Up to half of menopausal women in the UK have symptoms such as sore gums and tooth loss, studies show
Eileen Adamson was proud to have reached 50 without even having a single tooth cavity. She attributed it to her strict oral health regimen, which included flossing twice a week and dental checkups at least every three months. Then, two months ago, her dentist saw signs of gingivitis for the first time in her life.
“My gums were inflamed and there were signs that they were starting to recede,” says Dumfries’ teacher. “I also noticed that my mouth was becoming unbearably dry. I woke up several times during the night craving a drink, leaving me exhausted. If I drank a little too much coffee, I got that strange metallic, bitter taste.’
Eileen’s dentist suggested trying a different toothpaste made without certain substances that can irritate the mouth. But a month and a half later, there was no relief – so she arranged an appointment with a nutritionist who specializes in menopause.
“I went to her for advice on what to eat to maintain my muscle mass after menopause,” says Eileen, who had her last period two years ago. “When I mentioned the problems with my mouth, she immediately said it was probably menopausal. I was shocked.
Studies show that up to half of the 13 million menopausal women in the UK suffer from oral health symptoms such as sore gums, dry mouth, tooth loss and even phantom tastes
“It all started to make sense as I had also been experiencing hot flashes for a year and blood tests taken a few months earlier confirmed my hormones were at menopausal levels. But I thought, ‘Why didn’t anyone tell me this could happen?’
Studies show that up to half of the 13 million menopausal women in the UK suffer from oral health symptoms such as sore gums, dry mouth, tooth loss and even phantom taste – and that these are as common as hot flashes and memory loss.
But experts say too few health care professionals are aware of the link, leaving patients tossing back and forth between dentists and GPs and not receiving treatment that could help. The Mail on Sunday approached ten GPs with the question whether they would see menopause as a possible cause of any of the above problems. Only half said yes and were aware of available treatments.
dr. Uchenna Okoye, clinical director of London Smiling and former dental assistant at St George’s Hospital in London, sees this scenario in her clinic “most days”. She says, “Doctors and other dentists don’t even think menopause could have anything to do with it.
“Last week I saw a patient who had been told by her dentist that she would have to wear dentures at age 53. She had a terrible gum disease and her teeth moved, but she was ashamed, as if she hadn’t taken good care of her teeth. When I mentioned menopause, it was like a light bulb moment.”
dr. Okoye recommends that patients seek hormone replacement therapy (HRT) from their primary care physician to replenish the sex hormones such as estrogen and progesterone that decline after menopause.
A recent poll of 5,000 people indicated that 75 percent of British women visited a dentist in the past year, compared to 60 percent of men.
A 2017 study found that women who took supplemental hormones were 44 percent less likely to develop serious gum disease, the precursor to common complaints. “In some cases, patients may need a higher dose of estrogen, or in a different form, such as switching from the patch to a pill,” says Dr Okoye.
Eileen had been taking the treatment for over a year when the mouth symptoms started, but plans to ask her doctor to reconsider her dosage.
When the monthly reproductive cycle gradually stops, the dramatic drop in estrogen causes extensive damage to both the soft tissues and bones in the mouth.
“The mouth is rich in estrogen receptor cells, which depend on the hormone to function properly,” explains Dr. Philippa Kaye, primary care physician and author of The M Word: Everything You Need To Know About The Menopause. “Most of these cells are in the mucous membrane that lines the mouth and the glands that produce saliva.”
These elements keep the area sterile and moist. Without the hormone, the membrane produces less mucus, making it very dry and allowing bacteria to quickly build up. A 2003 Swedish study found that menopausal women with low levels of estrogen had significantly less saliva in their mouths and more bacteria, compared with another group of women of a similar age who took supplemental estrogen for a year.
Oral health symptoms experienced by menopausal women are as common as hot flashes and memory loss, studies show (file photo)
“Without estrogen, bacteria quickly start attacking the teeth and gums, leading to serious gum disease that leads to bad breath, bleeding gums and excruciating pain,” says Dr. Okoye. risk of them falling out.
“Many women feel like they wake up one day and their teeth are suddenly crooked,” she adds.
Estrogen is essential for making collagen, which keeps the elastic gum tissue taut and helps keep teeth in place.
And what about the metallic flavors that many menopausal women experience? Scientists aren’t exactly sure why this happens, but some think it’s related to malfunctioning estrogen receptor cells in and around the tongue. For about a third of menopausal women, this, combined with severely dry mouth, results in an extreme sensation known as Burning Mouth Syndrome, a burning or tingling sensation that can affect the lips and tongue and tends to to come and go.
But there is confusion about who is best placed to handle the problems. According to the guidelines of the National Institute for Health and Care Excellence (NICE), doctors should refer patients to a dentist for oral health problems, except for growth, muscle problems in the jaw, and suspected oral herpes.
But dr. Okoye says, “A lot of dentists don’t know what to ask about menopause, so they treat the gum disease but don’t get to the root of the problem.
A 2017 study found that women who took supplemental hormones were 44 percent less likely to develop serious gum disease, the precursor to many common complaints (file photo)
Or maybe they just offer an artificial saliva spray for dry mouth. But if the problem doesn’t go away or gets worse, patients won’t understand why.’
GPs are ‘stuck in the sand’ when it comes to treatment, says Dr Kaye. ‘The guidance says nothing about prescribing HRT to someone with oral complaints. If someone comes to us with a strange taste in their mouth and gum disease, we should first send them to the dentist for treatment.’
And this presents dentists with challenges. dr. Okoye says: ‘Our training contains almost nothing about menopause, except for a sentence at the bottom of a long list of possible causes of dry mouth. Ideally, all dentists should think about this as soon as they see a woman of a certain age.’
For most patients of Dr. Okoye HRT relieves symptoms. But for some, including those with Burning Mouth Syndrome, it’s less effective. “There are other things that can help, such as avoiding toothpastes with a detergent called SLS that further dries out the mouth,” she says. “And avoiding acidic, spicy foods and alcohol can reduce strange metallic tastes.”
Prevention is also crucial. dr. Okoye says she tells all premenopausal women to “overcompensate for what Mother Nature is going to do.” That means a full brushing at the dental hygienist every three months, instead of every six months. And floss twice a day, every day, under the close supervision of a dentist.
She says: ‘I want to arm as many women as possible with this information, so that they can ask the right questions, even if a dentist or doctor doesn’t know.’