The Unique Oral Health Needs of Women
Due to the many changes that occur in the lifetime of a woman, their health and oral care needs are unique. Puberty, pregnancy, menstruation, menopause and postmenopause all influence their treatment plan and how dental needs are met.
Hormonal fluctuations change the oral tissue, and an increase in hormones can even promote the growth of harmful bacteria. From puberty into young adulthood, oral health is also complicated by poor eating habits such as increased processed sugar intake, fad diets and bulimia; this is also when smoking is often introduced. Nutritional deficiencies can change lip, mucosa and gum health, and bulimia will further delay their healing. Decay is also found at a higher rate in bulimics due to tooth erosion and poor nutrition and eating habits. Also, high levels of caffeine, protein and sodium have been linked to bone loss.
Changes associated with menstruation are not always due to the period itself, but to hormonal imbalances experienced during menstruation. Not only can the monthly cycle cause puffy, red, tender gums, it can also cause an increase in gum and tooth sensitivity. This is also a time when a woman is more vulnerable to cold sores and canker sores.
Smoking can effect how early a woman starts menopause—smoking as a teen increases the occurrence of early menopause by a factor of three—which will also increase the progression of periodontal disease due to premature hormonal fluctuation. The latest data shows that women are more susceptible to lung cancer than men, and there is evidence that estrogen-related hormones may promote cancer in women exposed to tobacco smoke, even if they are no longer a smoker.
Periodontal health in a pregnant woman can be as simple as light gingivitis or as advanced as pregnancy tumors. It is preferable that dental treatment should only received during the second trimester. Regular cleanings are an important practice to prevent bacteria from entering the bloodstream and affecting the baby. Periodontal disease during pregnancy has also been linked to preterm low birth weight. Pregnant women also need to be aware of an increase in decay if they frequently throw up (bulimia), experience a change in saliva flow or have episodes of dry mouth.
Birth control pills may cause changes similar to pregnancy, and if an antibiotic is needed for a dental infection, that will decrease the effectiveness of the birth control. It is also much safer to delay extractions during the last week of the cycle, because the lack of estrogen could cause complications leading to a dry socket condition.
Menopausal and postmenopausal women need to monitor their blood sugar levels more closely, especially if they are already diabetic, to prevent taking too high or too low a dose of insulin. The fluctuation of hormones will cause an increase of blood sugar levels in times of hot flashes and menopausal symptoms. When hormones are decreased, the blood sugar drops and there are more issues with hypoglycemia.
Bone density is another aspect of oral health to consider. Women with decreased levels of estrogen, osteoporosis or osteopenia must be careful if they are at risk of or already have gum disease, due to the potential of faster bone loss. There has also been a higher rate of failure of implants in women with low estrogen and low bone density. They should also speak with their treating medical doctor before starting any orthodontics. Possible medications such as bisphosphonate and HRT taken during this time will change how the body responds to dental treatment, and may even require specialized care for surgical treatments.
Alternatives for medications that treat low bone density, hormonal increases/decreases and menopausal symptoms can be found by working with an alternative/integrative practitioner or acupuncturist. There are also yoga stretches and special Kegel exercises that balance the hormones.
Dr. Andie Pearson, DMD, CSST, is the owner of Gaiamed Dental, in Wilmette, a full-service holistic dental practice using the most biocompatible dental options. For more information, call 847-977-1655 or visit HolisticDentalChicago.com.