How menopause may affect oral cavity-

Menopause is associated with a large number of symptoms ranging from physical to psychological. This article attempts to provide an insight into the multifarious oral manifestations at menopause along with the relevant prosthodontic implications. The slippers and newspaper lifestyle traditionally adopted by women of a certain age is normally attributed to the world of weariness and lethargy. However, symptoms as often cited as being hallmarks of female menopause are very often rendered a lukewarm reception. Menopause is associated with a multitude of specific and nonspecific symptoms, ranging from physical to psychological, which may not be understood by the health care provider.

How menopause may affect oral cavity

How menopause may affect oral cavity

How menopause may affect oral cavity

How menopause may affect oral cavity

Symptoms of the menopause. Oral discomfort is found in many menopausal women in addition to general climacteric complaints. After examining the titles and abstracts, How menopause may affect oral cavity Prostetute porn was finally reduced to 42 articles, and after compiling meenopause from each of them we added two further articles two case-control studydue to their relevance. Med Oral ;, Oral health in perimenopausal and early postmenopausal women from baseline to 2 years of follow-up with reference to hormone replacement therapy. Another recent study nay by Imirzalioglu evaluated the liaison between residual ridge resorption and radiomorphometric indices along with demographic factors. J Am Dent Assoc. Salivary cortisol levels in post-menopausal women with oral dryness were studied in details by Farzaneh, et al. Association of estrogen and vitamin D receptor gene afvect with tooth loss and oral bone loss in Japanese postmenopausal women. J Prosthet Dent.

Printed uniform tops for men. References

Indian Journal of Endocrinology and Metabolism16 4 The prevalence and severity of symptoms may not be proportional to the amount How menopause may affect oral cavity saliva secreted by the glands. They observed that the symptoms of pain and dryness of the mouth were associated with climacteric symptoms in general but the use of HRT did not prevent or improve the symptoms. Keeping this in mind, we thought to review the literature for different aspects of oral health in the postmenopausal women. The underlying etiology remains ambiguous with hormonal changes and small-fiber sensory neuropathy of the oral mucosa suggested as Feeding privacy poncho underlying causes. HRT may be advised for short term in cases of persistent symptoms. Find articles by Puneet Mutneja. How menopause may affect oral cavity history of systemic diseases and use of drugs should be elicited. Females have a lower level of dehydrogenase enzymes — Alcohol breaking enzyme. Expert Opin Pharmacother. KNOWLEDGE Oral health specialists and gynecologists should be aware of the problems associated with menopause and need to provide these women complete health package consisting of oral health care as an integral part. Osteoporosis and periodontal disease are best diagnosed early so that treatment can be started sooner and fractures and tooth loss can be prevented. Education level and dental hygiene college curricula influenced the scores.

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  • Different phases of a woman's life: Puberty, menses, pregnancy, and menopause have varied influence on her oral health.
  • Menopause can begin as early as the 40s, although the specific age that menopause happens will vary from woman to woman.

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Received: January 30, Published: May 31, DOI: Download PDF. The aim of this review paper is to identify the reflection of menopause on the oral region and the impact of these manifestations on clinical applications.

During menopause, ovarian function declines and the production of sex steroid hormones reduces significantly affecting the oral tissues and periodontal structures leading to osteoporosis, chronic inflammation of the gingiva, increased risk of tooth loss, concurrent periodontitis, oral discomfort, xerostomia, burning mouth syndrome and many other manifestations.

Hormonal Replacement Therapy is used to relieve the previously mentioned complications. The effects of HRT will be reviewed as well. Menopause is a normal physiologic event in women, in which there's a cessation of menses. It takes from five to ten years and terminates with a sharp decline in female hormone levels. The decrease of estrogen production in postmenopausal women leads to many physiological changes, like: hot flashes, sweating, osteoporosis, cardiovascular diseases, cognitive changes, urogenital infections, skin changes and vaginal dryness.

The fact that periodontal tissues are significantly influenced by sex steroid hormones relies on the increased incidence and severity of periodontal diseases during periods of hormone fluctuations, retention and metabolic conversion of sex steroid hormones and the presence of steroid hormone receptors in the periodontium.

The periodontal tissues are highly affected by the endocrine system where they are influenced by androgens, progestins and estrogens [1]. Estrone is also secreted by the ovaries. During menopause, ovarian function declines and the production of sex steroid hormones reduces significantly affecting the oral tissues and periodontal structures leading to increased susceptibility to chronic inflammation of the gingiva, and alveolar bone loss.

