Experiencing problems with your teeth or gums? Discover how your hormones can play a part in these surprising symptoms
• Oral health issues – from dry mouth to sensitive gums – are common during perimenopause and menopause
• Changing progesterone, estradiol and testosterone levels and lifestyle changes can have an impact
• Effective brushing and HRT can help alleviate symptoms
You probably know that perimenopause and 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 more than 84% were unaware that some of the oral health symptoms and discomfort they experienced could be linked to 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 perimenopause and menopause and being aware of any changes you might experience can best help you determine how to deal with them.
Why do perimenopause and menopause affect my mouth?
Most diseases in the mouth are multifactorial, so a combination of factors can trigger or exacerbate symptoms. During perimenopause and menopause, a drop in estradiol (estrogen) and progesterone levels can make your gums more sensitive, trigger dry mouth and cause burning mouth syndrome [2]. Lower testosterone levels can also affect your mouth.
Hormonal changes can impact your oral microbiome, and can create conditions that favour the growth of certain types of bacteria over others [3]. This is important because your oral microbiome can impact your overall health and has been linked to inflammation-related conditions such as Alzheimer’s.
Stress and anxiety, which you may be more prone to during perimenopause and menopause, have also been shown to influence and exacerbate oral health symptoms [4,5,6].
RELATED: Why am I so stressed?
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 your 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 data on oral health and menopause, the most common issue was those related to gums and connective tissues, which can experience significant change during perimenopause and menopause. Up to 60% of women experience these symptoms [7].
Pain and inflammation in your gums, known as gingivitis, can be a common occurrence when estrogen 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 your 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 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.’
Your 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. One study found that 28% of menopausal women lost a tooth within a period of five years, with gum disease, diabetes, smoking, BMI and plaque index being among the significant risk factors [8].
RELATED: Receding gums and menopause
Gums are more important than many people realise, and the health of your gums can influence your health elsewhere in your body. Gum disease is more common in women after 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 your body, your upper and lower jaw bones lose their bone mineral density (strength) and decrease in size. This bone shrinkage increases the risk of your teeth becoming loose or, on occasions, falling out.
Dry mouth is also a common symptom - it’s experienced by a quarter of menopausal women [9]. This occurs when a lack of estradiol , progesterone and testosterone 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.
RELATED: Dry mouth, hormones, perimenopause and menopause
Surprising oral health symptoms
Burning mouth syndrome (BMS) – a feeling of burning that may affect your tongue, gums, lips, inside of your cheeks, roof of your mouth or your whole mouth – is experienced by 15% of menopausal women [7].
Meanwhile, other women notice an alteration in their sense of taste, especially with salty, peppery or sour foods.
RELATED: Burning mouth syndrome and menopause
What else can cause oral symptoms?
Changes to your habits often prompted by perimenopause and 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 such as cavities, or infections. If you have anxiety, you may start grinding your teeth at night too.
What can I do?
Reducing the amount of plaque bacteria in your mouth is the key to protecting your oral health during perimenopause and menopause. Oral care at home is of paramount importance to prevent gingivitis and periodontitis. Effective, daily removal of plaque can be more important than removal of plaque by your 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 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.
RELATED: Healthy eating for perimenopause and menopause
Can HRT help oral health symptoms?
The most effective treatment for perimenopause and menopause symptoms is HRT, which replaces – or tops up – the hormones your body is no longer producing in enough quantities.
Transdermal (through the skin) estradiol (estrogen), progesterone and testosterone are known as ‘body identical’ or natural HRT. This is the gold standard type of hormones and are not associated with risks.
One study found that HRT can help restore salivary estradiol levels in menopausal women who are experiencing dry mouth [9] while another found that HRT was associated with a lower risk of periodontal disease [10]. ‘This is a multifactorial disease,’ says Dr Shabnam, ‘but HRT can balance hormones, which in turn can improve oral symptoms. Still, I cannot emphasis enough the importance of good maintenance at home.’
Dentist Dr Shabnam Zai is clinical director at West House Dental. Follow her on Instagram @drshabnamzai
