Menopause and Oral Health

Menopause has been linked to substantial orofacial changes. The decrease in oestrogen has a wide-ranging impact on the salivary glands, oral mucosa, and periodontal health. Menopausal women have a higher prevalence of xerostomia compared to premenopausal women, which may be disproportionate to their rate of salivation. In addition, saliva demonstrates a decrease in pH, an increase in calcium, and a decrease in lysozyme activity. Reduced salivary flow may result in oral dysphagia, dysgeusia, increased caries incidence, and oral candidiasis, all of which have detrimental effects on quality of life. Mucosal changes include thinning and atrophic oral mucosa, which makes it prone to local mechanical injuries and ulcerations. In the absence of evident mucosal lesions, burning mouth syndrome presents as a burning or stinging sensation, typically on the anterior two-thirds of the tongue, lower lip, mucosa, and hard palate which can lead to irritability, anxiety, and depression. Mucosal alterations can also result in autoimmune diseases such as oral lichen planus, pemphigus vulgaris, and benign mucosal pemphigoid. Lastly, periodontal deterioration may occur during menopause due to systemic changes in bone mineral density caused by osteoporosis and an increase in proinflammatory cytokine production. Sufficient fluid intake, saliva substitutes, appropriate topical or systemic pharmacotherapy, maintaining good oral hygiene, regular dental visits, and managing osteoporosis are recommended for managing oral effects. Contradictory evidence exists regarding the efficacy of hormone replacement therapy in reducing oral symptoms, as the effect is extremely individual. Oral health specialists, gynaecologists, endocrinologists, and physicians must be aware of the challenges associated with menopause and provide these women with a comprehensive health plan that includes oral health care.