Many other oral changes occur during menopause period such as pain and burning in oral cavity, mucosal atrophy and oral dysesthesia. Post menopausal estrogen deficiency causes bone loss in the long bones and vertebrae. It was reported that this osteoporotic effect increases the probability of odontia by three times than in normal females as a result of alveolar bone resorption due to systemic osteoporosis.

The main two female hormones are estrogen and progesterone; both have a very important function in concern to the oral cavity. Estrogen was thought to have an effect only on the of reproductive tissue but it was found to have receptors in bone, endothelial cells, ligaments and gingival tissues, it was also discovered to have a reductive effect on the keratinized gingival tissue which will lead to reduced effectiveness of the oral epithelium as a barrier [1].

In case of post menopausal women secretion of both of these hormones is drastically reduced leading to oral symptoms in concern of their function. Postmenopausal women who undergo estrogen replacement therapy had less tooth and oral bone loss than postmenopausal women who are not undergoing hormone estrogen replacement therapy. Meisel et al. Diagnostic periodontal parameters, attachment loss, and number of teeth were determined. Urinary Excretion of collagen cross-links was measured, environmental and behavioral risk factors were assessed.

In postmenopausal women treated with estrogen, the number of teeth present was higher than in men of the same age, while in women not taking estrogen, the number of teeth was lower. The number of teeth was reduced by nearly one tooth with every child born.

By determination of excretion of collagen deoxypyridinoline cross-links as an indicator of osteoporosis, women had higher bone turnover rate, which is reduced by estrogen supplementation. In a comparison between men above 50 years of age, and postmenopausal women with and without HRT, it was found that only women who didn't take estrogen after menopause have fewer teeth than men. The use of hormonal therapy supplements reduced the urinary deoxypyridinoline excretion and the extent of attachment loss, thus associated with the increase in number of teeth [3].

Estrogen has been found to increase epithelial keratinization, stimulate fibroblast proliferation and the proliferation of basal epithelial cells with a specific basal membrane area of the gingiva, and thus increase the number of gingival epithelial cells.

Therefore postmenopausal women estrogen deficient might exhibit accordingly a decreased epithelial keratinization of marginal gingiva, and desquamation of gingival tissues as in benign mucous membrane pemphigoid and lichen planus where gingiva decreases in size and has a smooth surface with mottled appearance.

These observations are specifically reported in poor middle-aged women who would subsequently suffer from irregular or early ceased menopause [1]. According to the World Health Organization, Osteoporosis has two main categories, primary and secondary. Primary osteoporosis is further subdivided into three types.

As for the secondary osteoporosis causative factors or diseases can be acknowledged [5]. It is well-known that estrogen deficiency plays an important role in the etiology and pathophysiology of osteoporosis and bone loss by limiting the osteoblasts physiological activity compared to osteoclasts leading to increased level of resorption over restoration of bone.

It is possible to diagnose osteoporosis through mandibular radiomorphometric measurements in postmenopausal women. Vlasiadis et al. In this study authors relied on the fact that osteoporosis affects the craniofacial and oral structures in the same rate it affects the total body. Postmenopausal women lose their teeth after the age of Generalized bone loss due to osteoporosis makes the jaws susceptible to accelerated alveolar bone resorption.

Decreased mass and density of maxilla and mandible, in osteoporotic patients, might be accompanied with increased rate of bone loss in edentulous ridges or around the tooth.

Alekna et al. There wasn't a significant difference between the total height of mandibular body, the height from the lower border of mandible to the lower border of mental foramen, and the mandibular ratio indices in bone mineral density groups. Index of mandibular ratio correlated with the total height of mandibular body and the height from the lower border of mandible to the lower border of mental foramen [7].

Klemetti et al. Binte et al. Time of teeth loss and the number of teeth were not correlated with generalized density, while clinical height was related to bone density in some regions [9]. Several studies had shown that estrogen promotes tooth retention. There was significant difference between users and nonusers in number of total and anterior teeth, oral bone height and porosity, bone mineral density of lumbar spine and femoral neck.

Multiple regression analysis showed that the duration of estrogen use was significantly associated with the number of total and posterior remaining teeth, independent of age and oral bone height.

