Women’s hormones and oral health: From puberty to menopause

As International Women’s Day approaches, it’s a good time to consider the impact of hormones on oral health. From adolescence to menopause, a woman's body undergoes hormonal fluctuations that affect oral health and, consequently, overall physical and mental well-being.

During key hormonal periods such as adolescence, menstruation, pregnancy, and menopause, significant changes occur that can affect both oral and overall health. Hormonal changes can also impact the oral cavity, leading to various oral health issues such as increased gum sensitivity, gum bleeding, and tooth decay.

Understanding the connection between hormones and oral health can help patients take proactive measures to maintain oral health.

Establishing good oral hygiene habits from an early age

Hormonal changes during adolescence significantly affect oral health. Parents have an important role in serving as examples of good oral hygiene and teaching children healthy hygiene practices early on. Emphasizing good oral hygiene and establishing routines can lay the foundation for a child's lifelong oral health and well-being.

Adolescence may affect girls' self-esteem and body image, and good oral hygiene practices can support confidence. Dietary habits may change during adolescence, so adult encouragement toward a balanced diet can further support oral health. Additionally, orthodontic treatments often begin during adolescence, further highlighting the importance of good oral hygiene in preventing decay and gum inflammation.

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Puberty puts oral health to the test

Gingivitis associated with adolescence typically begins around the onset of puberty, between the ages of 8 and 13. Adolescent gingivitis manifests as swollen, red, tender, or sore gums that may bleed when brushing teeth or even with a light touch. Usually, inflammation is accompanied by bad breath as well as plaque and tartar buildup on teeth.^1,2

If adolescent gingivitis is left untreated, it can progress to periodontitis, causing gum recession and ultimately leading to tooth loss. Preventive care, including effective oral hygiene routines, is crucial.^1,2 Guidance and examples from adults support the health of adolescent gums.

The onset of menstruation during adolescence increases the impact of hormonal changes on oral health. Many women experience changes in oral health due to their menstrual cycle, including increased gum sensitivity and tendency toward bleeding. Studies suggest that fluctuations in hormone levels are associated with increased incidences of halitosis.³

Gum inflammation during pregnancy

Studies indicate that up to 75% of pregnant women suffer from gum inflammation. Hormonal fluctuations can cause mild gum inflammation in pregnant women and lead to periodontitis. Pregnancy-related gum inflammation affects many expectant mothers, especially in the second and third trimesters. Symptoms include swollen, tender gums that bleed easily.

Untreated inflammation can damage tooth support as bacterial plaque progresses under the gums and destroys the supporting connective tissue fibers. Accumulation of bacteria causing periodontitis in the gumline and pockets further increases inflammation. Untreated inflammation can lead to weakened tooth support and eventually tooth loss.^4,5

Poor oral hygiene often triggers gum inflammation. Regular and thorough brushing and flossing reduce gum irritation and bleeding in pregnant women by removing plaque from tooth surfaces and gum margins. Studies suggest that up to 95% of oral diseases are due to bacterial plaque.^4,5 Neglecting oral health during pregnancy can lead to premature birth, low birth weight, and the onset of preeclampsia during pregnancy.⁶

Good oral hygiene during pregnancy protects the unborn child. Oral health is part of general health and affects the well-being of both the expectant mother and the unborn child. Hormonal changes during pregnancy increase acidity of the saliva and decrease resistance to plaque, making oral hygiene particularly important during this stage of life. Brushing with strongly flavored and scented fluoride toothpaste may be unpleasant during pregnancy, so trying a different brand may be helpful.

Many expectant mothers suffer from hormonal-induced morning sickness, exposing tooth enamel to stomach acids, which can lead to erosion. Heartburn, a common ailment during pregnancy, can also erode tooth enamel. Softening of the tooth surface due to acid exposure increases the risk of wear, especially during chewing or if teeth are brushed shortly after consuming acidic foods. To prevent erosion, it is advisable to use xylitol regularly. Rinsing the mouth with water after vomiting also helps reduce erosion caused by stomach acids.

Gum disease has been associated with the risk of premature birth and low birth weight, underscoring the need for oral health during pregnancy. Antibacterial treatment is highly recommended during this stage as it helps expectant mothers take care of their oral health and the well-being of their unborn child. Frequent dental visits may be in order during pregnancy to reduce the oral health problems caused by hormonal factors.

