Interview from Charlotte Weekly, 7/17/09

Q: Dr. Van Gurp, I understand that today’s focus is on hormones and women’s oral health.

Dr. Van Gurp: Women have an increased propensity for oral health problems because of the hormonal changes that take place throughout their lives.

In general, these hormonal changes affect both the blood supply to the gum tissue and the body’s response to the toxins (poisons) that result from plaque build up.  As a consequence of these changes, women are more susceptible to the development of periodontal disease at certain stages of their lives, as well as to other oral health problems.

Q: Are there specific times in a woman’s life that one should be particularly concerned about these hormonal changes and their dental health?

Dr. Van Gurp: Actually, it is not confined to one specific point in time but more like several situations in the course of a woman’s life where there is an increased sensitivity to oral health problems.  They are: puberty, the monthly menstrual cycle, during the use of oral contraceptives, pregnancy and relative to menopause.

Q: Let’s hit this one at a time.  Tell me first about the effects of puberty.

Dr. Van Gurp: The body’s production of the hormones estrogen and progesterone increases dramatically during puberty.

The result of this can be an increase in blood flow to the gums.  It can also alter the manner in which the gum tissue reacts to bacterial plaque.  So what one might notice is gum tissue that is more red, tender and swollen.  And you are more likely going to see bleeding of the gums during brushing and flossing.

The presence of plaque on the teeth can worsen this response. This underscores the importance of good brushing and flossing habits learned at an early age, combined with periodic dental visits and cleanings. The tendency for inflammation and swelling associated with puberty appears to decrease as a young woman gets older.

Q: Let’s move on to the monthly menstrual cycle.  What kind of oral health concerns do you have there?

Dr. Van Gurp: Hormonal fluctuations during the monthly menstrual cycle can have a significant effect on the oral cavity.  Usually, these changes take place a few days prior to menstruation when progesterone levels are high.

Q: What does the progesterone do to the gums?

Dr. Van Gurp: Progesterone causes dilation of blood vessels, which in turn results in inflammation and thus obstructs the normal repair mechanisms of the gums.  So as with the puberty signs above, one finds red, swollen and tender gums that may bleed easily.  Note that if there is pre-existing periodontal disease present, these changes can be severe.

Q: What if the condition does doesn’t get better?

Dr. Van Gurp: If the condition doesn’t resolve soon after menstruation, you may want to consult your dentist.  Women that experience changes in their gums during their menstrual cycle may be more susceptible to a condition called Rapid Progressive Periodontitis.  This rather aggressive form of periodontal (gum) disease can cause rapid bone loss around the teeth.

Q: Are there other problems aside from periodontal disease that can occur during the menstrual cycle?

Dr. Van Gurp: A few days prior to the menstrual cycle, some women may develop cold sores on the lips or aphthous ulcers on the soft tissue inside the mouth.  Both of these will typically heal themselves within a few weeks.  During that two week period, topical ointments can be applied to relieve the discomfort.

Some women may also notice swelling of the salivary glands – in particular the parotid gland on the cheeks.  If the swelling is related to the hormonal changes experienced during the menstrual cycle, the changes are temporary and should be reversed within a few days.

The key to resolving the gum disease-related changes is good oral hygiene to remove any plaque that is present on the teeth.

Q: How do birth control pills affect a woman’s dental health?

Dr. Van Gurp: Women who take certain oral contraceptives that contain progesterone may experience inflamed gum tissue due to the body’s exaggerated reaction to toxins produced by bacterial plaque.  These changes are most pronounced during the first few months of taking birth control pills.

As a side note, women who take oral contraceptives should also bear in mind that antibiotics can reduce the effectiveness of birth control pills.

Q: I am seeing a pattern here.  Increased levels of certain hormones and in particular progesterone can lead to inflammation, the body’s exaggerated response to the toxins or poisons produced by plaque on the teeth and gums.  The result may be significant gum disease.

Dr. Van Gurp: That is correct.  And this also holds true during pregnancy when there are significantly elevated levels of estrogen and progesterone. I cannot emphasize enough the importance of good oral hygiene during pregnancy. In the presence of plaque, women who are pregnant are more prone to gum inflammation and periodontal disease. This appears to be more likely during the second through eight month of pregnancy.

In addition, studies show that women with periodontal disease may be at risk for pre-term, low birth-weight babies.

Q: What kind of oral changes take place due to menopause?

Dr. Van Gurp: There are a number of changes that can take place in the mouth as a result of menopause.  As estrogen levels decrease during menopause, women can find themselves at a greater risk for osteoporosis and periodontal disease that includes bone loss from around the teeth.

Jaw bones exhibiting osteoporosis may be unsuitable for dental implants and/or conventional prosthetic devices.  Other oral changes include altered taste, a burning sensation in the mouth and an increased sensitivity to hot and cold foods and drinks.

In addition, women might find that they do not produce as much saliva in their mouths as they did prior to menopause.  The result is a dry mouth, which in turn can lead to periodontal disease and dental decay because insufficient saliva is available to cleanse the mouth by neutralizing the acids and toxins produced by bacterial plaque on the teeth.

Preventing or at least decreasing the likelihood of the dental problems discussed above comes down to good oral hygiene – brushing and flossing.  See a dentist on a regular basis for cleaning and exams. And watch your diet. Eat a well balanced diet and avoid sugary snacks.

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