From Pregnancy to Menopause: How Hormones Affect Oral Health

From puberty to the first menstruation cycle, and from pregnancy to menopause, women go through significant hormonal changes during their lifetime. While some of these changes are expected and understood, many women may be surprised to learn just how much these same hormonal transitions can impact their gums, teeth, and overall oral health.

Hormonal life stages

Gingivitis is a recurring theme at each milestone during a woman’s life. It is, therefore, important  to have a basic understanding of this condition. Gingivitis is an initial stage of gum disease caused by an over-accumulation of plaque along the gumline and on the teeth. Gingivitis symptoms include inflamed gums (red and swollen in appearance), soreness, and bleeding during brushing and/or flossing. If gingivitis progresses without proper treatment, it can lead to periodontitis—a more serious condition linked to soft tissue and bone damage, and possible tooth loss. Fortunately, gingivitis can be treated effectively with proper dental care in each hormonal life stage.

Puberty

There is a correlation between an increased prevalence of gingivitis and increased levels of sex hormones that occur during puberty. In addition, there may also be a nodular overgrowth reaction of the gingiva (gums) in areas that come into contact with food debris, plaque, and calculus deposits.1 With red and swollen gums, bleeding may occur easily during brushing.

In addition to elevated levels of hormones, the lifestyle habits of younger adults increase the risk for gingivitis. Adolescents are more likely to wear braces than older adults (making it harder to floss and thoroughly clean the teeth and gumline), and are more likely to drink and/or eat sugary foods – without follow-up brushing. This extra plaque build-up can be a breeding ground for gingivitis.

Menstruation

Gum sensitivity and changes during menstrual cycles vary, with some women experiencing no gingival changes during this monthly hormonal shift, while other women report swollen and bleeding gums a few days before their period. This gum discomfort typically goes away once the menstrual flow begins,1 however, special care can be taken to alleviate oral inflammation during this time. It should also be noted that women taking the contraceptive Pill, an artificial steroid drug, may have decreased immune system functioning2 which in turn may affect one’s oral health.

Pregnancy

Gingivitis occurs in about 60 to 75 percent of all pregnant women. Hormones during pregnancy can exaggerate the inflammatory response to local irritants, like plaque, causing gums to become swollen and bleed more easily during this intense (and prolonged) hormonal surge.1

Some pregnant women state that gingival changes begin around the second month of gestation and peak in the eighth month.1 Others report that after gradually building in intensity throughout the pregnancy, gingivitis is at its worst during the third trimester. Gingivitis gains momentum during pregnancy as the plasma level of progesterone and estrogen levels rise.3 While these hormones (and the prevalence of gingivitis) decline after childbirth in the postpartum phase, often, the gums will not immediately transition back into their pre-pregnancy state. More significantly, periodontal disease during pregnancy may increase the risk factor for delivering a pre-term low birth weight (PLBW) baby.1

Another rare oral health condition called pregnancy tumors (a.k.a. “epulis gravidarum” or “pregnancy granuloma”) affects up to 10 percent of pregnant women. According to the American Dental Association, “a pregnancy tumor classically starts to develop in an area of an inflammatory process. Poor oral hygiene is invariably present, and often there are deposits of plaque or calculus on the teeth adjacent to the lesion. The gingiva enlarges in a nodular fashion to give rise to the clinical mass.”1 While the lesion typically shrinks or goes away in the postpartum phase, women should see their doctor and dentist for diagnosis and treatment.

Menopause

Perimenopause starts on average around the age of 47. Most women in the United States officially enter menopause around age of 51. Women who smoke or are thinner than average, may experience menopause even earlier.1

While hot flashes and night sweats are the most common menopausal symptoms, many women experience oral discomfort with these hormonal changes. Symptoms range from dry mouth and burning sensations, to taste perception. The gums may appear dry and shiny, range in color (from pale to red), and may bleed easily.1  While dry mouth is more common with age, and may occur due to medications prescribed during menopause, dry mouth can lead to tooth decay, gum disease and bad breath.

