Hormone challenges to women’s oral health

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  Posted by: The Probe      20th January 2021

As with many other aspects of human health, men and women are distinctly different when it comes to their oral status. According to one study, women are far more likely to be proactive at maintaining their oral health – and for a good reason.[1] Without timely and preventive oral care, women are more vulnerable to developing oral health problems due to the unique hormonal changes that they experience throughout their lifetime.[2] In fact, hormones that fluctuate during puberty, menstruation, birth control usage, pregnancy and menopause can determine how the oral cavity reacts to the build-up of plaque, which is a major risk factor of oral diseases such as dental caries and periodontitis.[3]

The role of hormones

Hormones are molecules produced by the body and secreted directly into the blood, which carries the hormones to tissues and organs in order to exert various bodily functions. Men and women possess both “male” and “female” sex hormones but in different quantities. The two main female sex hormones are oestrogen and progesterone, although women also produce and require a small amount of the male sex hormone, testosterone.

Most oestrogen comes from the ovaries, whilst the rest comes from the adrenal glands and fat cells. The ovaries and adrenal glands also produce progesterone. Oestrogen plays an important role in the reproductive and sexual development of women, affecting many parts of the body, including the brain, skin, hair and urinary tract, as well as the cardiovascular and musculoskeletal systems. Progesterone is key to preparing the body for conception, regulating the monthly menstrual cycle, and maintaining pregnancy. These two powerful hormones can influence oral health by directly impacting the oral tissues, as well as a multitude of other bodily functions that can, in turn, affect the oral cavity.[4] 

Puberty

During puberty, there is a surge in the production of both oestrogen and progesterone in young girls, increasing blood circulation to the gingiva and making it more sensitive to irritants in the mouth, including food particles and plaque. The soft tissue can then become tender, swollen and more likely to bleed during toothbrushing and interdental cleaning.[5] This reaction occurs at a time when many adolescents tend to neglect their oral care and consume more sugary food and drinks, which can facilitate the build-up of plaque and the consequent development of caries and gingivitis.[6], [7]

Menstruation

Due to hormonal changes (particularly the increased production of progesterone) that occur during the menstrual cycle, women can develop swollen salivary glands and/or canker sores around the time of their period.[8] Some women may also experience signs and symptoms of menstruation gingivitis, which usually resolves on its own either when the period begins or by the time it ends.[9]

Birth control usage

Women who take certain oral contraceptives that contain a combination of hormones or progesterone alone may develop inflamed gingiva due to the body’s exaggerated reaction to plaque. The most significant changes in the oral tissues are experienced in the first few months after starting birth control pills.[10] However, the newest pills typically contain smaller quantities of hormones, thereby reducing the gingiva’s inflammatory response to irritants in the mouth.[11]

Pregnancy

Hormone levels fluctuate considerably over the course of pregnancy as the female body undergoes a drastic transformation. During this period, some women develop gingivitis, which is most common between the second and eighth month of pregnancy. As this condition can affect pregnancy outcomes, it is important that mothers-to-be are encouraged to maintain good oral hygiene and attend the dental practice regularly in order to minimise the risk of developing gingivitis.[12]

Menopause

The menopause is a natural part of aging that usually occurs in women between the age of 45 and 55, as their oestrogen levels decline.[13] At this stage in their life, many women experience oral health complications that can include altered taste, a burning sensation in the mouth, decreased salivary flow resulting in xerostomia, and greater sensitivity to hot and cold food and drinks. Xerostomia, in particular, can increase the risk of caries and periodontal disease. Hormone changes can also impact the bones and trigger the development of osteoporosis in the jaw, which can cause gingival recession and potentially lead to tooth loss.[14]

Prevention is key

Considering the numerous affects that hormones can have on the oral cavity, it is important that dental professionals actively promote effective oral hygiene among patients. Clinicians are likely to come across many female patients who are undergoing significant physical changes that can increase their susceptibility to oral diseases. In this case, dental teams can recommend the use of ‘Perio plus’ mouth rinses as a temporary yet effective adjunct to at-home oral care regimes that can minimise the risk of infection.

