so you have a baseline of your dental and mouth health. This includes examining your oral mucosa (the soft tissues inside your mouth) and evaluating your salivary flow. Have regular X-rays taken.
- Do not use any tobacco products, and if you currently smoke, quit.
- Limit the amount of alcohol you drink.
- If you have a dry mouth, check your medications – talk to your healthcare provider to see if that could be the cause. If your dry mouth continues, stay hydrated, chew sugarless gum, and take extra care to avoid tobacco products and alcohol.
- See your doctor or a dentist if you have sudden changes in taste and smell. [6]
Therapy & Treatment for Oral Health
At age 40 find a reliable, educated primary care provider familiar with recognizing and treating symptoms of perimenopause and menopause. The North American Menopause Society provides a list of menopause practitioners here.
There are no guidelines specific to oral health care in perimenopausal or postmenopausal women. [3] However, following the basics of oral health care as described in the Self-Care section above will give you the basic guidance for good oral health. Talk to your healthcare provider about your oral health and any concerns you might have. The best case scenario would see both your healthcare provider and your dentist having awareness of your oral health and your menopausal status, especially your reproductive age. [2] [3]
Hormone Therapy (HT) for Oral Health
The use of hormone therapy to help manage oral health is controversial because no clear relationship has been seen between HT and improved oral health. [2] [3] [5] [7] [8] However, there are indications that HT can be helpful. For example, some studies reported significantly greater occurrences of periodontitis in post-menopausal women who were not using HT compared to women who had not entered the menopausal transition. Other studies showed that post-menopausal women using HT and premenopausal women had similar periodontal status. The Women’s Health Study assessed 42,171 post-menopausal women and found that the overall risk of tooth loss was 24% lower in current HT users than in non-users. [5]
Some studies have found that women who start using HT report improvement in their quality of life, including reduced oral discomfort. These studies propose that increased saliva secretion is the main reason for the improvement of oral discomfort. These studies also show that saliva production amounts in pre- and post-menopausal women does differ based on estrogen levels. [5] Other studies, however, show that women’s salivary gland function is not significantly influenced by either menopause or HT. [9]
It appears that the effect of HT on oral health varies among women – some women benefit while others do not seem to be affected and don’t show improvement. Researchers continue to call for better designed, well-controlled, long-term randomized clinical studies. The results from these studies would form the basis of better clinical guidelines for perimenopausal women’s oral health. [3] [5]
The Science
Periodontal Tissues [Tissue around the teeth]
Periodontal Tissues
The periodontal tissues, also called the periodontum, are specialized tissues that surround the teeth and support them in the jaw bones (the maxillary and mandibular bones). These tissues include the gingiva (the gums), the periodontal ligament, cementum (that covers the roots of the teeth), and alveolar bone, which is the thick ridge of bone in your jaw that holds the teeth. [3] Periodontal disease is the most common cause of tooth loss in adults.
Multiple species of bacteria are always present in the mouth. Plaque is a sticky film on your teeth (and sometimes under your gums) that bacteria attach to. These bacteria produce acids after you eat or drink anything and these acids will eat away at your healthy gum tissue, your tooth enamel, and can cause cavities in your teeth. If you don’t remove plaque regularly (both at home and at your dentist’s office) it hardens and becomes a substance called tartar.
As plaque and tartar build up, they can cause the gums to separate from around the tooth, making pockets under the gum line. These pockets fill with bacteria, infecting the gums and are very hard to clean at home. The inflammation caused by the bacterial infection also affects the bone, causing it to start disappearing (resorbing). When this happens, the tooth can become loose and fall out, or need to be pulled out.
Consider adding a sentence here about gum infections and the implications of them if left untreated?
