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Menopause can have a terrible effect on the oral health of women so why aren’t we talking about it with patients? By Kerryn Ramsey
While the effects of menopause are well known—hot flashes, mood changes, night sweats, muscle aches—there can also be negative oral health implications. Women in perimenopause and menopause are at an increased risk of developing oral health problems due to declining levels of the oestrogen hormone.
Recent research by pharmaceutical company Astellas Pharma revealed there is still a stigma around menopause. Despite 82 per cent of women who experience symptoms reporting impacts on their quality of life, many don’t feel comfortable talking about it. This reluctance to broach the subject makes it even more difficult for dentists to offer guidance and treatment options.
Dr Alistair Graham, owner and principal dentist of Mona Vale Dental on Sydney’s northern beaches, has many clients who are going through one of the three stages—perimenopause, menopause, and post-menopause.
“Our main demographic is families with many women in the 45 to 55 age bracket,” says Dr Graham. “I’ve found the best approach is to be open and honest about the condition. It’s nothing to be embarrassed about but a little empathy certainly goes a long way. I just try to open the lines of communication so we can have a forthright conversation.”
Dealing with symptoms
Menopause can affect the mouth in many ways including tooth sensitivity, ulcers, receding gums, cavities, loose teeth and reduced saliva flow.
“Lower oestrogen levels can lead to reduced blood flow to the gums,” says Dr Graham. “This can impede regeneration and impact on the immune system. Menopause can also lead to osteoporosis and even though it’s not necessarily a dental problem, long-term medications can have serious dental implications.”
Dental care providers are well positioned to initiate conversations with female patients and there’s a simple way to get the ball rolling.
In September 2022, Dr Namitha Thomas commenced a PhD study called ‘Promoting oral healthcare among women in perimenopause/menopause: A mixed methods study to inform intervention strategies at the Australian Centre for Integration of Oral Health, School of Nursing and Midwifery, Western Sydney University’.
“Participants in our study indicated that easily accessible information in dental waiting areas would have been helpful,” says Dr Thomas. “This would also encourage conversations with dental care providers. Despite this, educational resources on oral health and menopause are scarce.”
While all women go through menopause, it only has a negative oral health impact on slightly over 50 per cent. Many see very little symptom changes.
Support and training programs are needed for dental care professionals, along with revised guidelines and recommendations for dental providers to assist in managing women’s oral health needs in perimenopause and menopause.
Dr Namitha Thomas
“If a woman has existing periodontal disease with a relatively high decay rate, menopause may compound and exacerbate underlying issues,” says Dr Graham. “Without diagnosis or treatment, it will accelerate the existing problem. Saliva is beneficial to the remineralisation and rehydration of the mouth. An untreated reduction in saliva flow can certainly lead to bone degradation and permanent tooth loss.”
Talking about it
While much has been done to demystify and remove the stigma of menopause, dentists need to respect that it’s an uncomfortable subject for some women to discuss, particularly with a male dentist.
“Women in our study revealed a lack of awareness and knowledge about oral health changes associated with menopause,” says Dr Thomas. “They tended to assume adverse changes were due to ageing and therefore not preventable. Some women highlighted that their dentists did not volunteer information about the impact of menopause; instead, they simply dealt with their presenting complaints. This led to a lack of confidence in initiating conversations about menopause with their dentist.”
With such negative oral health implications, strategies need to be used to broach the subject in a non-confrontational way.
“Menopause affects 50 per cent of the population and we shouldn’t be brushing it under the carpet,” says Dr Graham. “As health professionals, we can’t be afraid to have those conversations. The best way is to inform the patient that her symptoms could be related to menopause and ask if this is something that’s affecting her. It’s all about opening the door to an honest and helpful conversation.”
Deducing the effects of menopause during an oral health examination is relatively straightforward. There may not be a single red flag, but an accumulation of symptoms in a woman in the target age range makes it likely. The dentist can point out these symptoms and gently suggest that menopause may be a cause.
Medical treatment
While it’s important to effectively treat the oral health issues, it’s just as important for the client to seek advice from a GP. The patient may then choose medication or, in some cases, hormonal treatment.
“From a dental point of view, we want to get the underlying cause treated rather than put out spot fires,” says Dr Graham. “We can look at rehydrating the mouth while encouraging ideal oral hygiene. Regular maintenance with dental professionals ensures we stay on top of any issues but it’s crucial that we point them towards their general medical practitioner.”
Raising awareness
Fully explaining the impact of perimenopause and menopause at an early stage can promote good oral hygiene and improve overall health. However, it’s not just about raising awareness.
“We should be creating safe spaces for women to encourage conversations about menopause-related oral health concerns with their dental care providers,” says Dr Thomas. “Support and training programs are needed for dental care professionals, along with revised guidelines and recommendations for dental providers to assist in managing women’s oral health needs in perimenopause and menopause.”
A frank and honest two-way conversation between dentist and patient needs to be the priority in addressing the situation, adds Dr Graham. “As it is with all medical conditions, putting your head in the sand is never a solution.”
Comprehensive menopause resources can be found at:
- Australian Menopause Centre, menopausecentre.com.au
- Australasian Menopause Society, menopause.org.au
- Dr Namitha Thomas’ study: doi.org/10.1111/jmwh.13668
- The M Factor: Shredding the Silence on Menopause (documentary), pbs.org
