The Impact of Hormonal Changes on the Oral Health of Women
Female hormones play an important regulatory role in reproduction, growth and development as well as the maintenance of the body’s internal environment. They also play a major role in the development and maintenance of the mouth. However, at various stages of life, hormonal imbalances can leave a woman more susceptible to oral diseases.
Puberty marks the start of maturation into adulthood. Women change physically through the production of sex hormones. At this stage, the ovaries begin the cyclical production of estrogen and progesterone. Several studies have shown that during puberty there is often an increase in gum inflammation, without an increase in plaque levels. Usually when the gums are inflamed, there is an associated high level of plaque accumulation in and around the gums. Puberty has also been associated with higher numbers of bacteria that cause gums to bleed more readily.
During the menstrual cycle, progesterone peaks at around 10 days and drops prior to menstruation. Progesterone has been associated with altered collagen production in the gums and an increase in inflammatory cells. As a result, it is common to see bleeding and swollen gums and a minor increase in temporary tooth mobility (loosening of teeth). When progesterone production peaks it is also common to see recurrent ulcers, herpes lesions and candida infections.
Some of the most obvious hormone related oral alterations occur during pregnancy. Pregnancy gingivitis is very common with a range between 30-100% of all pregnant women experiencing this form of gingivitis (depending on the study). Cases can range from minor inflammation to severe gum overgrowth (gingival hyperplasia), pain and bleeding. Gum inflammatory changes usually begin during the second month of pregnancy and the severity increases through the rest of the pregnancy until there is an abrupt decrease in sex hormone secretion. Beyond gum inflammation, there is also an increased incidence of pyogenic granulomas (also known as ‘pregnancy tumour’) which normally affect the gums but can also appear on the tongue, lips, cheeks and palate. An increased level of progesterone and estrogen also causes an increase in aggressive bacteria associated with gum disease.
Oral contraceptives are one of the most commonly used drugs and can affect the gums significantly. Inflammation can range from mild redness to severe inflammation with associated gum overgrowth and significant bleeding. It has also been reported that oral contraceptives can result in changes in skin pigmentation with a ‘spotty’ appearance commonly seen in the mouth.
Menopause and post-menopause
Menopause usually starts between 45 and 55 years of age and is associated with a decrease in estrogen. As a result, the most significant problem that can occur during this phase is osteoporosis. Osteoporosis is characterised by low bone mass and an increased fracture risk. Because the bone is affected, it has a profound effect on the quality of bone within the jaw. In the presence of gum disease, faster bone loss (a common side effect of gum disease) has been reported resulting in greater risk of tooth loss. In other words, menopause may affect the severity of a pre-existing disease. However, for women with good periodontal health, menopause is not a risk factor.
Reduced estrogen can also cause a reduction in saliva flow which can result in drying of the oral tissues. This can increase the risk of decay, as well as redness and bleeding when performing routine oral hygiene. Oral discomfort is also common amongst post-menopausal women with many reporting a burning sensation in the mouth, dry mouth and a foul taste.
Many post-menopausal women are on hormone replacement therapy (HRT). This has been associated with protection against tooth loss and a reduction in bleeding gums.
In conclusion, at all stages of life hormones can be problematic and leave a woman more susceptible to a range of oral diseases. It is therefore important to maintain a regular and effective oral hygiene routine and to visit a dental professional regularly.