The Unique Oral Health Challenges Facing Women

How Hormonal Changes Throughout a Woman’s Life Can Increase the Risk of Gum Disease and Tooth Decay

Being a woman at any age means contending with certain unique health risks. As a dental health care professional, you can help your female patients manage these risks by refamiliarizing yourself with the direct connections between a woman’s oral health and her overall health.

The teeth and gums hold vital clues to body-wide conditions. And poor oral health can increase the risk of certain fatal diseases – some of which, such as heart disease, affect women disproportionately.

By learning to recognize the warning signs of systemic illness and by encouraging good oral health habits, you can help the women in your care enjoy longer, healthier lives.

In the following sections, we’ll explore some of the oral health issues your female patients may encounter at different stages of their lives – many of them driven by natural hormonal cycles – and how those issues connect to overall health.

Oral Health Considerations After Menstruation Begins

Changing hormone levels can cause a woman’s gums to swell and become irritated. This may happen during ovulation and a few days before a woman starts her period when progesterone levels are high.

Women are also more susceptible to getting canker sores (small ulcers within the mouth with a white or gray base and a red border) during their menstrual periods.

Hormonal contraception (including oral birth control, patches, vaginal rings, and hormonal intrauterine devices) can raise estrogen and progesterone levels, making gums sensitive, red, or swollen.

The higher hormone levels associated with birth control can also prevent blood clots from forming after teeth are removed. One study found that oral contraceptive use may increase the incidence of painful dry socket in women after impacted mandibular third-molar extraction.

It’s crucial for women to develop good oral health habits and get regular cleanings and dental checkups. As you know, gum disease often goes unnoticed until it reaches an advanced state, and it is associated with several potentially deadly health conditions:

• People with periodontal disease are two to three times as likely to have a heart attack, stroke, or other dangerous cardiovascular events. Experts speculate that the relationship may have to do with periodontal disease increasing the body’s burden of inflammation. Heart disease is the number-one killer of women in America.

• Gum disease may increase the risk of developing diabetes, possibly by making it more difficult for people to control their blood sugar levels. Gum disease is also a complication of diabetes; people with diabetes are more likely to develop severe periodontal disease. Diabetes increases the risk of heart disease in women by about four times and puts women at risk for blindness, kidney disease, and depression.

• Bacteria that grow in the oral cavity can migrate to the lungs, triggering respiratory diseases such as pneumonia. People with gum disease are especially vulnerable to this phenomenon.

Oral Health Considerations During Pregnancy

To protect their own health and that of their babies, pregnant women should continue regular dentist visits and receive all necessary dental treatments. Women should let their dental care providers know that they are pregnant. Dental practices may choose not to x-ray pregnant women out of an abundance of caution, although the risks to the unborn baby are small.

Many pregnant women may not realize that they can pass cavity-causing bacteria on to their babies during and after pregnancy. This can lead to early childhood cavities and extensive dental care at a young age. Children whose mothers have multiple untreated cavities or tooth loss are more than three times as likely to have cavities themselves.

In addition, a quarter of women of childbearing age have untreated cavities, and as much as three-quarters of pregnant women have gingivitis. If you have pregnant patients, it is vitally important to instruct them that more than their own health rides on their oral hygiene routine.

Oral Health Considerations During Menopause

During menopause, a woman’s estrogen levels drop significantly. This can have an impact on oral health and comfort.

For example, low levels of estrogen can decrease the amount of saliva women generate. A dry mouth (xerostomia) can cause a number of oral health issues, such as sore and sensitive gums, cavities, ulcers, infections, and tooth decay.

After menopause, women face a higher risk of osteoporosis, which causes bones to weaken and break easily. Women with osteoporosis are three times as likely to lose teeth as those without.

This article from Dimensions of Dental Hygiene offers some guidelines for treating patients with osteoporosis and periodontitis. They include:

Routine dental hygiene care and periodontal assessments.

• More frequent radiographs.
• Evaluation for temporomandibular disease.
• Promotion of a well-balanced diet with plenty of calcium and vitamin D.
• Counseling your patients to avoid tobacco, vaping, cannabis, and carbonated soft drinks.
• Recommending the use of a power or soft-bristled toothbrush and flossing.

Oral Health Considerations for Transgender People

When considering the implications of oral health for women, it’s important to not limit these considerations to cisgender women only. Transgender people also may face unique oral health needs related to hormonal changes.

A 2019 CUNY study explained that changes in periodontal health may be associated with the variations in hormones that accompany either feminizing or masculinizing hormone therapy.

And even if hormone therapy isn’t in the picture, transgender people who were assigned female at birth may fly under the radar of dental professionals, particularly if they present as very masculine.

For this reason, it’s important to touch base with all patients, no matter what you assume their gender to be, and ask them if there are any existing hormonal issues that you should know about so as to provide more accurate care. Keep in mind that many trans people may be reluctant to come out to medical professionals due to fear of bias and discrimination, so clearly communicating that your practice is LGBTQ-friendly will go a long way toward encouraging that openness.

Your Role as a Dental Health Care Professional

Many women might not think much about how their biology impacts their oral health or that it would be any different for them than for men. It’s up to dental professionals to instruct their female patients on the need to take their oral health seriously. In most practices, dental hygienists are uniquely positioned for this educational role, as hygienists are the people patients spend the most time with, and they often establish trusting relationships with their patients.