How Hormonal Changes Affect Oral Health in Adults

Understanding How Hormones Correlate to Oral Health

For both women and men, hormones affect oral health by making you more susceptible to oral health issues like gum disease, tooth loss, and jawbone density issues. This article discusses when hormonal changes occur, how hormonal changes affect oral health in adults, and what you can do to manage them.

Causes of Hormonal Changes in Women

Primarily, oral health is affected by hormonal fluctuations, such as those during puberty in both sexes. In women, pregnancy, menstruation, perimenopause, and menopause cause hormonal changes.

During Puberty

Puberty is the stage of life when children begin to transition from childhood to adulthood physically. For girls, puberty typically happens between the ages of 8 and 13. According to information found on Cleveland Clinic regarding the relationship of hormones and oral health, as women go through hormonal fluctuations, it can cause the gum tissue to become red, tender, and swollen, which can cause more potential for bleeding gums when brushing and flossing.

While Menstruating

During a female’s life, monthly menstruation causes hormonal fluctuations, particularly surges in progesterone and estrogen before menstruation. This can trigger oral issues known as menstruation gingivitis. Symptoms include swollen, tender, or bleeding gums, canker sores, and swollen salivary glands. These issues typically arise 1 to 2 days before a period and subside once it begins.

Common Oral Effects of Menstrual Hormones

• Menstruation Gingivitis: Increased progesterone elevates blood flow to the gums, making them more sensitive to plaque, leading to redness, swelling, and bleeding.
• Canker Sores: Some women experience increased development of small mouth sores just before their period.
• Swollen Salivary Glands: Swelling of the glands can occur, causing discomfort.
• Sensitivity: Increased sensitivity in teeth and gums.

During Pregnancy

Pregnant women are at a greater risk for certain oral health conditions, including gum disease (called “pregnancy gingivitis”) and growths within the mouth (known as “pregnancy tumors”). Oral health during pregnancy is important not only for the expectant mother but also for the unborn child. Oral health is an important part of prenatal care because poor oral health during pregnancy can result in poor health outcomes for the mother and baby. According to the Centers for Disease Control, about 60% to 75% of pregnant women have gingivitis, which is an early stage of periodontal disease. If gingivitis is not treated, the bone that supports the teeth can be lost, and the gums can become infected. Teeth with little bone support can become loose and may eventually need to be extracted.

Pregnant women may also be at risk for cavities due to changes in behaviors, such as eating habits. Women with increased cavity-producing bacteria during and after pregnancy could transmit these bacteria from their mouth to the mouth of their baby, affecting the child.

Key Impacts of Pregnancy on Oral Health

• Pregnancy Gingivitis: Affecting 60%–75% of pregnant women, increased progesterone levels can make gums more sensitive to plaque, causing red, swollen, or bleeding gums.
• Increased Tooth Decay: Pregnancy cravings, frequent snacking, and reduced saliva flow can increase acid levels and the risk of caries.
• Enamel Erosion: Morning sickness and acid reflux can coat teeth in stomach acid, leading to weakened enamel, sensitivity, and decay.
• Periodontal Disease: Untreated gingivitis can advance to severe periodontitis, which is associated with premature birth and low birth weight.
• Pregnancy Tumors (Pyogenic Granuloma): These are non-cancerous, inflamed, and bleeding lumps that may grow on the gums, typically between teeth, and often disappear after birth.

During Perimenopause

Perimenopause is the transitional phase leading up to menopause. The perimenopause stage is often 4 to 10 years, usually starting in a woman’s 40s (or earlier), where estrogen levels fluctuate, causing irregular periods, hot flashes, sleep issues, and mood changes. It ends when a woman has gone 12 consecutive months without a period. It affects oral health through declining estrogen levels, which cause reduced saliva production (dry mouth), increased gum inflammation (gingivitis), and a higher risk of tooth decay, sensitivity, and jawbone density loss. These hormonal shifts can lead to burning mouth syndrome, metallic taste, and increased sensitivity to hot/cold.

Key Impacts of Perimenopause on Oral Health

• Dry Mouth (Xerostomia): Reduced estrogen decreases saliva, which protects teeth and neutralizes acid, often causing dry mouth, discomfort, and a higher risk of decay.
• Gum Disease and Sensitivity: Hormonal changes can lead to inflamed, bleeding, or receding gums (gingivitis/periodontitis).
• Bone Loss and Tooth Mobility: Declining estrogen can cause a loss of bone density in the jaw, which may result in weakened tooth support and increased risk of tooth loss.
• Burning Mouth Syndrome (BMS): Some women experience a chronic burning sensation in the mouth due to changing hormones, reduced saliva, and nerve sensitivity.
• Altered Taste and Sensitivity: A metallic taste or altered taste perception is common, sometimes affecting dietary choice.

During Menopause

Menopause is a natural biological process marking the permanent end of menstruation and fertility. After 12 consecutive months without having a period, a woman is thought to be in menopause. Menopause is strongly linked to oral health through declining estrogen levels, which cause reduced saliva (dry mouth), increased risk of gum disease, tooth sensitivity, and bone density loss. These hormonal changes can lead to burning mouth syndrome, changing tastes, and higher risks of cavities or tooth loss.

Key Oral Changes During Menopause

• Dry Mouth (Xerostomia): Lower estrogen reduces saliva flow, which can cause a burning sensation on the tongue and increase cavity risk.
• Gum Disease and Sensitivity: Hormonal shifts can cause gums to become tender, inflamed, or bleed easily (menopausal gingivostomatitis), which may lead to recession.
• Bone Density Loss: Reduced estrogen can cause a decline in jawbone density, potentially leading to tooth instability and loss.
• Burning Mouth Syndrome: A feeling of heat or tingling on the lips, tongue, or roof of the mouth is commonly linked to hormonal shifts.
• Changed Taste: Some women experience a metallic or salty taste in their mouth.

