Women have an increased sensitivity to oral health problems because of the unique hormonal changes they experience. These hormonal changes not only affect the blood supply to the gum tissue, but also the body’s response to the toxins (poisons) that result from plaque build up. As a result of these changes, women are more prone to the development of periodontal disease at certain stages of their lives, as well as to other oral health problems.
At what stages in a woman’s life is she more susceptible to periodontal disease and other oral health problems?
There are five stages in a women’s life during which changes in hormone levels make them more susceptible to oral health problems – puberty, the monthly menstruation cycle, when using oral contraceptives, during pregnancy, and at menopause.
Puberty — The surge in production of the female hormones estrogen and progesterone that occurs during puberty can increase the blood flow to the gums and change the way gum tissue reacts to bacterial plaque. This causes the gum tissue to become red, tender, and swollen, and more likely to bleed during brushing and flossing.
The monthly menstruation cycle — Due to the hormonal changes (particularly the increase in progesterone) that occur during the menstrual cycle, some women experience oral changes that can include bright red swollen gums, swollen salivary glands, development of canker sores, or bleeding gums. Menstruation gingivitis usually occurs a day or two before the start of the period and clears up shortly after the period has started.
Use of oral contraceptives (birth control pills) — Women who take certain oral contraceptives that contain progesterone might experience inflamed gum tissues due to the body’s exaggerated reaction to the toxins produced from plaque. The most profound changes in the gums are seen in the first few months after starting the birth control pills. Newer birth control pills, however, have lower concentrations of the hormones, which lessens the inflammatory response of the gums to dental plaque.
There is another reason for telling your dentist if you are taking oral contraceptives. Certain medicines, such as antibiotics, that your dentist might prescribe can lower the effectiveness of oral contraceptives. Always tell your dentist the names and dosages of all the medicines you are taking. He or she needs to know this information when planning your course of treatment, especially if prescribing medicines is a part of your care.
Hormone connection to TMJ — Researchers have evidence that the use of synthetic estrogens (birth control pills) can lead to decreased levels of natural estrogen. Decreased levels of natural estrogen are associated with another oral disorder, one affecting the temporomandibular joint (TMJ).
The temporomandibular joint connects your jaw to the side of your head. Temporomandibular disorders result from problems with the jaw, jaw joint, and surrounding muscles that control chewing and moving the jaw.
Because more women than men experience temporomandibular disorders, researchers thought there might be a hormone-related connection to this disorder. According to recently published research, this connection between birth control pills, decreased natural estrogen and TMJ appears to be true. Changes in the bones of this joint have been seen. Also, the combined effect of the compression within the joint caused by TMJ disorders and low levels of natural estrogen can lead to increased inflammation. In some individuals, this inflammation can result in osteoarthritis in the joint.
Always tell your dentist the names and dosages of all the medicines you are taking. He or she needs to know this information when planning your course of treatment, especially if prescribing medicines is a part of your care.
Pregnancy — Hormone levels change considerably during pregnancy. An increased level of progesterone in particular can increase your susceptibility to bacterial plaque causing gingivitis which is most noticeable during the second to eighth month of pregnancy. This condition is called pregnancy gingivitis where the gums become swollen and bleed easily. Your dentist might recommend more frequent professional cleanings during your second or early third trimester to help reduce the chance of developing gingivitis.
Menopause — Numerous oral changes can occur as a consequence of advanced age, the medicines taken to combat diseases, and hormonal changes due to menopause. These oral changes can include altered taste, a burning sensation in the mouth, and greater sensitivity to hot and cold foods and beverages, and decreased salivary flow that can result in dry mouth.
Dry mouth, in turn, can result in the development of periodontal disease because saliva is not available to moisten and cleanse the mouth by neutralizing acids produced by plaque. Dry mouth can also result from many prescription and over-the-counter medicines that are commonly prescribed to older adults.
The decline in estrogen that occurs with menopause also puts women at greater risk for bone loss or osteoporosis and inflammation of the tissues surrounding the teeth (called periodontitis). Loss of bone, specifically in the jaw, can lead to tooth loss. Receding gums can be a sign of bone loss in the jawbone and also expose more of the tooth surface to potential tooth decay.
Hormone therapy may play a role in preserving dental health in postmenopausal women. Estrogen therapy prevents bone loss in both the skeletal bones and the jawbones. This suggests that hormone therapy protects against tooth loss in postmenopausal women.
What can I do to prevent the development of periodontal disease?
Following these tips will help:
- Brush your teeth at least twice a day with a toothpaste containing fluoride. Floss at least once a day.
- Visit your dentist twice a year for a professional oral examination and cleaning.
- Eat a well-balanced diet.
- Avoid sugary or starchy snacks.
- Ask your dentist if he or she thinks you should use an antimicrobial mouth rinse.
- If you have dry mouth, ask your dentist about treatments for this condition, such as artificial saliva.
- American Dental Association. Women’s Oral Health Issues How menopause affects oral health, and what we can do about it Cleveland Clinic Journal of Medicine August 2009 vol. 76 8 467-475.
- Wadhwa Sunil, Kapila Sunil. TMJ Disorders: Future Innovations in Diagnostics and Therapeutics. Journal of Dental Education 2008;72(8):8 930-947.
- Pontual ML dos Anjos, Freire JSL, et al. Evaluation of bone changes in the temporomandibular joint using cone beam CT. Dentomaxillofacial Radiology. 2012;41(1):24–29.
- Gunson MJ, Arnett GW, Milan S. Pathophysiology and Pharmacologic Control of Osseous Mandibular Condylar Resorption. Journal of Oral and Maxillofacial Surgery. 2012 Aug;70(8):1918-34.
- Gunson, MJ, Arnett GW, et al. American Journal of Orthodontics and Dentofacial Orthopedics. Oral contraceptive pill use and abnormal menstrual cycles in women with severe condylar resorption: A case for low serum 17β-estradiol as a major factor in progressive condylar resorption. American Journal of Orthodontics and Dentofacial Orthopedics, 2009 Dec;136(6):772-9
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/10/2014...#11192