Tooth retention could be promoted by estrogen, through neither strengthening periodontal attachment, but not increasing bone height nor decreasing oral bone porosity. On the other hand during menopause estrogen levels decrease which induces osteoporosis. This suggests that long-term estrogen replacement therapy prevents tooth loss in post- menopausal women [10]. It's defined as an inflammatory disease of specific bacteria origin that will influence the supporting structures of the teeth.

The two main dental issues that are related to osteoporosis in post menopausal women, relationship between progress of periodontal disease and progress of osteoporosis and the success of implants in post menopausal women.

Recent studies suggest that postmenopausal osteoporosis is a risk indicator in periodontal disease in postmenopausal white women [11]. Osteoporosis is a concern in the field of removable prosthodontics, especially in the conditions affecting the mandibular residual ridge.

Because successful dental implants depend only on sufficient bone density and volume, it might be of good benefit to osteoporotic patients, but it should follow bone regeneration therapy.

In cases where there is postmenopausal women with osteoporosis, dental implant are suppose to have a higher risk of failure due to the assumption that the impaired bone metabolism affects the mandible and the maxilla in a similar manner as the other bones. Beikler at al. Therefore mandibular implants have a higher success rate than the maxilla which consists mainly of trabecular bone [13].

Dao et al. Saliva has a very important role in protecting the oral cavity; this is accomplished by the salivary pH, buffering capacity BC and flow rate. Individuals who suffer from low salivary flow rates have higher caries experience in comparison with individuals with normal salivary flow rate.

Dural et al. The two groups were assisted for saliva flow rate, buffering capacity, pH of stimulated saliva and oral hygiene instruction. Also the postmenopausal group had a significantly high DMFT values in comparison with the control group.

Also, xerostomia is a subjective sensation accompanied by unpleasant sensation in throat and mouth [15]. Hosseini et al. This study showed that there is no significant difference between menopausal women with and without xerostomia in stimulated salivary flow rate. Oral dryness may not be related to lowered salivary flow rate, but there might be a relationship between calcium levels in saliva and oral dryness in menopausal women [16].

It was demonstrated that Hormonal Replacement Therapy decreases the extent of menopause-associated mandibular alveolar bone loss and sometimes lead to an increase in bone mineral density according to the hormone dosage received [1]. Postmenopausal women who are receiving HRT are less likely to lose teeth or need dentures due to improvement of bone production.

Beikler et al. The oral status of non menopausal women was better than the women in menopause. Decrease in estrogen levels that occurs in menopause, might cause an increase in salivary calcium levels [16]. In , Bullon et al stated that for all post-menopausal women, thorough clinciacal inverstigation followed by detailed oral examination is essential this includes the periodontal and dental status, and salivary flow for both quantity and quality.

The use of toothpastes, varnishes or gels containing fluorides is also advised for the prevention of dental caries. In conclusion, menopause has been proven that it highly affects oral and dental structures.

Gingival tissues exhibit decreased epithelial keratinization of marginal gingiva and desquamation of gingival tissues. Postmenopausal women were found to have a higher risk of developing osteoporosis which is thought to be the main cause of a lot of oral complications such as periodontal diseases and limitations of dental treatments like dental implants.

According to some studies, there has been significant relationship between osteoporosis and periodontitis. As for dental implants, studies showed that implants in the mandible have higher successful rate than in the maxilla due to bone type differences. Also, the bone repair process in postmenopausal osteoporotic patients is not susceptible to endocrine regulation; therefore, implants can be placed in those patients and could have good prognosis taking into consideration individual evaluation.

As for saliva, flow rate is decreased initiating state of xerostomia, oral discomfort and burning mouth syndrome. The pH level is decreased as well causing higher DMFT scores although the buffering capacity is not affected.

Hormonal Replacement Therapy improves the oral manifestations except buffering capacity and flow rate of saliva. However, long-term use of HRT is contraindicated as it is associated with the increased risk of breast cancer. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.

Withdrawal Policies Publication Ethics. Journal of. Review Article Volume 7 Issue 4. Go to Article Title Abstract Conclusion References. The role of female hormones The main two female hormones are estrogen and progesterone; both have a very important function in concern to the oral cavity. Effects on gingival tissues Estrogen has been found to increase epithelial keratinization, stimulate fibroblast proliferation and the proliferation of basal epithelial cells with a specific basal membrane area of the gingiva, and thus increase the number of gingival epithelial cells.