Causes of Hormonal Changes in Men

Males experience significant hormonal changes primarily during puberty (ages 11 to 16) and a gradual decline in testosterone starting around age 30 to 40. This is not an abrupt “menopause”; instead, it is a slow decrease, sometimes called andropause, and can lead to symptoms like low libido, fatigue, and mood changes in some men as they age.

During Puberty

For boys, physical changes generally start between the ages of 11 and 16. In addressing puberty and hormone fluctuations in men, the article “Oral Health Across the Lifespan: Adolescents” in the NIH National Library of Medicine cites fluctuations in testosterone and androgens linked to gum disease, tooth loss, and jawbone density issues. Hormonal fluctuations that occur during puberty increase blood flow to the gums, which can cause tenderness, swelling, and increased sensitivity to plaque. This can lead to “puberty gingivitis,” characterized by bleeding gums and a higher risk of developing gum disease and increased cavity-causing bacteria.

Key Impacts of Puberty on Male Oral Health

• Puberty Gingivitis: Increased hormones, particularly testosterone, can trigger gum inflammation, making the gums red, swollen, and prone to bleeding.
• Increased Bacterial Growth: Hormonal shifts can increase microbial growth in the mouth, leading to a higher susceptibility to tooth decay, cavities, and bad breath.
• Jaw and Teeth Changes: As males go through physical growth, the jawbone changes and the last of the permanent teeth fully erupt, sometimes leading to crowding, which makes cleaning more difficult.
• Increased Sensitivity: Gums may become more sensitive to plaque, meaning even good hygiene habits might need to be stepped up to avoid gingivitis.
• Increased Risk of Tooth Decay: Increased bacteria combined with diet changes can lead to higher risks of enamel-attacking cavities.

As Men Age

Testosterone levels begin to decline when men are in their 30s and 40s, averaging about 1% decrease per year after age 30, with more noticeable, consistent drops for many starting around 40. Male menopause, known as andropause, is a condition linked to the gradual decline of testosterone levels in men. Unlike female menopause, this decline is slow, often leading to symptoms like reduced libido, erectile dysfunction, fatigue, depression, and loss of muscle mass.

As it relates to oral health, fluctuating and decreasing hormone levels in older men with andropause increase the risk of gum disease, bone density loss in the jaw, gum recession, tooth decay, dry mouth, and tooth loss. However, illness can also cause hormonal fluctuations, including:

• Chronic and acute stress
• Autoimmune disorders
• Infections and inflammation
• Endocrine disruptors
• Metabolic issues

Key Impacts on Oral Health

• Periodontal Disease (Gum Disease): Reduced testosterone weakens the immune system’s control over inflammation, making gums more vulnerable to infection, bleeding, and periodontal disease.
• Xerostomia (Dry Mouth): Decreased testosterone levels, sometimes coupled with medication side effects, can reduce saliva production, which increases the risk of tooth decay, cavities, and difficulty swallowing.
• Reduced Bone Density: Similar to osteoporosis, lower testosterone can lead to decreased bone mass, causing the jawbone to lose density, which may lead to tooth loss or issues with tooth stability.
• Increased Sensitivity: Many men experience increased sensitivity in their gums and teeth (specifically at the neck of the tooth).
• Delayed Healing: Reduced testosterone slows down tissue regeneration, leading to slower recovery from oral irritation or minor injuries.

How to Manage Oral Health During Hormonal Changes

During phases of your life when hormonal changes occur, you may not be able to manage the fluctuations, but you can take actions that will manage your oral health. Here are some ways to counteract the effects of hormonal changes:

• Brush your teeth twice a day: Use a soft toothbrush and fluoride toothpaste to brush in the morning and before bed. Do not rinse after brushing. The small amount of toothpaste that stays in your mouth is good for the teeth. See this article for the proper way to brush your teeth.
• Floss once a day: Flossing cleans between teeth where a toothbrush cannot reach.
• Prevent damage to your teeth from stomach acid: If you vomit or have heartburn, rinse your mouth afterward with a teaspoon of baking soda in a cup of water.
• Keep regular dental checkups: Consistent dental visits are essential for early detection of accelerated tooth decay or bone loss.
• Enlist lifestyle changes: Addressing high-stress levels (which increase cortisol and affect oral health), improving diet, and managing sleep can help mitigate the impact.
• Eat healthy foods: Eat more whole-grain foods, fruits, vegetables, non-fat or low-fat milk, cheese, cottage cheese, and unsweetened yogurt. Lean meats, fish, chicken, eggs, beans, and nuts are also good choices.
• Drink water: Make sure to get enough water, especially between meals and snacks. Drink tap water that has fluoride.
• Eat fewer sweets and sugary drinks: Avoid candy, cookies, cake, dried fruits, fruit-flavored drinks, pop (soda), and fruit juice.

Contact Hamby Family Dental Center to Schedule Your Dental Check-Up

It is important to keep your dentist informed when you feel you are experiencing hormonal fluctuations, such as during pregnancy for a female. If you are experiencing any symptoms, it is recommended to consult with a dentist or a doctor to discuss the changes. Our professional dental staff can listen to your concerns and outline possible solutions you can take to counteract the effects of hormones on your oral health. Contact us today by calling 919-552-2431 or by filling out our convenient online appointment request form below for a dental check-up.