Oral Health: What Women Need to Know?

International Women’s Day celebrated annually on March 8th is a time when people around the world come together to celebrate women’s achievements while raising awareness for gender equality; reproductive rights; and violence and abuse against women.

As part of this female focus, let's know about women’s oral health. Owing to hormonal influences, women have unique needs when it comes to dental care . 

This blog reviews phases of the female life cycle from puberty through menopause.

PUBERTY

Puberty occurs between the ages of 11-14 in most women. The production of sex hormones - estrogen and progesterone increases. Also, the prevalence of gum diseases (gingivitis) increases without an increase in the amount of plaque. As part of preventive care, brushing, flossing & tongue cleaning twice a day becomes vital. 

This age group is also susceptible to eating disorders - bulimia & anorexia nervosa. The chronic regurgitation of gastric contents on intraoral tissues leads to  perimolysis (smooth erosion of enamel & dentin), usually on the palatal surfaces of maxillary anterior teeth. Enlargement of the parotid glands may be seen in the patients who binge & purge, causing reduced salivary flow, which in turn makes them susceptible to dental caries. 

MENSES

Gingival tissues have been reported to be more edematous (swollen) during menses & erythematous (reddish) before the onset of menses in some women. 

Increased bleeding from the gums and tenderness associated with menses require close periodontal  monitoring. An antimicrobial rinse before menses may be indicated. Emphasis should be placed on oral hygiene.

During menses, progesterone increases from the 2nd week, & peaks at approximately 10 days, & dramatically drops before menstruation. ( Note that this is based on a 28-day cycle; individual cycle varies) 

When the progesterone level is the highest, intraoral recurrent aphthous ulcers, heroes labialis lesions & candidal infections occur in some women as a cyclic pattern which necessitates 

dental visits.

PREGNANCY

The link between pregnancy and periodontal inflammation has been known for many years. Periodontal disease may alter maternal systemic health & adversely affect the well - being of the foetus by elevating the risk for low-birth-weight, preterm infants.

Pregnancy tumor or pyogenic granulomas appear may occur during the 2nd or 3rd month of pregnancy. They have the tendency to bleed easily, & become nodular. It is mostly associated with poor oral hygiene and calculus. 

Perimolysis may occur if morning sickness or esophageal reflux is severe involving repeated vomiting of gastric contents.

Dry mouth or xerostomia is a frequent complaint among pregnant women.

A rare finding is ptyalism, or sialorrhea (excessive secretion of saliva). This usually begins at 2 to 3 weeks of gestation & may abate at the end of 1st trimester.

Other than good plaque control, it is better to avoid elective dental care if possible during the 1st trimester & the last half of the 3rd trimester. 

The 1st trimester is the period of organogenesis, when the foetus is highly susceptible to environmental influences. 

In the last half of the 3rd trimester, a hazard of premature delivery occurs as the uterus is very sensitive to external stimuli. 

Early in the 2nd trimester is the safest period for providing routine dental care. The emphasis is on controlling active disease & eliminating potential problems that could arise in late pregnancy. Major elective oral surgery is postponed until after delivery.

Dental Radiographs - The safety of dental radiography during pregnancy has been well established, provided features, such as high speed film, filtration, collimation, & lead aprons are used. 

However, it is most desirable to not to have any irradiation during 1st trimester, because the developing foetus is particularly susceptible to radiation damage.

Medications should only be taken when prescribed. 

Breastfeeding - The mother should take prescribed drugs just after breastfeeding & then avoid nursing for 4 hours or more, if possible, to decrease the drug concentration in the breast milk.

Oral Contraceptives - OCs may exaggerate gingival inflammation requiring meticulous oral hygiene regimen.

MENOPAUSE

It is associated with symptoms of estrogen deficiency. Oral changes may include thinning of oral mucosa, burning mouth, xerostomia, altered taste sensation, alveolar bone loss, & alveolar ridge resorption.

Brushing with a soft toothbrush may prevent scrubbing the thinning gingiva. Toothpaste with minimal abrasives should be used. Hormone replacement therapy/HRT or Estrogen replacement therapy/ERT can be of significant help.

Reference 

Carranza's Clinical Periodontology 11th edition.