By Laura Freeman
From preterm birth to an increased risk of heart disease, oral health can affect the health of the body. For women, the reverse is also true. Starting with the first fluctuations of estrogen and progesterone that come with puberty, the hormones a woman’s body produce make protecting her gums and teeth more challenging.
“When estrogen and progesterone increase, blood flow to the gums also increases. Bacteria in the mouth change and the immune system’s response to plaque also changes, increasing inflammation,” Mia Geisinger, DMD, of the UAB School of Dentistry, said. “Although advanced gum disease is seen more often in men, primarily due to lower rates of regular dental care, the shift in hormones every month put women at greater risk of developing red and swollen bleeding gums, swollen salivary glands, and mouth ulcers. In severe cases, pyogenic granulomas can develop. The tumor is noncancerous, but it can be painful and bleeding.”
Hormonal shifts occur monthly during menstruation, when using oral contraceptives, and during pregnancy and at menopause. Physicians and dentists need to work together to protect oral health, body health and the health of pregnant women and their babies.
“During hormonal shifts, women should be extra vigilant about brushing, flossing and keeping up-to-date on dental exams and cleanings.” Geisinger said. “We hope to partner with gynecologists, obstetricians and primary care providers to make sure that women who are pregnant or plan to be are current on their dental visits and have a dental home to help them maintain good oral health during their child bearing years. Periodontal disease has been linked to poorer pregnancy outcomes, including preterm delivery and lower birth weight.”
Physicians and dentists may also need to coordinate their efforts during menopause. It’s no coincidence that “long in the tooth” became a term for aging, since receding gums, periodontal disease and other oral health problems tend to become more pronounced as people age. In addition to nutritional problems that can be related to the loss of teeth or painful teeth and gums, inflammation and bacteria that gets into the bloodstream can endanger the valves of a weak heart and add to the burden of other parts of the body.
“Mouth dryness also tends to increase with age,” Geisinger said. “Some prescription drugs can make the dryness worse. Since a dry mouth is more at risk for decay, patients experiencing the symptom or taking medications than increase dryness should have a plan for keeping their mouth clean and well-hydrated.
“Estrogen also plays a role in osteoporosis and the loss of bone strength in the body and jaw. In the past, some medications prescribed for osteoporosis were suspected in the development of osteonecrosis of the jaw which made oral surgery and reconstruction of the jaw and face after an accident more difficult and risky. Now the problem seems to be related to using certain drugs in people who have specific health problems.”
Still, the recommendation to make sure any dental issues are addressed and preventive care is up-to-date before beginning difficult treatments is likely to put the patient in a better position to focus on getting better. Recovering from heart surgery or chemotherapy can be demanding enough without the pain of suddenly needing a root canal.
If you want to see a picture of health, look for a healthy smile.
“You can tell a lot about a person’s overall well-being just looking in their mouth,” Geisinger said. “How well they are taking care of their teeth and gums is a clue to how well they are taking care of the rest of their body. The mouth is where good health begins, supporting and nourishing every cell of the body. Early warnings often show up in the mouth first. You can see stress and anxiety in how people grind their teeth or clench sore jaws at night. Side effects of medication and the symptoms of some diseases show up here first. The better doctors and dentists communicate, the better we can take care of our patients.”