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MENOPAUSE AND DENTAL HEALTH

Menopause Defined Benefits of Visit to Dentist
Physiological Changes Menopause Health Updates
What you Dentist Can Do


      Approximately 36 million women in the United States are in the postmenopausal phase of life. The vast majority of these women experienced spontaneous cessation of menses between the ages of 47 and 55 years when the production of estrogen decreased because of an inadequate number of functioning follicles within their ovaries.

     Fewer women entered menopause after surgical removal of both ovaries.
This procedure usually is performed preventively to prevent ovarian cancer in conjunction with a hysterectomy, which is required to treat abnormal bleeding, endometriosis or pelvic inflammatory disease.

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Changes in hormones can affect a woman's oral health

     The physiological changes associated with spontaneous or surgical menopause cause some women to experience uncomfortable symptoms such as hot flashes, night sweats and vaginal dryness. In addition, estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of:

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developing cardiovascular disease ( myocardial infarct, stroke)

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osteoporosis

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Alzheimer's disease 

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oral disease. 

      Hormone replacement therapy, or HRT (estrogen or estrogen and progestin), often is prescribed on a short-term basis to alleviate the
uncomfortable symptoms associated with estrogen deficiency and on a
long-term basis to prevent some of the chronic illnesses common to
postmenopausal women.

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     Your dentist  needs to consider this stressful phase of life that you may be experiencing.  He may look for the following postmenopausal problems at your dental examination which may include:
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decrease in saliva flow

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increased dental caries

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dysesthesia

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taste alterations

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gingivitis

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periodontal disease -at least 23 percent of women ages 30-54 have periodontitis and 44 percent of women ages 55-90 who still have their teeth have periodontitis.  

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osteoporotic jaws unsuitable for conventional prosthetic devices
or dental implants

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Panoramic dental radiographs may reveal calcified carotid artery atheromas.

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      Your dentist thus have an opportunity to refer women who are not under the care of a gynecologist for an evaluation to determine the appropriateness of HRT for its systemic and oral health benefits * because estrogen supplements may offer:

  1. gum tissue benefits

  2. helps relieve the above symptoms 

  3. help prevent against osteoporosis

  4. protect against losing your teeth.

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Women of all ages deserve a beauitfull smile.
You are never to old to have a beautiful smile through Invisalign

Menopause Dental UPDATE:  

Periodontal Disease and the Incidence of Tooth Loss in Postmenopausal Women

The study population included 106 dentate white postmenopausal women who participated in a cross-sectional study between 1989 and 1991 who were willing and eligible to have a repeat examination after 10 to 13 years. At baseline, full-mouth assessment of periodontal status was performed clinically and radiographically. Assessment of tooth loss during follow- up was assessed clinically by a periodontist. Odds ratio (OR) and its 95% confidence interval (CI) for each periodontal variable was obtained from separate multiple ;ogistic regression analyses adjusting for the effect of age, household income, smoking, hormone therapy, snack consumption, and number of decayed teeth.
Periodontal disease, especially measured by alveolar bone loss, is a strong and independent predictor for incident tooth loss in postmenopausal women.
Journal of Periodontology 2005, Vol. 76, No. 7,  Dr. Mine Tezal et al.J Periodontol 2005;76:1123-1128.

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Effect of Alendronate on Periodontal Disease in Postmenopausal Women:

We investigated the effect of oral alendronate (ALN) treatment on radiological and clinical measurements of periodontaldisease in postmenopausal women without hormone replacement therapy.
ALN treatment improved periodontal disease and bone turnover in postmenopausal women.
 J Periodontol 2004; 75:1579-1585.Journal of Periodontology 2004, Vol. 75, No. 12, Pages 1579-1585
 

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Ladies Home Journal states: "Japanese researchers found that an X-ray known as a panoramic  radiograph detected signs of osteoporosis up to 87% of the time in  post menopausal women. 'What affects the quality of bone in the spine also affects the quality of bone in the rest of the body, including the jaw.'  "

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Oral Cancer Increasing In USA Oral cancer is on the increase among women over 40 because the numbers who smoke has increased. There is some evidence to suggest that tongue cancer among males under 40 could also be increasing. Early detection is key.  According to the American Cancer Society, oral cancer occurs almost as frequently as leukaemia and claims almost as many lives as melanoma cancer. The stage of an oral cancer diagnosis is critical. When detected at its earliest stage, oral cancer is more easily treated and cured. When detected late, its five-year survival rate is about 50 percent. Testing is painless and there is no question that early detection saves lives.

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HRT Toothpaste, Taste of Things to Come? 

Women seeking to counter the effects of the menopause may soon be able to do it simply by brushing their teeth: American scientists have developed a toothpaste that provides hormone replacement therapy (HRT). The toothpaste, which also works perfectly for dental hygiene, will offer an easily remembered alternative for women suffering the hot flushes, flagging libido and sleeplessness that often accompany the menopause. Research at the University of Texas Medical School in Houston has shown that controlled, long-lasting doses of the female hormone oestrogen can be administered effectively in this way. Although further trials are still required, the HRT toothpaste could reach the market within five years. British Dental Association Dec 02 

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Osteoporosis: The periodontal connection 

Researchers may soon be able to harness the information gathered in dental exams for use as an early warning of osteoporosis.  Risk factors for developing osteoporosis parallel those for periodontitis: smoking, daily alcohol consumption, family history, lifelong low calcium intake, and advancing age.  The osteoporosis/periodontitis link, one thing that has come out of current research is the idea that a routine dental X-ray may someday be a recognized screening tool for osteoporosis risk. 

