Oral Health Across the Life of a Woman
Author: Dr. Hafsa Shah
Oral health means the health of the mouth. According to FDI ( Fédération Dentaire Internationale) – Oral Health is multifaceted and includes the ability to speak, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of craniofacial complex( head, face and oral cavity). Here is all you should know about women and their oral health issues.
Women Hormones and Oral health
Women may be more susceptible to oral health problems because of the unique hormonal changes they experience at certain stages of life. These are puberty, menstruation, when using oral contraceptives, during pregnancy and at menopause. One needs to pay extra attention to their oral health during these stages as hormones affect the body’s response to toxins that result from plaque build up leading to the development of periodontal disease.
PUBERTY – Raging hormomes can leave a teenage girl’s gum red, swollen and bleeding. This is known as GINGIVITIS. Some teenage girls may also find themselves developing canker sores which usually heal on their own.
MENSTRUAL CYCLE– During menstrual cycle, there is an increase in levels of hormone progesterone due to which some women experience oral changes that can include bright red swollen gums, swollen salivary glands, and development of canker sores or bleeding gums. Menstruation gingivitis usually occurs a day or two before the start of period and clears up shortly after period has started.
USING BIRTH CONTROL PILLS – Birth control pills (hormonal contraceptives) contain progesterone, which increases the level of that hormone in the body. These hormone changes can bring about an inflammatory response in the gums leading to sore, swollen or
bleeding gums. According to Journal of ADA (American Dental Association) women who use oral contraceptives are nearly twice as likely to experience dry socket after having a tooth extracted. Be sure to tell your dentist if you are taking an oral contraceptive during your visit as your dentist may need to write a prescription and some medications can make your birth control less effective.
PREGNANCY – During pregnancy a woman’s body is in hormonal hyperdrive. Changing hormonal levels accentuates the gingival response to plaque. Nearly 60-75% of pregnant women have gingivitis that occurs when gingival becomes red and swollen and sometimes has raspberry like appearance. There is an increased tendency to bleed however it is usually painless. In some cases, the inflamed gingival forms discrete tumour like masses which are referred to as pregnancy tumours. It is most common between second and the eight months of pregnancy (first and third trimester respectively). Partial reduction in severity of gingivitis occurs by 2 month postpartum, and, after 1 year, the condition of the gingiva is comparable to that of patients who have not been pregnant. Approximately 40% of pregnant women have some form of periodontal disease (inflammatory disease of tissues surrounding and supporting the teeth). Pregnant women may also be at risk for cavities due to changed eating habits.
MENOPAUSE – During menopause, the usual rhythmic hormonal fluctuations of female cycle are ended. There is a huge change in a woman’s life and woman’s mouth. The oral symptoms include altered taste, burning sensation and increased sensitivity to hot and cold foods. The gingival and remaining oral mucosa are dry and shiny, they vary in colour from abnormal paleness to redness, and they bleed easily. There are two critical changes to be aware of: Dry mouth and Bone loss Dry mouth, also known as xerostomia, can result in the development of tooth decay and gum disease because saliva is not available to moisten and cleanse the mouth. It is important to know that dry mouth can also result from many prescription and over-thecounter medications. The gradual loss in estrogen that occurs with menopause also puts older women at risk for loss of bone density (a condition called osteoporosis) which can lead to tooth loss. Receding
gums, which expose more of the tooth surface to potential tooth decay, can be a sign of bone loss in the jawbone.
Oral health problems and its relationship with general health
Mouth is a gateway to the body. A healthy mouth can help you maintain a healthy body. Researchers have discovered a connection between declining oral health and underlying systemic conditions. Oral bacteria and the inflammation associated with a severe form of gum disease known as periodontitis might contribute to various diseases and conditions, including:
Endocarditis: This infection of the inner lining of the heart chambers or valves typically occurs when bacteria or germs from another part of body, such as mouth, spread throughout the bloodstream and attach to certain areas in the heart.
Cardiovascular diseases: Although a direct casual link between periodontal diseases and vascular diseases has not been shown to date, clogged arteries and stroke may be linked to the inflammation and infections that oral bacteria can cause .
Diabetes: Gum disease appears to be more frequent and severe among people who have diabetes. This led to the designation of periodontal disease as a complication of diabetes by Löe H in 1993. Research shows that people who have periodontitis have a harder time controlling their blood sugar levels. Regular periodontal care can improve diabetes control.
Adverse Pregnancy Outcomes: Pregnant women with periodontal diseases have been reported to be at increased risk of adverse pregnancy outcomes, including preeclampsia, preterm delivery and low birth weight. There is a two-fold increased risk for preeclampsia (hypertensive disorder) in presence of periodontal disease and it is a major cause of perinatal and maternal morbidity and mortality. Periodontal disease is associated with an increase in the systemic levels of inflammatory mediators which have a potential to cause premature rupture of membrane leading to delivery of preterm and low birth weight infant. Other conditions that might be linked to oral health include pneumonia and other respiratory disorders, rheumatoid arthritis, eating disorders and an immune system disorder that causes dry mouth (Sjögren’s syndrome)
Prevention of Oral Health Problems in Women
Hormones are a fact of life, but they don’t have to interfere with a woman’s ability to maintain a healthy smile at every age and stage of life.
– The best ways to keep your teeth and gums healthy are to:
– Brush your teeth atleast twice daily ( preferably with a fluoride toothpaste)
– Floss your teeth atleast once a day
– Clean your tongue to remove bacteria atleast once a day
– Rinse mouth with antiseptic mouthwash atleast once a day
– Decrease intake of sugars and eat a high-fibre, low fat diet that includes plenty of
fruits and vegetables.
– Drink fluoridated water
– Avoid tobacco products
– Replace toothbrush every three to four months
– Have your teeth cleaned by a dental professional every six months.
A woman should not skip her dentist appointments while pregnant. Treatment during every trimester is safe with the second trimester being the safest. Just make sure you let your dentist know that you are pregnant. Taking everything into account ,the broader societal impact of improving oral systemic health cannot be overemphasized. We need to only educate ourselves and implement small logical changes in our practice.
As Hummel et al state, “It is time to include oral health in routine medical care and achieve the promise of comprehensive, whole person care for all.”