Naturally occurring hormonal changes that usher aging women into menopause can affect bones and the development of osteoporosis. Loss of bone, specifically in the jaw, can lead to tooth loss. Receding gums can be a sign of bone loss in the jawbone. Receding gums also expose more of the tooth surface to potential tooth decay.”4

Gum disease treatment during hormonal shifts

Hormonal changes can leave gums and teeth vulnerable to infection if the initial problem is left untreated. Preventing gum disease begins with proper oral hygiene. Women should establish a consistent and dedicated routine that includes brushing and flossing after every meal (including snacks), replacing toothbrushes at least every 3-4 months, and visiting the dentist every 6 months. Women should discuss any gum and tooth concerns with their dentists as well as any health changes (like a life phase transition) that may have occurred between visits.

Since gums can be sensitive during peak hormonal times, women can benefit from using natural, alcohol-free oral care products. Professional strength Truly Natural® Dental Herb Company products are made with herbal extracts that provide a gentle and effective treatment for gum disease without harsh chemicals that can further aggravate gum tissue. Dental Herb Company products are completely safe for use during pregnancy, and regular use helps maintain healthy oral tissues long term.

Dental Herb Company products contain five pure essential oils (not derivatives or synthetic equivalents) and two alcohol-free organic herbal extracts, which work synergistically to help rebuild and condition gum tissue, reduce oral bacteria, and soothe oral irritation. When looking for a powerful and effective all-natural way to help prevent gum disease, choose Tooth & Gums Tonic® by Dental Herb Company, available for purchase online.

References:

  1. “Oral Health Care Series: Women’s Oral Health Issues.” American Dental Association Council on Access, Prevention and Interprofessional Relations; November 2006.
  2. Sellman, Sherrill, Hormone Heresy, Bridger House Publishers, Inc. 2009
  3. Nayak R1, Choudhury GK, Prakash S, Deshpande S, Ashok KP, Spoorthi BR. “The role of plasma female sex hormones on gingivitis in pregnancy: a clinicobiochemical study.” J Contemp Dent Pract. 2012 Nov 1;13(6):760-3.
  4. “Hormones and Health,” WebMD. http://www.webmd.com/oral-health/hormones-oral-health

Is There a Connection Between Gum Disease and Rheumatoid Arthritis?

Scientists have long been aware of a connection between gum disease and systemic diseases such as heart disease and diabetes. A new growing body of evidence now appears to link gum disease to rheumatoid arthritis (RA). While the evidence is not conclusive, a strong correlation between the two exists.

Rheumatoid arthritis is a chronic inflammatory disease that affects the joints by causing pain, stiffness, and inflammation. It currently affects .5% to 1% of the global population.1 Periodontal disease is also a chronic inflammatory condition; it primarily affects gum tissue. Evidence from one study states that over 75% of Americans have some form of gum disease, yet most people are unaware they have it.2 Gingivitis, the earliest stage of gum disease, is typically marked by noticeably inflamed gums, as well as soreness and/or bleeding during brushing or flossing. If not treated, plaque accumulates at the gum line, causing further inflammation and gum recession. When the tissue of the pockets surrounding the teeth is damaged, harmful bacteria have access to the bloodstream—which in turn can cause serious problems in other parts of the body.3

Researchers have found a substantial increase in the prevalence of gum disease in patients with RA compared to those without it. In addition, the incidence of RA is higher in those with gum disease than those without.1 Statistics from the Third National Health and Nutrition Examination Survey (NHANES III) explain the connection between the two chronic ailments based on several key factors. Both gum disease and arthritis result from an inflammatory response, and both are characterized by an overgrowth of bacteria that release toxins destructive to supporting tissues. People affected by both diseases exhibit more anti-citrullinated protein antibodies (ACPA), which increase bodily inflammation and exacerbate both conditions.4

Of the 20 bacterial species identified as periodontal pathogens, all are linked to gum disease. The most studied is Porphyromonas gingivalis (P. gingivalis).1 Researchers from Germany’s Martin Luther University Halle-Wittenberg recently examined samples of synovial fluid (the fluid within joint capsules) from 42 patients with RA and found DNA matching oral bacteria—P. gingivalis in particular. The study concluded that those with RA are approximately 4.5 times more likely to have P. gingivalis bacteria in their synovial fluid than those without arthritis. Furthermore, they discovered that RA patients were 12 times more likely to have oral infections from P. gingivalis.5 Another study found that arthritis patients displayed a considerable increase in the levels of gingivitis bacteria, and the severity of gum disease correlated with the severity of the arthritis.7

What is the best gum disease treatment for patients with rheumatoid arthritis?