It may be possible, say the researchers, to harness the information gathered in dental exams for use as an early warning of osteoporosis. Adequate calcium and estrogen levels, long recognized as important components in the prevention of osteoporosis, are also being studied as they relate to periodontal disease. Research has found that people with inadequate calcium intake - fewer than 500 mg. daily - suffer from periodontal disease nearly twice as often as those who get enough calcium. The American Dental Association states that estrogen replacement therapy appears to reduce the risk of tooth loss in post-menopausal women.

 One surprising discovery is that sodium fluoride, long recognized for building strong teeth, can be a powerful weapon in the fight against osteoporosis. All current studies seem to clearly point to one idea: Dental health is not independent of total body health, but fully involved with it. There are some preventive dietary measures people can take to reduce the risk of osteoporosis - adequate calcium, Vitamin D, and hormone replacement therapy at the time of menopause. We know they work for osteoporosis. There is a biological link (to oral health), so these preventive measures might also have a role in reducing periodontitis. Cathy Hester-Seckman, RDH, is a frequent contributor to RDH magazine based in Calcutta, Ohio. RDH, July 2002 issue.

Update: Nutrition and Osteoporosis PowerPoint presentation. 6/06

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Estrogen, Calcium & Vit D may prevent tooth loss 

  Researchers have discovered a possible added benefit of hormone replacement therapy: saving teeth. Postmenopausal women who took a daily dose of estrogen along with calcium, vitamin D and regular dental check-ups improved the condition of their jaw, which could potentially reduce the risk of tooth loss. Women who had regular check-ups but took only calcium and vitamin D also improved jaw mass and density, though to a significantly lesser extent than those who received estrogen. This is the first prospective, controlled study aimed at determining the effects of estrogen on the jaw. 

"Tooth loss is fairly prevalent in the aging population, particularly in people over 65, about 40 percent of whom have lost all their teeth,". "The risk is higher for women aged 65 or older, and continues to increase the longer a women has been postmenopausal.  Estrogen already has been shown to help reverse the effects of osteoporosis and to improve bone density in postmenopausal women

Women who received hormone replacement therapy had a significantly greater increase in alveolar bone mass compared with those who took the placebo. The effects of estrogen on jawbone density seems to reflect an overall effect on the skeleton, since improvements in the facial bones of women on estrogen correlated with increases in the lumbar spine and femur. "This means that perhaps you can prevent bone erosion in the jaw with calcium and vitamin D, but those supplements are not sufficient to restore bone loss," says Civitelli. "However, estrogen does appear to restore bone throughout the body."

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Estrogen for women's bones may also lessen tooth loss: Estrogen hormone helps keep teeth.  A substantial portion of the elderly gradually lose their natural teeth and women are particularly vulnerable, with many cases thought to be associated with bone loss in the jaw, or alveolar, bone that surrounds the teeth. Roughly 40 percent of American women over age 65 do not have any of their natural teeth, and many suffer from gum disease. Just as estrogen has been shown to strengthen skeletal bones susceptible to osteoporosis, it has a similar impact on the alveolar bone and potentially prevents tooth loss Those who received the hormone replacement therapy had an average 3.6 percent gain in bone density in their femur, the leg bone joined to the hip, compared to an 0.2 percent bone density improvement in those taking the placebo. In tests of the alveolar bone, density improved an average of 1.8 percent among those taking estrogen, and 1 percent among those taking a placebo. This means that perhaps you can prevent bone erosion in the jaw with calcium and vitamin D, but those supplements are not sufficient to restore bone loss, however, estrogen does appear to restore bone throughout the body.
Study author Dr. Roberto Civitelli, a professor of medicine, cell biology and physiology.

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Perio, Periods and progesterone

A woman's hormones may cause the gum tissues to a target organ for estrogen and progesterone. In the presence of plaque-induced inflammation (swollen gums) these hormones can cause gum disease.  These fluctuations
in a woman's hormones she may cause her to develop special oral health needs that differ from those of men.

The combined oral-contraceptive pill can cause changes to the gum tissues. The two sex hormones found in the pill cause an increase in gum tissue exudate, and gingivitis. Also the hormone progesterone can produce tissue breakdown causing significant tooth loss.

Women taking hormone-replacement therapy (HRT) may also experience a generalized gingivitis, although oestrogen supplementation alone has anti-inflammatory effects. HRT protects against tooth loss and reduces the risk of tooth loss and also increases jaw bone density levels.  

Smokers with osteoporosis are more likely to loose their teeth post menopausally than non-smokers. The burning-mouth syndrome and changes in taste sensation that commonly coincide with the menopause cannot be attributed directly to hormonal deficiencies.

Gender equality does not extend to the oral mucosa. Teeth and the mouth are not a gender-free zone so we give women  an extra dose of TLC and oral hygiene instruction at certain stages in their hormonal cycles.
Caroline Pankhurst 


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Bone of Contention
If you're taking a vitamin A supplement, you may be putting your bones at risk.

A recent study revealed that postmenopausal women who regularly took
a vitamin A supplement were 40% more likey to suffer a hip fracture compared to women who did not take a vitamin A supplement. For proper amounts of vitamin A, eat beta carotene-rich foods or take a daily multivitamin with less than 8,000 IU of vitamin A.

RealAge Cost: Taking unnecessary vitamins and supplements can make your RealAge as much as 1.7 years older.
January 2002

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*Physiology, Medical Management and Oral Implications of Menopause; The Physiology, Medical Management and Oral Implications of Menopause
Friedlander A.H., JADA 133(1):January 2002:73-81
Women and Heart Disease.
American Heart Association on Women and Heart Disease or Simple Solutions
Women's Heart Organization.                

February 06, 2008

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PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
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