Page 12 - GP Fall 2019

Patients should be advised to avoid things fibroblasts and periodontal ligament fibro- the tongue does not take long and will like-
that can irritate their mouth, such as: blasts provide a mechanism for direct ac- ly result in the patients’ appreciation of the
tion on different periodontal tissues. 34,35 clinician’s efforts and increase the patients’
• Tobacco emotional investment in their own oral
• Hot, spicy foods Management of the periodontal impact of health. The intraoral examination should
• Alcoholic beverages menopause includes: serve to illustrate patients’ symptoms along
• Mouthwash that contains alcohol with additional objective findings of which
• Food products high in acid such as • Regular professional dental cleanings the patients may be unaware. The patient
citrus fruits and juices 29 • Good toothbrushing technique who has been educated on the long-term
• Use of fluoride-containing dentifrices functional (and financial) impact of meno-
Periodontitis • Use of antimicrobial mouth rinses pause on their oral cavity is more likely to
Sex hormones affect both skeletal growth • Daily interproximal cleansing with adhere to homecare guidelines and accept
and periodontal stability. These hormones floss or interdental cleaner periodontal and restorative treatment rec-
actively maintain homeostasis of the ma- • No smoking ommendations.
ture skeleton through osteoblastic and os- • Early clinical intervention with evi-
teoclastic modeling. The estrogen decline dence of periodontal pocket develop- References
of menopause can create an extreme disrup- ment or increase 1. 2006-2019 LoveToKnow, Corp.https://se-
tion of that homeostasis. During this stage, niors.lovetoknow.com/Baby_Boomer_Sta-
both osteoblasts and osteoclasts increase in Women taking bisphosphonates for sys- tistics
number and activity, with osteoclasts at a temic osteoporosis have been shown to 2. Online etymology dictionary. https://www.
disproportionately higher number. The re- have improved non-surgical periodontal etymonline.com/search?q=menopause/
sult is net bone loss of both cancellous and outcomes – greater alveolar bone levels and 3. Oxford dictionaries. https://en.oxforddic-
tionaries.com/definition/menopause
cortical bone. This occurrence correlates to less inflammation. Changes in the maxilla 4. (National Vital Statistics Report , Volume 6
the rise in osteoporosis postmenopause. 30,31 and mandible have also been documented Number 5 July 2018..https://www.cdc.gov/
with bisphosphonate use. Bisphosphonates nchs/data/nvsr/nvsr67/nvsr67_05.pdf)
Endogenous hormonal influences on the have the potential for direct therapy for 5. (http://www.yourhormones.info/glands/
periodontium are well known but the periodontal disease; that avenue is being ovaries/ You and your hormones. Society
once-accepted link between osteoporo- explored. 35 for Endocrinology.
sis, menopause, and periodontal disease 6. Sherman BM, West JH, Korenman SG.
in women has been challenged in recent A beneficial effect on the periodontium The menopausal transition: analysis of LH,
years. Current efforts are researching the of postmenopausal women has also been FSH, estradiol, and progesterone concen-
32
possibility that estrogen deficiency in wom- demonstrated with the use of hormone re- trations during menstrual cycles of older
en accelerates preexisting periodontitis. placement therapy (HRT). Attachment gain women. J Clin Endocrinol Metab. 1976
illustrated by a decrease in pocket depth Apr;42(4):629-36.
Histologically, estrogen affects the rate and has been noted. At this time, HRT is not 7. What Is Menopause? National institute
on aging https://www.nia.nih.gov/health/
maturation of gingival keratinocytes and prescribed as a direct treatment for peri- what-menopause
fibroblasts, which are integral to gingival odontal disease. Further evaluations in this 8. Ponjola C. Chief Editor: Lucidi R, Med-
resilience and resistance to injury. More- area are in progress. 36 scape. Menopause. Updated: Jun 06, 2018.
over, estrogen loss during menopause chal- 9. American Heart Association. Menopause
lenges periodontal protective mechanisms, There are no defining guidelines regarding and heart disease. https://www.heart.org/
causing a cascade of oral changes that alter oral health care in menopausal women and en/health-topics/consumer-healthcare/
the microenvironment of the mouth. These very little in the way of public service lit- menopause-and-heart-disease. Accessed
lead to mucosal thinning and atrophy, erature on the topic. Proper management April 10, 2019.
slower repair, and xerostomia, all of which of any of the oral effects of menopause 10. Somani YB, Pawelczyk JA, De Souza MJ,
Kris-Etherton PM, Proctor DN. Aging
result in persistent sensitivity. 33 starts with a guided conversation with women and their endothelium: Probing
It has become clear that the net skeletal the patient, whether new or recall. Medi- the relative role of estrogen on vasodilator
changes during transition from estrogen cal intake forms should include questions function. Am J Physiol Heart Circ Physiol.
sufficient to estrogen deficient cannot be about dry mouth, burning mouth and oth- 2019 Jun 7.
aligned to match a periodontal model. er menopausal symptoms. With the dearth 11. Simpson ER. Sources of estrogen and their
Whether periodontal alterations result from of information on menopause available to importance. J Steroid Biochem Mol Biol.
the direct or indirect sex steroid influences the lay public, female patients in the meno- 2003 Sep;86(3-5):225-30.
is of less relevance than the responsibility pausal age range may not have connected 12. van der Bijl P, Thompson IO, Squier CA.
to assess the clinical picture, diagnose ac- disparate oral symptoms as part of a sys- Comparative permeability of human vagi-
curately and treat effectively. temic change. Clinicians must allow time nal and buccal mucosa to water. Eur J Oral
to educate these patients in a way that ele- Sci. 1997 Dec;105(6):571-5.
Estrogen receptors within the periodontal vates their understanding of oral impacts of 13. Peck T, Olsakovsky L, Aggarwal S. Dry
ligament exert a regulatory effect on bone menopause. Menopause is a phase as dis- Eye Syndrome in Menopause and Peri-
menopausal Age Group. J Midlife Health.
dynamics, when activated. Additionally, tinct as pregnancy and should be afforded 2017 Apr-Jun; 8(2): 51–54.
estrogen receptors in osteoblast-like cells equally attentive consideration. Taking the 14. Matossian C, McDonald M, Donaldson
provide a mechanism for direct action on time to explain the significant effects that K, Nichols K, MacIver S, Gupta P. Dry
bone while estrogen receptors in periosteal hormonal changes have on teeth, gums, and Eye Disease: Consideration for Women’s

www.nysagd.org l Fall 2019 l GP 12