Oral health and the menopause

Experiencing problems with your teeth or gums? Discover how your hormones can play a part in these surprising symptoms

You probably know that menopause can affect many areas of your body, but did you realise it can affect your oral health? A study of 1,061 women aged 50 found over 84% were unaware that some of the oral health symptoms and discomfort they experienced could be linked to the menopause [1].

And yet these symptoms aren’t rare – the same study found that 70% of the women had experienced an oral health symptom since experiencing menopausal symptoms. Oral health issues can vary, from changes in the appearance of teeth and gums to more surprising symptoms, such as a burning mouth.

While practising good oral hygiene is important at all stages of life, making an extra effort during the menopause and being aware of any changes you might experience can best help you determine how to deal with them.

Why does the menopause affect my mouth?

Most diseases in the mouth are multifactorial, so a combination of things can trigger or exacerbate symptoms. During the perimenopause and menopause, the drop in oestrogen and progesterone levels can make gums more sensitive, trigger dry mouth and cause burning mouth syndrome. Stress and anxiety, which you may be more prone to during the menopause, can also exacerbate symptoms, significantly more so when sleep is affected.

RELATED: dry mouth and the menopause

Dentist Dr Shabnam Zai says: ‘If your mouth is dry, you may notice clicking or difficulty in speaking, food may not taste the same and the dryness can affect swallowing. Overall, your mouth can feel more sensitive and your gums may bleed more when brushing.

‘One thing that always surprises me is how many people are OK with their gums bleeding. I explain that blood from anywhere in the body is not normal. If blood was coming out of your eyes or your ears, you would instantly go to the doctors. Bleeding from the gums is your body’s way of telling you it needs some TLC.

‘The good news is that inflammation is caused by the presence of bacteria so being shown how to brush and clean your teeth well, alongside regular check-ups and good hygiene, significantly improves the situation, sometimes as quickly as within a few days.

‘As we age our gums naturally recede, some patients who brush too aggressively or have an incorrect brushing technique can significantly accelerate the recession, making teeth more sensitive and putting the teeth at more risk.’

RELATED: menopause and bleeding gums

What are the common changes?

In a review of oral health and menopause data, the most common oral health symptom was periodontal health, with up to 60% of women experiencing symptoms [2]. Periodontal heath refers to that of the gums and connective tissues, which can experience significant change during the menopause.

Pain and inflammation in the gums, known as gingivitis, can be a common occurrence when oestrogen is in short supply. ‘These fluctuations in hormones decrease your body’s ability to fight off infections, they also affect its ability to maintain a healthy balance of bacteria in the mouth,’ says Dr Shabnam.

‘There is a lack of evidence when it comes to menopause and oral symptoms, however there are ample studies confirming how hormones affect the gums during pregnancy. Women who often have the same cleaning habits suddenly become more sensitive and have more inflammation and bleeding in their gums due to the fluctuations in hormones.’

Gums can change in colour, becoming paler or more often, a deeper red colour. You may notice your gums bleeding, especially when you brush your teeth, or that your gums are shrinking around the teeth, known as gum recession. Other problems might be bad breath, more food trapping between teeth, pain on chewing, or bite problems.

Chronic gum problems can lead to destruction of the bone supporting your teeth, known as periodontitis. Gum disease is the leading cause of tooth loss – studies have suggested more than one in four (28%) post-menopausal women are likely to suffer from tooth loss within five years [3].

Your gums are more important than many people realise, and the health of your gums can influence your health elsewhere in the body. Gum disease is more common in women after the menopause and there is evidence it is linked to certain cancers, heart disease, stroke and diabetes.

Another issue is bone thinning. As with bones elsewhere in the body, the upper and lower jaw bone lose their bone mineral density (strength) and decrease in size. This bone shrinkage increases the risk of teeth becoming loose or, on occasions, falling out.

Dry mouth is also a common symptom, it’s experienced by a quarter of menopausal women [4]. This occurs when a lack of oestrogen and progesterone can reduce production of saliva from your salivary glands. As well as being uncomfortable, dryness can make your mouth more vulnerable to infection. As a result of the dryness, you may be more prone to tooth decay, especially if you use sugary sweets to suck on to alleviate the dryness.

