How Menopause Affects Teeth and Gums

Every significant change in hormone levels has an effect on the gums and on the other nearby tissues that support the teeth.  However, the hormonal changes of menopause affect the gum health of women more permanently than the hormonal changes of puberty, menstruation or pregnancy.

In the overview section on the Healthy Gums page, we saw how the various living tissues around the tooth (including the gums) work together to keep our teeth in good condition.  And on the on Gum Disease page with details about plaque, gingivitis and periodontal disease, we saw how gum disease typically starts from the outside surface of the gums and teeth, and moves into the interior connective tissue around the tooth and ultimately to the tooth-supporting ligaments and bone.  With the onset of menopause, we also have to be concerned about changes originating in the jaw bone itself.

Bone cells throughout the body are steadily being replaced to replenish the bone structure.  It’s as if two sisters were to build a giant sand castle on a beach for a sand sculpture exhibition.  As people come by with ice cream cones to “ooh” and “aah,” the sun starts to dry out some sand and then tiny bits of turret or drawbridge start to crumble.  To keep the sand castle in good shape, one sister brushes the crumbled sand into a plastic bucket, and the other adds sea water to the sand and re-sculpts the missing bits.  But if something slows down the sister who is re-sculpting the little bits, and the other sister keeps brushing away crumbling sand at the same pace, the castle will deteriorate.  Similarly hormonal change can upset the balance between building new bone cells (remodeling) and breaking down old bone cells (resporption), and bone loss can occur.

The same resorption and remodeling processes take place in the lower jaw (the mandible) as in all bones of the skeleton, but at a much faster rate than in the other bones.  So the jaw bone is often the first bone in the body to experience this kind of deterioration after menopause.  It’s such a common occurrence that the loss of bone in the lower jaw that’s associated with periodontal disease is often considered a predictor of osteoporosis throughout the rest of the skeleton.

If there already is a bacterial inflammation of the gums that are adjacent to the jaw bone (gingivitis), the balance can quickly get out of hand and lead to the destruction of gum and bone tissue (periodontal disease) during menopause.  Going back to the sand castle analogy, hormonal changes might be slowing down the sister rebuilding the sand castle, but bacterial infection is like a magnifying glass focusing sunlight on the castle, causing additional bits of it to crumble faster.  The balance between breaking down (resorption) and building up (remodeling) can get out of hand quickly and severely.  It shows up in the high numbers of periodontal problems experienced by women after menopause.  While women generally take better care of their teeth than men, women make up three-fourths of the visits to periodontists, with problems no less severe than those of men.  By the age of 65, almost a third of women have lost many or even all of their teeth.  The situation tends to be worse for impoverished minority women, but a 2005 study in Buffalo, New York on post-menopausal white women showed that over half of them also had problems, having lost at least one tooth to periodontal disease in the previous 10 to 13 years.

Periodontal disease, whether triggered by menopause or other factors, can cause more problems than losing teeth.  It’s also associated with heart disease, the #1 cause of death for women as well as men.  And it’s also associated with other serious whole body diseases.

During menopause it’s very important to avoid periodontal disease, which means keeping the plaque bacteria of the mouth in check, the mouth (gum, periodontal ligaments and alveolar bone) cells strong through good nutrition and beneficial supplementation, and the mouth environment in balance.  This is the approach we recommend.

The approach can also help offset menopause’s tendency toward reduced production of acid-neutralizing saliva.  Saliva somewhat neutralizes acids in the mouth, thereby making the mouth environment less hospitable for acid-loving, plaque-causing bacteria.  Besides promoting bacteria and their production of plaque, acid also acts to break down tooth enamel, but saliva contains minerals (particularly calcium and phosphate) that help to strengthen the microscopic structure of tooth enamel in a process called saliva remineralization.