Menopause and saliva Saliva has a very important role in protecting the oral cavity; this is accomplished by the salivary pH, buffering capacity BC and flow rate.

Minor gland and whole saliva in postmenopausal women using a low potency oestrogen oestriol Arch Oral Biol. J Midlife Health. Arch Oral Biol. The patients also filled in a structured questionnaire on their systemic health, medication, and health habits. Several studies have found a possible relationship between the bone density in the jaw and the density in the rest of the skeleton. Eating disorders psychological distress in menopausal women may lead to eating disorders. This article is thus an attempt to improve the health of postmenopausal women by improving interspecialty understanding and collaboration.

How menopause may affect oral cavity

How menopause may affect oral cavity

How menopause may affect oral cavity

How menopause may affect oral cavity

How menopause may affect oral cavity. Factors that affect the age at Onset of Menopause

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The menopause is physiological changes in women that give rise to adaptive changes at both systemic and oral level. As we all begin to reach an older age, dental health and hygiene becomes a major concern. The dentist is often the first person to appreciate numerous changes that are experienced throughout the body during menopause. The teeth and gums are extremely susceptible to any hormonal changes that take place just before menopause and readily decrease body's ability to fight off minor infections or maintain a healthy balance of useful and harmful bacteria within the oral environment.

This review aimed to develop better understanding for major oro-dental complications observed in women during menopause, and schematic approach towards the different dental management protocols used during these periods. Though, the usage of hormone replacement therapy is effective but it does not necessarily prevent or help women with oral symptoms.

Natural menopause is defined as a spontaneous cessation of natural menstruation for 12 consecutive months at years of age mean Other unpleasant symptoms associated to menopause are managed with hormone therapy HT. In the third millennium, HT is extensively used to alleviate menopause related oral symptoms for the well-being of the women treated. Oral discomfort is found in many menopausal women in addition to general climacteric complaints.

The principal pre- and post-menopausal oral symptoms are dry mouth, sensation of painful mouth PM due to various causes and less frequently burning mouth syndrome BMS. Painful oral symptoms have been frequently associated with reduced salivary flow rate that may be further aggravated in presence of removable partial dentures. Other potential complications of dry mouth are mandibular dysfunction, diffuse gingival atrophy or oral ulcerations, oral candidiasis, pernicious anemia, etc.

BMS is one of the major complications seen in menopausal and post-menopausal women. It is a chronic condition characterized by a burning sensation of the oral mucosa, with or without dysgeusia the distortion of the sense of taste and xerostomia, in the setting of no identifiable clinical lesions, laboratory abnormalities, or causative systemic disease.

The affected individual usually complains of moderate to severe, bilateral burning or cutting sensation of the tongue, lips or other oral mucosal surfaces.

The salivary composition is not seems to be affected and altered in variety of oral and maxillofacial pathologies. However there are sufficient data available in the literature to show changed saliva compositions in menopause state including the changes in salivary proteins and calcium concentration.

In this review, authors has attempted to seek major oro-dental complications, practical guidelines and management approaches for women and their physicians in menopause-related oral health problems. The search was limited to reviews, meta-analyses and clinical guides in dental journals published over the last 30 years in English and Spanish.

A total of articles were identified. After examining the titles and abstracts, this number was finally reduced to 42 articles, and after compiling information from each of them we added two further articles two case-control study , due to their relevance. Thus, a total of 44 publications were finally considered to assess clinical as well as follow-ups following management.

The promptly fluctuating hormonal levels in menopausal women are the key factors that are answerable to the alterations detected within the oral cavity. Endocrinal alteration induced bone resorption appears to be the principle pathogenic mechanism underlying accelerated bone loss in postmenopausal women with no direct relationship between the two phenomena. The role of HT in ameliorating oral symptoms is still controversial. BMS, also known as glossodynia or stomatodynia, mainly affects women in the fourth or fifth decade of life.

It is often bilateral, and is characterized by the absence of pathological findings. The accompanying symptoms may include dry mouth sensation or alterations in taste sensation.

It has been suggested that female sex hormones and neuropathic factors may be implicated, possibly through small-fiber sensory neuropathy of the mucosa oral. Normal clinical tests and explorations distinguish primary BMS from secondary stomatodynia.

Treatment consists of low-dose topical without swallowing or systemic clonazepam. Hypo salivation associated subjective oral dryness or Xerostomia is another common manifestation in post-menopausal women. The patients typically report a decrease in salivary flow, despite the fact that in only one-third of all cases hyposialia actually present. In some cases, sialogogues such as pilocarpine may be indicated.

