Perio and the post- menopausal patient - DentalProductsReport.com

Pros and cons of HRT

Pros:

Prevents bone loss that can lead to osteoporosis
Relieves symptoms of menopause
Lowers risk of colon cancer
Lowers risk of macular degeneration, vision loss that occurs when the macula, the part of the retina at the back of the eye that provides sharp, central vision, deteriorates with age

Cons:
While HRT may help many women get through menopause, the treatment is not risk free. Known health risks include:

An increased risk of endometrial cancer (if a woman still has her uterus and is not taking progesterone along with estrogen)
Increased risk of blood clots
Increased risk of stroke
Increased risk of gallbladder disease
Increase in blood pressure in some women
Increased risk of larger, more invasive breast cancers (combination HRT only)

Source: WebMD

Beyond tooth loss

While the overarching goal of dental and periodontal therapy is preventing tooth loss, it is by far not the only consequence following the loss of endogenous estrogen production. Many women may notice more subtle symptoms such as dry mouth and altered taste sensation, while also possibly developing more serious pain and burning sensations in the gingiva, cheeks and tongue, including desquamation and bleeding of the gingival tissues.^19,20 These symptoms, while not as dramatic as tooth loss, can have significant detrimental effects on a patient’s quality of life.

Burning mouth syndrome (BMS) for one, is rarely seen in women younger than 30. The usual demographic time of onset is between 3-12 years after menopause.²¹ BMS patients frequently have depression, anxiety, sometimes diabetes, and even nutritional/mineral deficiencies, but overall, it is difficult to explain the pathogenesis of BMS even in light of these associated diseases. Treatment is still often palliative in nature, but therapies today tend toward suppressing neuropathic transduction, including the use of anti-anxiety and antidepressant medications.^21-23

Desquamative gingivitis is another clinical finding characterized by epithelial desquamation, erythema, ulceration and/or the presence of vesiculobullous lesions of gingival and other oral mucosa. Several conditions can result in desquamation, including lichen planus, cictricial pemphigoid, and pemphigus vulgaris.^24,25 Another interesting finding is that these conditions are most commonly found in postmenopausal female patients older than 49.^26,27 The presence of these conditions can complicate treatment, from straightforward prophylaxis to gingival grafting.²⁸ Successful treatment of these conditions is predicated on establishing the correct diagnosis via biopsy and immunofluoresence testing and eliminating contributing etiologic factors, such as plaque accumulation and removal of irritants.^29,30 Most treatments center around the use of topical steroids to relieve pain, control inflammation, and allow tissue repair and normal maturation.

Conclusion

Our female patient population faces numerous challenges during the onset of menopause and depending on the patient, postmenopause. Included among these complications are any number of oral complications, from the severe (i.e. tooth loss), to the subtle (gingival redness, inflammation, altered taste sensation). It is up to the dental professional to be wary of the signs and symptoms, to listen to patients as they detail any changes to their quality of dental function, and institute treatment regimens that allow correction and prevention of future problems.

Eduardo R. Lorenzana, DDS, MS, is a Diplomate of the American Board of Periodontology and maintains a private practice limited to Periodontics and Dental Implants in San Antonio, Texas. Dr. Lorenzana earned his certificate in Periodontics and Masters in Oral Biology from Baylor College of Dentistry–TAMUS in Dallas, Texas. Dr. Lorenzana holds academic appointments at BCD-TAMUS as an Adjunct Assistant Professor in the Graduate Periodontics Department and at The University of Texas Health Science Center in San Antonio Dental School as a Clinical Assistant Professor in the Department of Restorative Dentistry. Dr. Lorenzana is a Fellow in the International Team for Implantology (ITI) and is President of the Texas Society of Periodontists.

References
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