Women have a variety of special health care needs, many of which are related to hormonal changes that occur throughout the life span of a woman. The sex hormones have a very distinctive role in the oral health of a woman as she progresses through puberty, childbearing years, menopause, and post-menopause. During each phase in the cycle of life, estrogen influences the body, including the oral cavity, in a variety of ways. As a woman’s health care needs change, oral health can change as well because oral health and overall health are connected. Good care of oral health is a necessary part of overall health, which is why it is important to learn how one affects the other.

There are estrogen receptor sites in more re than 300 areas in the body, including the oral cavity. As estrogen and progesterone levels increase, such as during adolescence and menses, so does the prevalence of gingivitis or gum inflammation. Oral bacteria, particularly those associated with periodontal or gum disease, thrive in the presence of these hormones. Depending on the person’s immune function and the increase in these disease-causing bacteria, gingivitis may result. The hormonal effects, such as swollen and tender gums, are temporary. However, poor oral hygiene and a lack of routine professional care can cause the effects of gingivitis to progress into irreversible damage to the gums and ultimately the teeth.

Women of child-bearing age are also affected by an overabundance of sex hormones. Eight to ten million women in the United States and 50 million women worldwide take oral contraceptives containing various amounts of synthetic sex hormones. Once again, destructive, disease-causing bacteria, particularly the Prevotella and Bacteroides bacteria species, thrive on the elevated estrogen. Common oral manifestations of oral contraceptive use include generalized gingivitis, exaggerated response to local irritants such as tartar deposits under the gum line, and in some cases, spotty discoloration of the lining inside the mouth (gingival melanosis). Additionally, oral contraceptives have been linked to folate deficiency that can alter oral tissue repair. This may delay the healing time of the gums after a period of inflammation.

There is a marked elevation in sex hormones during pregnancy, and as many as 75% of all women exhibit changes in their gums during pregnancy. Known as "pregnancy gingivitis," the gums bleed easily and may be tender and swollen. Pyogenic granulomas or "pregnancy tumors" may also appear in the oral cavity, particularly the interdental papillae or gum tissue between the teeth. These "tumors," which bleed easily if manipulated, are benign and will resolve as hormone levels return to normal after pregnancy and/or breastfeeding. Some studies have suggested that periodontal infection during pregnancy can put the mother at risk for delivering a premature, low birth-weight baby.

While an abundance of sex hormones causes oral changes for younger women, the decrease in sex hormones in menopausal and post-menopausal women also have significant oral implications. The oral manifestations of menopause can include changes in the tissue that lines the oral cavity as well as altered taste, especially salty or sour. At the onset of menopause and afterward, a woman may experience a burning sensation in her mouth known as "burning mouth syndrome." Occasionally, a condition called "menopausal gingivostomatitis" can cause the oral tissues to bleed easily, become dry, appear shiny, and range in color from abnormally pale to dark red in color. Most women find that estrogen supplements, either in pill form or a solution applied directly to the affected tissue, help to relieve these symptoms. Osteoporosis can affect a woman’s entire skeletal system, including the jaw bone and/or bone around the teeth. The basic principle of osteoporosis is that more bone is being dissolved than formed, putting a woman at risk for tooth loss. Studies have shown that women who take postmenopausal hormone supplements are at reduced risk of tooth loss associated with osteoporosis and gum inflammation.

Hormonal changes put women at an increased risk for periodontal disease. Thewarning signs of gum disease include swollen, tender, red and bleeding gums. Persistent bad odor or bad taste in the mouth, and possibly a sense of "loose" teeth may also be signs of a periodontal problem. If any of these symptoms are noted, it’s important to immediately notify a dentist.

During the hormonal fluctuations that occur throughout a woman’s life, it is imperative to practice diligent home oral care by brushing teeth at least twice per day and flossing at least once per day. Use of an antimicrobial mouth rinse, such as Listerine, may also be helpful. Professional dental cleanings are essential to remove hard tartar deposits that can form at and below the gumline, to monitor the status of the gums and to provide specific instructions for the daily care of the teeth and gums.

Related Sites

American Dental Hygienists’ Association: http://www.adha.org
American Academy of Periodontology: http://www.perio.org
American Dental Association: http://www.ada.org
American Academy of Pediatric Dentistry: http://www.aapd.org

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