When we think of safeguarding our health during the menopausal transition, we mainly think about our hearts, bones and breasts. But our oral health is important, too. June Rogers, editor of A Friend Indeed, spoke to Dr. Susan Sutherland, chief of dentistry at Sunnybrook and Women’s College Health Sciences Centre in Toronto, to find out what those of us in menopause can do to keep our mouths healthy.
Q: What may women want to be aware of before, during and after menopause regarding oral health?
A: Women may want to tune into a healthy lifestyle in general, with one or two minor changes in oral care. Regular exercise and a balanced diet are important, including avoiding excessively sweet or acidic foods. Maintaining good oral hygiene such as brushing and flossing their teeth on a daily basis as well as regular visits to their dentists every six to nine months – or more frequently if dental problems are present – are crucial. They may want to be aware of their stress levels so they don’t grind or clench their teeth. Dentists can tell if there are problems with grinding and may suggest ways of treating the problem with mouth guards, for example.
Q: During menopause, what happens to our gums?
A: Due to lower hormonal levels, the gums become more sensitive and reactive. They may turn red and bleed easily. (This is unrelated to periodontitis, in which the gums pull away from the tooth, forming pockets that trap bacteria. The infection progressively erodes the jawbone that anchors the teeth, causing tooth loss.) In most women, gum sensitivity does abate after a few years postmenopause.
Q: What can women do about red, bleeding gums?
A: They may want to discuss the situation with their dentists to make sure that the problem is addressed. They should continue to floss and brush properly with a soft tooth brush. In fact, if their gums bleed, it may be due to the fact that they don’t floss regularly enough. Some women who have difficulty using floss due to arthritis, for example, may want to ask about other special methods to clean between the teeth.
Q: Many menopausal women report a high degree of tooth sensitivity during menopause. What are the causes?
A: Several factors may cause tooth sensitivity at this time of life. One is that the enamel of the tooth may be eroded from years of drinking soft drinks that contain phosphoric and citric acids, eating excessively acidic foods such as sucking on oranges, or overusing do-it-yourself bleaching kits. Women who have experienced eating disorders may also have extreme sensitivity. Overly aggressive tooth brushing with a hard brush, which tends to make the gums recede, may have exposed the sensitive roots.
Q: What may a woman do to reduce sensitivity?
A: A woman may want to limit or avoid soft drinks and acidic foods and drink more water instead. It may also be time for her to review with her dentist the proper way to brush teeth – down on the uppers and up on the lowers – instead of harsh, side-to-side brushing. As for bleaching, she may want to either cut back or discuss professional tooth-whitening with her dentist. Soft toothbrushes are a must. There are also a variety of toothpastes available that help reduce sensitivity.
Q: Dry mouth is fairly common among menopausal women. Why is that?
A: When we refer to this condition, we mean that a woman experiences dry mouth at all times, not just during periods of stress or thirst. Lower hormone levels tend to change the composition of saliva, which may not lubricate as well as before. About 400 different kinds of drugs – from blood pressure medication to older forms of anti-depressants – can also aggravate the condition. A symptom of diseases such as Sjogren’s and diabetes include dry mouth. Smoking, chemotherapy, and radiation to the head and neck can also cause dryness.
Q: What can a woman do to keep her mouth moist?
A: Unfortunately, we can’t make the saliva come back, but good oral hygiene is a must. Frequently sipping water during the day and at meals can alleviate the dryness. Sucking on sugarless candy or chewing sugarless gum can increase saliva production. Stopping smoking, avoiding alcohol, caffeine, salty and spicy foods may also help. Women need to be aware that dry mouth can make them susceptible to cavities and bad breath. They may want to discuss topical moisturizers and fluoride treatments with their dentist. Harsh alcohol-containing mouthwashes may also aggravate dry mouth and should be avoided.
Q: Osteoporosis is a common problem among menopausal women. How does this affect the teeth and jawbone?
A: First of all, teeth are not bone and as a result are not affected. The jawbone, however, is part of the skeletal structure and is susceptible to bone-thinning. Women who wear dentures may notice the change. However, an osteoporotic jawbone is not associated with tooth loss from periodontal disease.
Q: What can a woman do about preventing osteoporosis in the jawbone?
A: She may ask her family doctor to assess her risk of osteoporosis by ordering a bone density scan. Also, she may want to be looking at a balanced diet that includes 1,500 mg of calcium and 800 IU of vitamin D a day, regular weight-bearing exercise, and medication if advised by her physician. Smoking cessation is important in the prevention of osteoporosis. If a woman has a family history of the disease, or has been diagnosed as osteoporotic, her dentist needs to be aware of that fact. If she wears dentures, she may need to have them adjusted.
Q: Some menopausal women suffer from a condition called burning mouth syndrome. What is this?
A: Burning mouth is a common and complicated condition with many causes. Low hormone levels at menopause tend to thin out the tissues of the mouth, making them more susceptible to irritation. Menopausal women with burning mouth syndrome also report having altered taste perceptions. For example, they may lose their sensitivity to sweet tastes, which may cause them to eat more sugary treats, increasing their risk of weight gain, diabetes and dental problems. Burning mouth syndrome may be related to dry mouth, or caused by vitamin B deficiencies, medications, irritating dentures, or allergies to foods and flavourings.
Q: How can burning mouth syndrome be alleviated?
A: First, a woman may want to discuss the problem with her dentist to figure out the potential cause. Women may also find that avoiding irritants such as caffeine, alcohol, strong mouthwashes, tar-tar-reducing toothpastes, salty and spicy foods help. Some women may want to rinse their mouth with a weak solution of l tsp. of bicarbonate of soda (baking soda) and a cup of water to reduce the acidic levels in their mouths. Some women report that sucking on ice chips temporarily relieves the burning.
Q: Some women have fears about going to the dentist, which may be due to previous negative experiences or past traumas. What can a woman do?
A: Fears should be discussed with the dentist. Often, simple measures such as music and a caring environment may be enough to allay the anxiety associated with dental appointments. In other cases, a mild sedative or nitrous oxide (“laughing gas”) may be helpful. In patients with a severe phobia, deep sedation by a qualified dental anesthetist may be appropriate.
The Canadian Dental Association has a lay-friendly Web site (www.cda-adc.ca) that reviews proper brushing and flossing techniques and other relevant information.
The American Dental Association Web site (www.ada.org)provides information on various aspects of oral health, dental care and news updates.
Resources for patients and health providers concerning fears during dental and medical examinations are available at: www. cwhn. calresourceslcsalindex.php
Copyright Initiatives for Women’s Health, Inc. Sep/Oct 2004
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