Saliva
Saliva
Saliva plays a significant role in maintaining oral health, helping to build and maintain the health of soft and hard tissues. [10] Salive is an exocrine substance, meaning it is released to your body surfaces (in this case, your oral mucosa) through openings called ducts. Salive is 99% water with the remaining 1% made up of electrolytes and proteins. Saliva flows continuously, even at rest, and the amount of saliva produced increases in response to stimuli such as smelling food or chewing food. [10]
Saliva has two major functions. It protects the tissues inside the mouth by lubricating them, helping with tissue repair, and inhibiting the growth of bacteria. It also works to help you eat, by helping break down and digest your food, and speak, by lubricating your oral tissues. [10]
It has been proposed that many of the oral health issues women experience during the menopausal transition result from reduced levels of saliva flowing in the mouth. Unfortunately, current research does not give a clear answer on whether any reduced salivary flow is associated with reduced estrogen levels, or if it is more related to increased age. [5]
Oral Cancer
Oral Cancer
Oral cancer is known to be more common in males than in females. When oral cancer does present in women, they are almost always post-menopausal. This is determined with reproductive age, not physical age, as women who have undergone hysterectomy and as a result entered into a premature menopause, also have higher rates of oral cancer. At this time, no specific research has been done on exploring the hypothesis that estrogen deficiency plays a role in developing oral cancer. [11]
Oral cancer can appear on the lips, gums, tongue, inner cheeks, roof of the mouth, or under the tongue. Be aware of any sore that doesn’t heal, white or reddish patches, or growths and lumps on the inside of your mouth, or general mouth pain. If you see any of these, or have any concerns, visit your healthcare provider or your dentist. [12]
Myths & Mysteries
MYTH
Unfortunately, this is not true. While gum disease can definitely cause bad breath, it is not the only cause by far. If your bad breath or a bad taste in your mouth doesn’t go away, talk to your dentist or your healthcare provider to see what the cause could be.
MYTH
Gum disease is painless so there aren’t any obvious indicators that you are experiencing gum disease. Your dentist can help determine if you are at risk. If your gums are red and sore and / or bleed easily you are at an early stage of gum disease and the condition can be reversed with the help of proper dental care.
MYTH
No, unfortunately gum disease is very common. The US Centers for Disease Control and Prevention states that 50% of adults over the age of 30 have some form of gum disease. You can help keep your gums healthy by practicing good dental hygiene and brushing and flossing regularly to remove the buildup of plaque on your teeth.
Citations
[1] https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes
[2] Friedlander AH. The physiology, medical management and oral implications of menopause. J Am Dent Assoc. 2002 Jan;133(1):73-81. doi: 10.14219/jada.archive.2002.0025. PMID: 11811747.
[3] Suri V, Suri V. Menopause and oral health. J Midlife Health. 2014 Jul;5(3):115-20. doi: 10.4103/0976-7800.141187. PMID: 25316996; PMCID: PMC4195183.
[4] Alves RC, Félix SA, Rodriguez-Archilla A, Oliveira P, Brito J, Dos Santos JM. Relationship between menopause and periodontal disease: a cross-sectional study in a Portuguese population. Int J Clin Exp Med. 2015 Jul 15;8(7):11412-9. PMID: 26379957; PMCID: PMC4565340.
[5] Dutt P, Chaudhary S, Kumar P. Oral health and menopause: a comprehensive review on current knowledge and associated dental management. Ann Med Health Sci Res. 2013 Jul;3(3):320-3. doi: 10.4103/2141-9248.117926. PMID: 24116306; PMCID: PMC3793432.
[6] https://www.cdc.gov/oralhealth/basics/adult-oral-health/tips.html
[7] Geurs NC, Lewis CE, Jeffcoat MK. Osteoporosis and periodontal disease progression. Periodontol 2000. 2003;32:105-10. doi: 10.1046/j.0906-6713.2003.03208.x. PMID: 12756036.
[8] Grodstein F, Stampfer M. The epidemiology of coronary heart disease and estrogen replacement in postmenopausal women. Prog Cardiovasc Dis. 1995;38:199–210.
[9] Ship JA, Patton LL, Tylenda CA. An assessment of salivary function in healthy premenopausal and postmenopausal females. J Gerontol. 1991 Jan;46(1):M11-5. doi: 10.1093/geronj/46.1.m11. PMID: 1986036.
[10] https://www.nature.com/articles/bdjteam2015123
[11] Suba Z. Gender-related hormonal risk factors for oral cancer. Pathol Oncol Res. 2007;13(3):195-202. doi: 10.1007/BF02893499. Epub 2007 Oct 7. PMID: 17922048.
[12] https://www.mayoclinic.org/diseases-conditions/mouth-cancer/symptoms-causes/syc-20350997