Menopause is a period in a woman’s life that comes from the cessation of menstrual cycles. Most women become menopausal around the age of 45-55yrs. During this period, women experience many changes in their body due to decreased levels of hormones like estrogen and progesterone. With our current generation living one-third of their lives in the menopausal stage, it becomes vital to maintain physical and mental health during this time.
Living with menopause
Menopausal women commonly experience symptoms such as hot flushes, night sweats, body aches, vaginal dryness, urinary frequencies and sleep difficulties. Additionally, decreased estrogen levels also increase the risk of developing heart disease, stroke, Alzheimer’s disease and osteoporosis. Changes in the oral cavity can also occur during this time due to changes in hormonal levels.
Oral effects
Estrogen can affect the oral cavity directly or indirectly. With menopause, women tend to commonly experience oral symptoms such as dry mouth, burning mouth syndrome, gum inflammation and altered taste in the mouth.
Dry Mouth (Xerostomia): Saliva acts as a defence mechanism in the mouth to prevent decay. A reduction in salivary flow can cause bacterial colonisation in susceptible areas as well as dryness and irritation of gums. Dry mouth can be triggered by a few factors such as:
- Medications (muscle relaxants, antidepressants, sedatives, pain relief, anxiety meds etc)
- Sjogren’s syndrome (an autoimmune disease that affects salivary and tear glands)
- Surgical removal of the salivary glands
- Radiation therapy for head and neck cancers/tumours.
In patients with dry mouth, water intake must be increased. Chewing sugar-free chewing gum can also induce salivation. In severe cases, the use of salivary substitutes may be required.
Burning Mouth Syndrome (BMS): Patients may complain of a burning sensation in the mouth with an unknown cause in the presence of a completely normal physical examination. It affects the anterior two-thirds of the tongue, palate, lips, floor of the mouth and any surface under dentures.
It can appear as a primary condition or secondary to identifiable causes. Underlying nutritional disorders, thyroid disorders, allergic stomatitis, dry mouth, diabetes, psychiatric illness and other illness are often identified in patients with burning mouth syndrome. The initial management for BMS is topical anaesthetic gel/mouthwash, gargles, topical estrogen or artificial saliva. If there is no improvement, systemic medications may be required.
Gum health: During the menopausal stage, gums may exhibit symptoms of swelling, pain, uneasiness, bleeding and dryness. Gingivitis is a reversible inflammatory response to bacterial plaque build-up. If uncontrolled at the early stage, gingivitis can progress to periodontitis, a disease caused by inflammation of gums and supporting structures. To avoid gingivitis and periodontitis, good oral hygiene must be maintained to reduce the bacteria in the oral environment.
Altered Taste: Changes in taste bud function cause alterations in taste perception. It is caused by a reduction in saliva production, changes in sensation and gingivitis. Women also tend to have reduced perception of sucrose which can alter eating habits, such as an increased preference for sweeter foods.
Other factors affecting gum health
Osteoporosis: It is a disease characterised by low levels of calcium weakening the bones. After menopause, many women are at risk of developing osteoporosis. Estrogen plays a part in regulating calcium levels in the body and reduction of estrogen can result in porous and fragile bone causing fractures. Other factors such as physical inactivity, a diet with low calcium, long periods without menstruations, smoking, alcohol, cortisone drugs treatments and genetic predisposition can also cause osteoporosis. Osteoporosis is considered a risk factor for gum disease and loss of tooth in menopausal women. Research suggests that women with severe osteoporosis were three times more likely than healthy individuals to lose teeth.
Bisphosphonates: Bisphosphonates are drugs used to prevent the resorption of bone in postmenopausal osteoporosis. The use of bisphosphonate drugs is associated with the development of osteonecrosis of the jaw (ONJ). The presence of dental infection, gum disease treatment, ill-fitting dentures and root canal therapy have been implicated as a cause of ONJ. Ideally, a patient should have a full dental examination and complete any required dental treatment before commencing bisphosphonate therapy.
Managing Menopause
Hormone Replacement Therapy (HRT): HRT helps women manage their menopausal symptoms such as hot flushes, vaginal dryness and night sweats. It also helps to improve heart health and increase bone density. HRT could also be used to reduce gum disease and prevent tooth loss. Studies have shown that the rate of gum disease was significantly lower in those receiving HRT, with many seeing a 44% improvement in gum health.
What can we do?
Maintaining good oral health habits can alleviate many post-menopausal symptoms:
- Brush twice daily with fluoride toothpaste to remove bacterial biofilm.
- Replace your toothbrush every three months.
- Clean between teeth with floss or interdental brushes.
- Maintain regular dental examinations and cleans.
- Maintaining a balanced diet; and
- Avoid smoking and alcohol intake.
Menopause is a time for some extra self-care. If you’re affected by any of the above, never be afraid to start a conversation with your favourite Bite team member.