Additionally, HT seemed to have no effect on the amount of the total salivary bacteria in either peri-menopausal or post-menopausal women. Thus, salivary progesterone level appears associated with oral dryness feeling in menopause.

Salivary cortisol levels in post-menopausal women with oral dryness were studied in details by Farzaneh, et al. For all post-menopausal women, full clinical history should be compiled followed by thorough intraoral examination, together with complete evaluation of the mucosal membranes, the periodontal and dental conditions, and salivary flow for both quantity and quality.

The significant confirmatory tests X-rays, periodontal probing, sialometry must also be performed wherever needed. In post-menopausal women, alterations of the oral cavity are related to the hormone alterations that characterize these patients and to physiological aging of the oral tissues, potentially giving rise to periodontitis, BMS and xerostomia. Today the standard of dental treatment allows people to retain their own teeth but it seems that many periodontal problems still occur.

Interestingly, as shown in this review, the relative occurrence of PM seemed to be associated with climacteric symptoms in general, but the use of HT did not reduce the prevalence of oral symptoms. It seems that the effect of HT is highly individual so that some women with menopause-related symptoms benefit from HT while others do not. However, so far there are no randomized controlled studies to answer these questions. Therefore, further studies with longer follow-up time are needed to evaluate and authenticate the effect of HT on oral health parameters.

Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Ann Med Health Sci Res. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract The menopause is physiological changes in women that give rise to adaptive changes at both systemic and oral level. Introduction Natural menopause is defined as a spontaneous cessation of natural menstruation for 12 consecutive months at years of age mean Oral Alterations During Menopause The promptly fluctuating hormonal levels in menopausal women are the key factors that are answerable to the alterations detected within the oral cavity.

Periodontal health and menopause Endocrinal alteration induced bone resorption appears to be the principle pathogenic mechanism underlying accelerated bone loss in postmenopausal women with no direct relationship between the two phenomena.

BMS BMS, also known as glossodynia or stomatodynia, mainly affects women in the fourth or fifth decade of life. Saliva and menopause Hypo salivation associated subjective oral dryness or Xerostomia is another common manifestation in post-menopausal women. Oral Health and Dental Management in Menopause; the Right Way to Approach For all post-menopausal women, full clinical history should be compiled followed by thorough intraoral examination, together with complete evaluation of the mucosal membranes, the periodontal and dental conditions, and salivary flow for both quantity and quality.

Conclusion In post-menopausal women, alterations of the oral cavity are related to the hormone alterations that characterize these patients and to physiological aging of the oral tissues, potentially giving rise to periodontitis, BMS and xerostomia.

Footnotes Source of Support: Nil. References 1. The normal menopause transition. Guideline on oral health care for the pregnant adolescent. Pediatr Dent. Suresh L, Radfar L. Pregnancy and lactation. Turner M, Aziz SR. Management of the pregnant oral and maxillofacial surgery patient. J Oral Maxillofac Surg. Efficacy of hormone replacement therapy in postmenopausal women with oral discomfort. Oral discomfort at menopause.

Laine MA. Effect of pregnancy on periodontal and dental health. Acta Odontol Scand. Vitamin status of patients with burning mouth syndrome and the response to replacement therapy.

Br Dent J. Prospective study of aetiological factors in burning mouth syndrome. Prevalence of perceived symptoms of dry mouth in an adult Swedish population: Relation to age, sex and pharmacotherapy.

Community Dent Oral Epidemiol. Nederfors T. Xerostomia and hyposalivation. Adv Dent Res. Salivary flow rate and clinical characteristics of patients with xerostomia according to its aetiology. J Oral Rehabil. An assessment of salivary function in healthy premenopausal and postmenopausal females. J Gerontol. How much saliva is enough? J Am Dent Assoc. Stimulated whole salivary flow rate and composition in menopausal women with oral dryness feeling.

Oral Dis. Osteocalcin in serum, saliva and gingival crevicular fluid: Their relation with periodontal treatment outcome in postmenopausal women. Relationship of stimulated saliva 17beta-estradiol and oral dryness feeling in menopause. Osteoporosis and periodontal disease progression.

Periodontol Women's health issues and their relationship to periodontitis.

How menopause may affect oral cavity

How menopause may affect oral cavity