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Wednesday, September 29, 2021

From puberty and periods to the menopause: the link between female hormones and oral health

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There is an old wives’ tale that goes: gain a child, lose a tooth. To expectant mothers who haven’t come across this saying before, you’ve probably just done something of a virtual double take. Gain a child, lose a what?! Sleep maybe, or time for yourself, but something as irreplaceable as a tooth?

Before you start to panic, it’s important to get a few things clear. Yes, scientists have found links between times of hormonal fluctuation – puberty, pregnancy and the menopause – and gum disease, but there are all sorts of variables at play. A European study published in the Journal of Epidemiology and Community Health (JECH) found that women with three children had four fewer teeth, on average, than mums with two children. But the authors warned that more investigation was needed into other causal factors – for example, less time for good oral hygiene due to the demands of a large family. Another study that looked at the effects of the menstrual cycle on periodontal health found that ovarian hormones in premenstrual women “may exaggerate pre-existing inflammation in gingival tissues”. To translate, fluctuating hormones may make the inflammation that you already have in your gums more apparent.

So what’s the deal then? Along with the joys of puberty, the menstrual cycle, pregnancy and the menopause, does the female sex have the added burden of potentially more problematic teeth and gums?

“If we specifically think about the female sex hormone, so estrogen levels, we see increases in inflammation around certain times in patients’ lives,” says Dr Ian Dunn, a dentist and specialist periodontist. Effectively, when hormones are raging, patients are more prone to developing what Dunn describes as “hormonal-induced gingivitis”.

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Puberty, periods, pregnancy and the menopause can all affect oral health. Photograph: Guille Faingold/Stocksy United

To brush up on a few oral health terms, gingivitis is bleeding gums caused by a buildup of plaque on the teeth. Crucially, if you catch it early, it can be reversed, and no further damage done. If left to fester, however, gingivitis can lead to periodontal disease – or gum disease. Think bone loss, teeth becoming loose and gums shrinking. Cue the image of a poor, toothless, long-suffering mum.

But it really need not be as dramatic as that.

“I think if the sex hormones were such a big player in destructive gum disease, we’d expect to see more women with gum disease,” says Dunn. But that’s not to say women shouldn’t be vigilant about oral hygiene during times of hormonal fluctuation. Indeed, reputable health bodies – from the NHS and National Childbirth Trust (NCT) to the British Society of Periodontology and Implant Dentistry – are clear that pregnant women are more susceptible to gingivitis. “Certainly, during the first and third trimester, it’s very common for pregnant, female patients to be very aware of increased gingival bleeding,” says Dunn.

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Some women notice more gingival bleeding when menstruating. Photograph: damircudic/Getty Images/iStockphoto

Additionally, he adds that most women don’t tend to notice signs of gingivitis in relation to menstruation – but some do. “We see some patients who are so sensitive to hormonal changes that they notice more [gingival] bleeding or less bleeding, depending on which week of their cycle they’re in. But again, that is not necessarily destructive inflammation.”

And what about the menopause? Similar to puberty and pregnancy, researchers have found that it is one of those times in a woman’s life when increased inflammation can be seen, but not necessarily increased gum disease. Some studies do point to higher rates of periodontal disease in post-menopausal women who have osteoporosis. But Dunn says that developing gum disease is certainly not a foregone conclusion for osteoporotic, post-menopausal women.

“Post-menopausal patients who develop osteoporosis often worry that [the disease] will have a negative impact on their periodontal health. But we don’t want post-menopausal women or osteopathic patients to write themselves off and think it’s a fait accompli, because it really is quite the opposite.”

On the whole, the message seems clear enough. Be on the lookout for signs of inflammation during periods of hormonal change. Gingivitis is not a one-way street to periodontal disease, but it can certainly lead to that without proper care and attention.

So whether it’s that time of the month or that time of your life, do your due diligence and brush twice a day, floss and have regular checkups. Your hormones may change over the seasons of your life – but just make sure your good oral hygiene routine never does.

Healthy gums don’t bleed – if yours do, it’s time to take action. Brushing with Corsodyl toothpaste twice a day is clinically proven to help stop and prevent bleeding gums – so that’s one thing off your to-do list. To find out more, head to corsodyl.co.uk/products/toothpaste

If you are pregnant, please speak to your dentist for a suitable product recommendation.

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