Page 10 - GP Fall 2019

The Mouth and Menopause
Why we cannot continue to overlook the unique oral health challenges

affecting over 10% of the nation.

by Lorna Flamer-Caldera, DDS, FAGD, FACD

The oral cavity is a dynamic environment. tion after release from the follicle triggers pause can have on oral health. Regardless
Despite all anatomic and histologic cer- breakdown of the corpus luteum, cessation of blogs and websites, the dental office is
tainties, there exists a fluidity within the of progesterone/estrogen secretion and re- where patients can be informed and educat-
components of the mouth that is essential sults in menstruation, a sloughing of the ed by a source they trust. Moreover, it is
to oral balance, a basic programming that uterine lining. During the perimenopausal the place where the patient has the greatest
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allows for full function - most of the time. period the number of ovarian follicles start opportunity to absorb and integrate recom-
decreasing. Menopause occurs when the mendations into their routines.
For women, the most common disruptions follicles stop releasing eggs, stop secreting
to that fluidity are inflammatory processes estrogen and progesterone, and break down Estrogen
and hormonal changes. These influences until they are no longer present; the uterine The primary driver of the menopausal tran-
can yield both dramatic and subtle chang- lining stops undergoing fertilization prepa- sition is the change in estrogen levels. Es-
es over the course of a woman’s lifetime. ration and menstruation ceases. During the trogen, a steroid hormone, is produced in
Although oral changes that occur during menopausal transition, which can take up to several areas of the body although the ova-
pregnancy have been well-documented four years, laboratory testing would show ries are the production site of estradiol (E2),
and integrated into patient evaluation and decreased estradiol levels, and increased the main form of estrogen. Receptors for
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treatment, the equally significant effects levels of both follicle-stimulating hormone estradiol have been detected in many tis-
of menopause have routinely received less (FSH) and luteinizing hormone (LH). Post- sues throughout a woman’s body, giving
attention and are often poorly incorporated menopause is the stage where hormonal se- rise to the whole-body reaction which oc-
into the oral health plan. These effects in- cretion has completely stopped. 6 curs in response to estrogen depletion. In-
clude alterations which, unlike those occur- active receptors, void of estrogen, contrib-
ring during pregnancy, are permanent and Although the benchmark of menopause ute greatly to epithelial mucosal changes in
last through the remainder of a woman’s is the absence of menstruation for twelve areas such as the eyes, vagina and mouth.
life. It is essential that practitioners redress consecutive months , a long list of physio- Oral and vaginal mucosa are histologically
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this shortcoming. logic changes also heralds the menopausal, similar and have similar responses to es-
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and postmenopausal, phases of a woman’s trogen. Both sites can develop mucosal
A look at the numbers will make it clear life. These include vasomotor symptoms thinning and atrophy in reaction to low hor-
why this is of such importance to our clini- (hot flashes), weight gain, mastodynia, and mone levels.
cal practices. In the Unites States, the baby depression. 8
boom generation has resulted in a 39.7 An excellent example of a non-reproduc-
million strong cohort of women , experi- Many menopausal women attempt to min- tive organ interaction with estrogen is
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encing the gamut of menopausal symp- imize their symptoms, either as a way to found with the eyes. Estrogen influences
toms. Menopause, a word coined in the deflect from the significantly changed production of all layers of tear film (aque-
1800’s literally means “month, cessation life status it represents, or to avoid dis- ous layer, lipid, and mucin). Estrogen de-
or pause” ; “the [permanent] ceasing of cussion of uncomfortable elements of the ficiency affects ocular surface homeostasis
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menstruation”. The average age range of menopausal process like night sweats, and and can result in dry eye disease (DED), a
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menopause is 48-52 years so with an aver- changes in body odors, in addition to those condition where tear production is not ad-
age life expectancy of 78.6 years, a signif- listed above; also, perhaps, out of fear of equate to keep the eyes sufficiently lubri-
icant percentage of a woman’s life is spent the unknown. cated; this can result in decreased vision,
postmenopausal. Providing this popula- irritation, redness, and pain. The incidence
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tion with services and knowledge germane Real medical challenges occur with meno- of DED in women over age 50 is twice that
to the optimization of their long-term oral pause, such as increased risk factors for of men the same age. 13,14
health is crucial for dental practitioners. cardiovascular disease and stroke. 9,10 The
The clinician should be as familiar with protective health role that sex hormones The following is a list of the primary con-
this set of circumstances as they are with play during the procreative years decreas- ditions that challenge the oral health of the
the oral effects of pregnancy. es, leaving the immune system vulnerable patient experiencing the stages of meno-
and at risk. pause. Included in the summary are the key
Etiology elements clinicians should keep in mind
Ovarian follicles produce estrogen as they It is absolutely vital that dental clinicians when treating patients undergoing this
mature. At ovulation, an egg is released give due importance to the oral consid- life-changing transition.
from the follicle and the remaining folli- erations of menopause and impart that to
cle, now called the corpus luteum, releas- affected patients. The dental office is the Xerostomia
es progesterone and estrogen in order to prime source of information on how to Xerostomia refers to oral dryness resulting
thicken the uterine lining in preparation for protect against and prevent the real, de- from a change in the quantity or composi-
fertilization. An absence of egg fertiliza- structive, irreversible impacts that meno- tion of saliva. It can be both a subjective

www.nysagd.org l Fall 2019 l GP 10