Hormonal fluctuations can ultimately have a profound impact on a woman’s body, emphasising the importance of providing appropriate support in optimising oral hygiene in order to protect the teeth and gingiva. Raising awareness and educating patients on the link between hormones and oral health is also essential in order to ensure they better understand and appreciate their role in disease prevention. 

 

For more information please call 01480 862084, email info@curaprox.co.uk or visit www.perioplus.com/uk

 

Author: Dawn Woodward National Sales manager Curaprox UK

 

[1] Furuta, M., Irie, K., Azuma, T., Tomofuji, T., Ogura, T. and Morita, M. (2011) Sex Differences in Gingivitis Relate to Interaction of Oral Health Behaviors in Young People. Journal of Periodontology. 82(4): 558–565. DOI: 10.1902/jop.2010.100444.

[2] McCann, A. L. and Bonci, L. (2001) Maintaining women’s oral health. Dental Clinics of North America. 45(3): 571–601. 45(3): 571–601.

[3] Jepsen, S. et al. (2017) Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. Journal of Clinical Periodontology. 44(Suppl 18): S85-S93. DOI: 10.1111/jcpe.12687.

[4] Nwadike, V. R. (2019) How Do Female Sex Hormones Affect Menstruation, Pregnancy, and Other Functions? Healthline. Available at: https://www.healthline.com/health/female-sex-hormones. [Last accessed: 08.10.20].

[5] Chaitra, T. R., Manuja, N., Sinha, A. A. and Kulkarni, A. U. (2012) Hormonal effect on gingiva: pubertal gingivitis. BMJ Case Reports. bcr2012006193. DOI: 10.1136/bcr.2012.006193.

[6] Moynihan, P. (2016) Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake. Adv Nutr. 7(1): 149–156. DOI: 10.3945/an.115.009365.

[7] Chesters, R. K., Huntington, E., Burchell, C. K. and Stephen, K. W. (1992) Effect of Oral Care Habits on Caries in Adolescents. Caries Research. 26(4): 299–304. DOI: 10.1159/000261456.

[8] Saluja, P., Shetty, V., Dave, A., Arora, M., Hans, V. and Madan, A. (2014) Comparative Evaluation of the Effect of Menstruation, Pregnancy and Menopause on Salivary Flow Rate, pH and Gustatory Function. J Clin Diagn Res. 8(10): ZC81–ZC85. DOI: 10.7860/JCDR/2014/9935.5071.

[9] Koreeda, N. et al. (2005) Periodic exacerbation of gingival inflammation during the menstrual cycle. Journal of Oral Science. 47(3): 159–164. DOI: 10.2334/josnusd.47.159.

[10] Ali, I., Patthi, B., Singla, A., Gupta, R., Dhama, K., Niraj, L. K., Kumar, J. K., & Prasad, M. (2016). Oral Health and Oral Contraceptive – Is it a Shadow behind Broad Day Light? A Systematic Review. J Clin Diagn Res. 10(11): ZE01–ZE06. DOI: 10.7860/JCDR/2016/19439.8790.

[11] Preshaw, P. M., Knutsen, M. A. and Mariotti, A. (2001) Experimental Gingivitis in Women Using Oral Contraceptives. Journal of Dental Research. 80(11): 2011–2015. DOI: 10.1177/00220345010800111201.

[12] Wu, M., Chen, S. W. and Jiang, S. Y. (2015) Relationship between gingival inflammation and pregnancy. Mediators of Inflammation. 623427. DOI: 10.1155/2015/623427.

[13] NHS. (2018) Overview: Menopause. Available at: https://www.nhs.uk/conditions/menopause/#:~:text=The%20menopause%20is%20a%20natural,a%20woman’s%20oestrogen%20levels%20decline. [Last accessed: 08.10.20].

[14] Grover, C. M., More, V. P., Singh, N. and Grover, S. (2014). Crosstalk between hormones and oral health in the mid-life of women: A comprehensive review. Journal of International Society of Preventive & Community Dentistry. 4(Suppl 1): S5–S10. DOI: 10.4103/2231-0762.144559.


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