Written by: Jacqueline Plemons DDS, MS (Dallas County Dental Society Member)
Women face unique challenges in maintaining good oral health over their lifetime, in part because they ARE women. As early as puberty, increased hormone levels of progesterone, and to a lesser extent estrogen, result in changes in periodontal health. The gingiva becomes swollen, erythematous and bleeds easily. Similar changes are reported by some women during menstruation, with use of birth control pills, and during pregnancy. Menopause poses its own set of challenges as women experience a slow but steady decrease in levels of estrogen, progesterone and testosterone. Clinical changes during menopause include a dry and/or burning mouth, thinning of the or al mucosa resulting in erythema or pallor, taste disturbances and non-specific erythema of the gingiva (gingivostomatitis). Loss of estrogen in perimenopausal and menopausal women is also a risk factor for osteoporosis, which in turn may be associated with alveolar bone loss and an increase in tooth loss.
Hormones produced in our bodies generally function to help maintain body “balance” or homeostasis. Receptors for estrogen and progesterone have been found in the periodontal tissues, including the gingiva and the periodontal ligament. Levels of these hormones can affect the periodontium by modifying vascular proliferation and permeability, local immune response, collagen turnover and repair, crevicular fluid levels, and the oral biofilm or microbiota. These changes within the tissues are ultimately reflected in clinical signs and symptoms such as swelling, edema, bleeding and increase in probing depth. There often appears to be an exaggerated inflammatory response in the periodontal tissues that does not always correlate with the level of plaque observed in the mouth.
Over one third of women in the United States live with periodontal disease resulting from a complex interplay between bacteria in plaque and the host’s immune response. As a result, the most common periodontal challenge for women (and men as well) remains good plaque control through brushing and flossing and seeing the dentist regularly for examination and cleanings. Women should be aware of the risk factors associated with periodontal disease and know when extra effort and help may be needed to overcome challenges related to issues such as fluctuations in hormone levels.
From parents of children approaching puberty to the mature post-menopausal woman, anticipation and recognition of potential problems will likely prevent disease. Women who are pregnant or considering becoming pregnant should ideally see a dentist for a periodontal examination not only to prevent periodontal disease but also to perhaps decrease the chance of adverse pregnancy outcomes. The old wives’ tale of not getting your teeth cleaned while pregnant is a myth – controlling inflammation is of benefit in almost any situation associated with hormonal changes. Finally, post-menopausal women often experience dry mouth that leads to greater plaque accumulation as well as non-specific gingival inflammation resulting in discomfort which further complicates plaque control.
In creating an oral health treatment plan for women at different life stages, dentists should evaluate all potential modifying factors to develop the plan in the best interest of the patient. In that context, dentists and patients would benefit from a more fluid approach that meets patient-specific needs at any given time of a woman’s life. Chances are that the patient you met and evaluated at their initial examination may not be the same patient with the same needs who is sitting in your dental chair just a few years later. In a lifetime, women experience certain periods of change that may adversely affect oral health. Recognizing these potential changes and developing treatment strategies to prevent disease and maintain optimal oral health over a lifetime is the ultimate goal.