How does menopause affect women's oral health?

Many women experience pain or burning sensations in the mouth during or after menopause. The mouth may be sore, and the mucous membranes may be sensitive and ulcerated. Taste perception can also change.

Estrogen production in the body significantly decreases during menopause and can affect oral health as saliva production decreases.⁷ Saliva protects teeth from decay, so a lack of saliva can cause teeth to decay more easily. Hormonal changes cause the defense capabilities of the gums to weaken, so even a small amount of bacterial plaque can easily cause gum inflammation.^7,8 Xerostomia is much more common in women than in men due to hormonal fluctuations. Many diseases and medications prescribed to women of menopausal age also increase the feeling of dryness in the mouth.^8,9

Low levels of estrogen hormone after menopause increase the risk of osteoporosis. As bones weaken, gum disease can occur more quickly, and if bone mineral density is low, tooth loss is more likely.¹⁰

Aging increases the likelihood of needing dental implant treatment. The durability of implants that are placed in patients treated for periodontitis can be challenged as healthy facial bone and healthy gums are required. Careful self-care of teeth becomes essential for successful implant treatment; implants don’t eliminate the risk of gum disease. Without proper treatment, inflammation can develop around the implant. Peri-implantitis occurs when plaque bacteria affect the gum tissue and bone around the implant. Regular antibacterial treatment can protect against peri-implantitis.

Good oral health pays off

Good oral hygiene habits, regular dental visits, and special treatments (if necessary) can help women maintain their oral health throughout life changes. Oral health promotes overall well-being and helps prevent potential complications such as premature birth or tooth loss. Educating patients about the connection between hormones and oral health can empower them to take preventive measures during every stage of life so they can enjoy healthy mouths and smiles for a lifetime.

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. Chaitra TR, Manuja N, Sinha AA, Kulkarni AU. Hormonal effect on gingiva: pubertal gingivitis. BMJ Case Rep. 2012;2012:bcr2012006193. doi:10.1136/bcr.2012.006193
2. Jafri Z, Bhardwaj A, Sawai M, Sultan N. Influence of female sex hormones on periodontium: a case series. J Nat Sci Biol Med. 2015;6(Suppl 1):S146-S149. doi:10.4103/0976-9668.166124
3. Alzoman H, Alssum L, Helmi M, Alsaleh L. Relationship between hormonal changes and self-perceived halitosis in females: a cross-sectional study. Healthcare (Basel). 2022;11(1):43. doi:10.3390/healthcare11010043
4. Wu M, Chen SW, Jiang SY. Relationship between gingival inflammation and pregnancy. Mediators Inflamm. 2015;2015:623427. doi:10.1155/2015/623427
5. Yenen Z, Ataçağ T. Oral care in pregnancy. J Turk Ger Gynecol Assoc. 2019;20(4):264-268. doi:10.4274/jtgga.galenos.2018.2018.0139
6. Srinivas SK, Parry S. Periodontal disease and pregnancy outcomes: time to move on? J Womens Health (Larchmt). 2012;21(2):121-125. doi:10.1089/jwh.2011.3023
7. Suri V, Suri V. Menopause and oral health. J Midlife Health. 2014;5(3):115-120. doi:10.4103/0976-7800.141187
8. Dutt P, Chaudhary S, Kumar P. Oral health and menopause: a comprehensive review on current knowledge and associated dental management. Ann Med Health Sci Res. 2013;3(3):320-323. doi:10.4103/2141-9248.117926
9. Jacob LE, Krishnan M, Mathew A, Mathew AL, Baby TK, Krishnan A. Xerostomia – a comprehensive review with a focus on mid-life health. J Midlife Health. 2022;13(2):100-106. doi:10.4103/jmh.jmh_91_21
10. Grodstein F, Colditz GA, Stampfer MJ. Post-menopausal hormone use and tooth loss: a prospective study. J Am Dent Assoc. 1996;127(3):370-377. doi:10.14219/jada.archive.1996.0208

Nina Garlo-Melkas, MSc, is a health and science journalist who works as communications manager at Koite Health Ltd., a quickly growing health technology company and innovator in light-activated antibacterial solutions for treating and preventing oral diseases.