Oral health is interconnected with one’s overall health. And while the scientific community is in agreement regarding the connection between periodontal disease and rheumatoid arthritis, the exact relationship between these two destructive chronic inflammatory diseases is unknown. It is known that systemic diseases (which includes arthritis) are accompanied by an increase in the severity of gum disease6 because oral infections create a pathway for bacteria to enter the bloodstream. This can elicit an inflammatory response elsewhere7 in the body. And even though plaque buildup is recognized as one of the primary causes of periodontal disease, the progression of the disease is largely dependent on the overall strength of the subject’s immune functioning.8 According to the American Academy of Periodontology, the presence of gum disease can be an indicator of several forms of systemic diseases including RA.9

It is unknown whether gum disease precedes RA or RA precedes gum disease. What is known is that it is extremely important to take oral care seriously if you have arthritis. Regular dental visits are a must. In fact, some health professionals recommend those with RA have as many as four annual cleanings, as research suggests that treating dental problems early on will result in decreased symptoms in patients with severe arthritis.10 One study showed that reversing gum disease through professional dental care actually decreased RA sufferers’ overall pain level, number of swollen joints, and morning stiffness.10

Finding a natural treatment for gum disease

Increasing public awareness of the connection between gum disease and systemic diseases like arthritis is important from a holistic perspective. Brushing and flossing regularly, and using all natural gum disease treatment products are key to oral health. Natural toothpastes and mouth rinses both clean and heal inflammation safely and effectively. The ingredients in Dental Herb Company’s line of oral care products are completely natural and proven to be effective in combating harmful bacteria, reducing inflammation and eliminating bad breath. Pure essential oils and organic herbal extracts work synergistically to maintain healthy teeth and gums, and they’re a great alternative to the chemical products lining most commercial shelves. The best natural remedy for gum disease, lasting oral health and a reduced risk for systemic diseases is preventative care. Commit to better oral care today.

References:

  1. Ogrendik, Mesut. “Rheumatoid Arthritis Is an Autoimmune Disease Caused by Periodontal Pathogens.” National Center for Biotechnology Information. U.S. National Library of Medicine, 24 May 2013. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668087/>.
  2. “Gingivitis- In-Depth Report.” Health.nytimes.com. New York Times, n.d. Web. <http://health.nytimes.com/health/guides/disease/gingivitis/print.html>.
  3. “Joint Failures Potentially Linked to Oral Bacteria.” ScienceDaily.com. ScienceDaily, 18 Apr. 2012. Web. <http://www.sciencedaily.com/releases/2012/04/120418112047.htm>.
  4. Pablo, P., T. Dietrich, and TE McAlindon. “Association of Periodontal Disease and Tooth Loss with Rheumatoid Arthritis in the US Population.” Ncbi.nlm.nih.gov. U.S. National Library of Medicine, n.d. Web. <http://www.ncbi.nlm.nih.gov/pubmed/18050377>.
  5. Adams, Case. “Arthritis Linked to Gingivitis Bacteria.” GreenMedInfo.com. GreenMedInfo, n.d. Web. <http://www.greenmedinfo.com/blog/arthritis-linked-gingivitis-bacteria>.
  6. Chi, Angela C., DMD, Brad W. Neville, DDS, Joe W. Krayer, DDS, and Wanda C. Gonsalves, MD. “Oral Manifestations of Systemic Disease.” Aafp.org. American Family Physician, n.d. Web. <http://www.aafp.org/afp/2010/1201/p1381.html>.
  7. Gude, Dilip, Rekha Rani Koduganti, Surya J. Prasanna, and Lakshmi Radhika Pothini. “Mouth: A Portal to the Body.” Ncbi.nlm.nih.gov. U.S. National Library of Medicine, 03 May 2006. Web.
  8. Kinane, DF. “Periodontitis Modified by Systemic Factors.” Ncbi.nlm.nih.gov. U.S. National Library of Medicine, n.d. Web. <http://www.ncbi.nlm.nih.gov/pubmed/10863375>.
  9. “Diagnosis of Periodontal Diseases.” Journal of Periodontology 74 (2003): 1237-247.Umn.edu. University of Minnesota. Web. <http://www1.umn.edu/perio/periocasepresent/text/Diagnosis_of_Perio.pdf>
  10. “Treating Gum Disease Helps Rheumatoid Arthritis Sufferers.” ScienceDaily.com. ScienceDaily, 29 May 2009. Web. <http://www.sciencedaily.com/releases/2009/05/090528135252.htm>.