Surprising oral health symptoms

Burning mouth syndrome (BMS) – a feeling of burning that may affect the tongue, gums, lips, inside of your cheeks, roof of your mouth or your whole mouth – is experienced by 15% of menopausal women [4]. Meanwhile, other women notice an alteration in their taste, especially with salty, peppery or sour foods.

RELATED: 10 surprising menopause symptoms

What else can causes symptoms?

Changes to your habits often prompted by the menopause can have an adverse effect on your teeth and oral health. It is common to crave more sugary foods, and increase your alcohol intake or smoking due to stress, anxiety or feeling low. These habits can cause dental problems like cavities, or infections. If you have anxiety, you may start grinding your teeth at night too.

What can I do?

Taking care of your mouth and teeth is even more important around the time of the menopause. This is the best way to prevent many oral health problems developing.

Reducing the amount of plaque bacteria in your mouth is the key to protecting your oral health during this time. The role of your oral home care is of paramount importance to prevent gingivitis and periodontitis, but it requires training and instruction from your dental team. Effective, daily removal of plaque by patients themselves can be considered more important than removal of plaque by the dental team during scaling and polishing.

‘One thing I always go over when I meet a new patient is how to brush their teeth,’ says Dr Shabnam. ‘Many people brush twice a day, yet have so much plaque in their mouth because of brushing with the incorrect technique. Small modifications to their technique can make significant improvements – within days their mouth feels so much fresher and lighter, and any bleeding can almost entirely stop. They sometimes cannot believe it was so easy!’

Minimising the amount of sugary food and drink you consume will reduce your risk of dental decay. It is advised that you visit your dentist and hygienist as often as the team deem necessary. Work with your dentist to design a plan that fits your situation with regards to frequency of dental visits and the products you use with your oral care.

Can HRT help?

The most effective treatment for the menopause is hormone replacement therapy (HRT) which simply replaces – or tops up – the hormones your body is no longer producing in enough quantities.
Transdermal (through the skin) oestrogen and micronised progesterone – known as ‘body identical’ HRT – is the ‘gold standard’ type of HRT and is also safe for women who have migraine, have a history of a clot or stroke, and for most women who have had cancer or have a family history of cancer.

One study found that HRT was associated with a lower risk of periodontal disease [5]. ‘This is a multifactorial disease,’ says Dr Shabnam, ‘but HRT may lessen some of the psychological symptoms as well as balance hormones, which in turn can improve oral symptoms. Still, I cannot emphasis enough the importance of good maintenance at home.’

Resources

Dentist Dr Shabnam Zai is clinical director at West House Dental, westhousedental.com. Follow her on Instagram @drshabnamzai

References

1. Delta Dental Breaking the Stigma: Let’s Talk about Menopause and Oral Health

2. Dutt P, Chaudhary S, Kumar P. (2013), ‘Oral health and menopause: a comprehensive review on current knowledge and associated dental management’, Ann Med Health Sci Res. Jul; 3(3):320-3. doi: 10.4103/2141-9248.117926

3. Bole C, Wactawski-Wende J, Hovey KM, Genco RJ, Hausmann E. Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study. Community Dent Oral Epidemiol. 2010 Dec;38(6):487-97. doi: 10.1111/j.1600-0528.2010.00555. 

4. Dutt P, Chaudhary S, Kumar P. (2013), ‘Oral health and menopause: a comprehensive review on current knowledge and associated dental management’, Ann Med Health Sci Res. Jul; 3(3):320-3. doi: 10.4103/2141-9248.117926

5. Lee, Y., Kim, I., Song, J. et al. The relationship between hormone replacement therapy and periodontal disease in postmenopausal women: a cross-sectional study the Korea National Health and Nutrition Examination Survey from 2007 to 2012. BMC Oral Health 19, 151 (2019). https://doi.org/10.1186/s12903-019-0839-9