Oral manifestations of menopause

Abstract

The aim of this review paper is to identify the reflection of menopause on the oral region and the impact of these manifestations on clinical applications. During menopause, ovarian function declines and the production of sex steroid hormones reduces significantly affecting the oral tissues and periodontal structures leading to osteoporosis, chronic inflammation of the gingiva, increased risk of tooth loss, concurrent periodontitis, oral discomfort, xerostomia, burning mouth syndrome and many other manifestations. Hormonal Replacement Therapy is used to relieve the previously mentioned complications. The effects of HRT will be reviewed as well. Menopause is a normal physiologic event in women, in which there’s a cessation of menses. It takes from five to ten years and terminates with a sharp decline in female hormone levels. The decrease of estrogen production in postmenopausal women leads to many physiological changes, like: hot flashes, sweating, osteoporosis, cardiovascular diseases, cognitive changes, urogenital infections, skin changes and vaginal dryness. The fact that periodontal tissues are significantly influenced by sex steroid hormones relies on the increased incidence and severity of periodontal diseases during periods of hormone fluctuations, retention and metabolic conversion of sex steroid hormones and the presence of steroid hormone receptors in the periodontium. The periodontal tissues are highly affected by the endocrine system where they are influenced by androgens, progestins and estrogens. Estradiol is the most potent estrogen and is secreted by the ovary, testis, placenta and certain peripheral tissues. Estrone is also secreted by the ovaries. In premenopausal women, estradiol is the most profuse hormone; while in postmenopausal women, estrogen is the most abundant hormone in the plasma. Progestrone has been reported as an antagonist of estrogen as it reduces its number of receptors in target tissues. During menopause, ovarian function declines and the production of sex steroid hormones reduces significantly affecting the oral tissues and periodontal structures leading to increased susceptibility to chronic inflammation of the gingiva, and alveolar bone loss. Moreover, hormones changes may lead to cardiovascular diseases accompanied by xerostomia which will increase susceptibility to dental caries and Candida infection. Many other oral changes occur during menopause period such as pain and burning in oral cavity, mucosal atrophy and oral dysesthesia. Post menopausal estrogen deficiency causes bone loss in the long bones and vertebrae. It was reported that this osteoporotic effect increases the probability of odontia by three times than in normal females as a result of alveolar bone resorption due to systemic osteoporosis. Moreover, the presence osteoporosis and concurrent periodontitis may exaggerate the response to dental plaque characterized by abnormal, painless, dry, shiny, thin gingival bleeding called concurrent senile atrophic gingivitis which might progress to menopausal gingival stomatitis. Certain diseases can amplify the mentioned manifestations like Sjogren Syndrome, Pemphigus Vulgaris, Burning Mouth Syndrome and Trigeminal Neuralgia. In order to prevent or at least alleviate these manifestations, Hormonal Replacement Therapy (HRT) and Vitamin D and Calcium supplements are used.