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Menopause Live - IMS Updates
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Date of release: 22 December, 2014

Menopause and oral health

Physicians do not deal with oral health, since this is traditionally accepted as the domain of dentists. But the mouth is obviously an important organ since people eat, talk and kiss with it. People usually think of oral health in connection with esthetics: how the teeth and smile look, how the lips look, or whether there is some malodorous breath. Are there any specific associations between menopause-related issues and oral health? Suri and Suri recently published an interesting review on oral health and menopause, in which they outlined the various relevant entities, such as the oral mucosa, the salivary glands and periodontal health, and the physiological alterations attributed to menopause [1]. During the menopause, women go through biological and endocrine changes, particularly in their production of sex steroid hormones, affecting their health. Because the oral mucosa contains estrogen receptors, variations in hormone levels directly affect the oral cavity. Suri and Suri claimed that there is a paucity of randomized controlled trials in this field and more data are needed, before the recommendations for oral health care in postmenopausal women can be made.

Comment

The first studies on oral complaints and menopause were published some 20–25 years ago: in a small cohort from Australia, the prevalence of oral discomfort was found to be significantly higher in perimenopausal and postmenopausal women (43%) than in premenopausal women (6%) [2]. The results also showed an association between oral discomfort and psychological symptoms in menopausal women. Ben Aryeh and colleagues found that about half of the menopausal women who participated in their study complained of oral discomfort, which was strongly associated with menopausal symptoms [3]. Also, the salivary flow rate was similar in healthy women compared to those with diseases and on various medications. Since then, not too many studies and reviews have addressed oral health in the menopause and there is an agreement that more data are needed. An attempt in 2009 to retrieve and summarize the relevant published information was disappointing [4]. When PubMed and Cochrane databases were searched with key words such as "menopause", "menopausal complaints", "postmenopausal complaints" and "oral diseases", "oral discomfort", "dental health", "dental diseases", "saliva", "burning mouth syndrome", "dry mouth", "xerostomia", no systematic review could be conducted because of a scarcity of controlled studies. Another attempt in 2012 was a little more successful, since it evaluated a total of 44 publications [5].
 
The main three oral problems in the menopausal population seem to be xerostomia and the related burning mouth syndrome, periodontal disease and osteoporotic jaws [1]. Control of oral infections and removal of plaques are the mainstay of preventive strategies. Dentists should be aware as well of the effects of menopause and aging on the oral cavity. Dental examination may reveal a paucity of saliva, increased dental caries, dysesthesia, taste alterations, atrophic gingivitis, periodontitis and osteoporotic jaws unsuitable for conventional prosthetic devices or dental implants [1,5–7]. 
 
What is the impact of postmenopausal hormone therapy in this respect? In the early study of Wardrop and colleagues, they noted that approximately two-thirds of the menopausal women with oral discomfort, but without oral clinical signs, experienced a symptom that was relieved after hormone replacement therapy [2]. In another small-scale study, hormone replacement therapy improved subjective and objective symptoms in 12 out of 22 patients treated with estriol and in seven out of ten patients treated with conjugated estrogens plus norethisterone [8]. Yet examination of oral exfoliative cytology showed a similar maturation index and volume in hormone-treated and untreated women. In contrast to these findings, a larger cohort from Finland did not demonstrate any improvement in oral dryness in hormone users and, in fact, the occurrence of oral pain increased (p = 0.03) [9]. Nevertheless, climacteric symptoms were found to be predictive of painful mouth (p = 0.000) and dry mouth (p = 0.000). The same group of investigators also suggested that their database indicates that hormone users may have a more health-conscious attitude, which results in more dental care appointments and procedures [10]. As for periodontal problems, in a study ancillary to the Women's Health Initiative with a 5-year follow-up, changes in periodontal measures among generally healthy postmenopausal females were, on average, small and did not suggest a consistent pattern of disease progression [11]. Mean change in worst-site alveolar crest height was greater (p < 0.001) in females with severe periodontitis and osteoporosis at baseline and with tooth loss during follow-up. Periodontal changes did not differ according to baseline age, hormone therapy use, smoking status, or age at menopause.
 
Females with a history of severe periodontitis or osteoporosis may experience accelerated oral bone loss despite stability or small improvement in routine probing measurements. 
 
Suri and Suri draw attention to the fact that there are no guidelines regarding oral health care in postmenopausal women by any society [1]. Furthermore, health conferences rarely have any oral health content at all. They suggest that, whenever a woman attends a menopausal clinic, she should be asked about complaints like dry mouth, discomfort in the mouth, tongue and pain in the teeth, etc. Oral hygiene measures in the form of good teeth brushing, use of floss and chlorhexidine mouth wash should be advised. As suggested by Covington already in 1996, there must be an effort to increase the general awareness of the importance of oral health as it relates to the overall health and well-being of both women and men [12].

Amos Pines
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    References

  1. Suri V, Suri V. Menopause and oral health. J Midlife Health 2014;5:115-20
    http://www.ncbi.nlm.nih.gov/pubmed/25316996

  2. Wardrop RW, Hailes J, Burger H, Reade PC. Oral discomfort at menopause. Oral Surg Oral Med Oral Pathol 1989;67:535-40
    http://www.ncbi.nlm.nih.gov/pubmed/2497421

  3. Ben Aryeh H, Gottlieb I, Ish-Shalom S, et al. Oral complaints related to menopause. Maturitas 1996;24:185-9
    http://www.ncbi.nlm.nih.gov/pubmed/8844632

  4. Meurman JH, Tarkkila L, Tiitinen A. The menopause and oral health. Maturitas 2009;63:56-62
    http://www.ncbi.nlm.nih.gov/pubmed/19324502

  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;3:320-3
    http://www.ncbi.nlm.nih.gov/pubmed/24116306

  6. Friedlander AH. The physiology, medical management and oral implications of menopause. J Am Dent Assoc 2002;133:73-81
    http://www.ncbi.nlm.nih.gov/pubmed/11811747

  7. Mutneja P, Dhawan P, Raina A, Sharma G. Menopause and the oral cavity. Indian J Endocrinol Metab 2012;16:548-51
    http://www.ncbi.nlm.nih.gov/pubmed/22837914

  8. Volpe A, Lucenti V, Forabosco A, et al. Oral discomfort and hormone replacement therapy in the post-menopause. Maturitas 1991;13:1-5
    http://www.ncbi.nlm.nih.gov/pubmed/1861638

  9. Tarkkila L, Linna M, Tiitinen A, Lindqvist C, Meurman JH. Oral symptoms at menopause the role of hormone replacement therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:276-80
    http://www.ncbi.nlm.nih.gov/pubmed/11552144

  10. Tarkkila L, Furuholm J, Tiitinen A, Meurman JH. Oral health in perimenopausal and early postmenopausal women from baseline to 2 years of follow-up with reference to hormone replacement therapy. Clin Oral Investig 2008;12:271-7
    http://www.ncbi.nlm.nih.gov/pubmed/18299902

  11. LaMonte MJ, Hovey KM, Genco RJ,et al. Five-year changes in periodontal disease measures among postmenopausal females: the Buffalo OsteoPerio study. J Periodontol 2013;84:572-84
    http://www.ncbi.nlm.nih.gov/pubmed/22813344

  12. Covington P. Womens oral health issues: an exploration of the literature. Probe 1996;30:173-7
    http://www.ncbi.nlm.nih.gov/pubmed/9610337