Hormone Replacement Therapy
For over a decade now, Hormone Replacement Therapy has been used to balance hormones like estrogen, testosterone and progesterone. Estrogen therapy has been shown to significantly reduce post-menopausal symptoms, such as night sweats, hot flashes, insomnia and weight gain for many women. Over the years, research has noted additional benefits of estrogen therapy not previously found. For example, researchers have recently noted that estrogen therapy may help patients improve the health of their teeth and gums by preventing Periodontitis.
Periodontitis is a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth. Periodontitis can cause tooth loss, an increased risk of heart attack or stroke and other serious health problems. During menopause, estrogen levels fall and this accelerates the bone remodeling cycle. Loss of bone density, especially after the age of 50 years, characterizes osteoporosis and osteopenia. These disorders weaken bones including those in the oral cavity and increase chances of Periodontitis.
In the study titled Association Between Osteoporosis Treatment and Severe Periodontitis in Postmenopausal Women, patients on estrogen therapy showed a lower prevalence of periodontal disease. The goal of the study was to estimate the association between osteoporosis treatment and severe Periodontitis in postmenopausal women. This cross-sectional study included women that were over 50 years old and were in menopause for at least one year. The first group consisted of women on estrogen therapy (or estrogen and progestin) as well as calcium and vitamin D supplements for at least six months. The other group consisted of women that were on no medications at all. Severe Periodontitis was considered to be at least two interproximal tooth sites with clinical attachment loss of at least 6 mm and a least one interproximal site with probing depth of at least 5mm. Dental caries experience was measured using the decayed, missing and filled teeth (DMFT) index. Analysis included descriptive statistics and Poisson multivariate analysis with robust variance.
The results of the trial showed that women receiving osteoporosis treatment had less periodontal probing depth, less clinical attachment loss, and less gingival bleeding than women not receiving treatment group and estimated mean DMFT index score was approximately 20. Severe Periodontitis prevalence was 44% lower in the osteoporosis treatment group than in the non-treatment group. The authors concluded that these results suggest that women treated with estrogen for postmenopausal osteoporosis have a lower prevalence of severe Periodontitis than women not receiving treatment.
In 2013, a review of the literature was conducted covering 5 different studies that focused on the relationship between postmenopausal osteoporosis and periodontal disease. Experts looked at each study individually and formed conclusions based on their results. Of the 5 longitudinal studies reviewed, 4 of them (80%) showed an association between periodontal disease and osteoporosis. However, more studies would be needed to conclude that postmenopausal osteoporosis actually causes periodontal disease. Still, due to the association between osteoporosis and menopause, the authors recommend that “medical and dental professionals enhance their collaborative actions for prevention, evaluation and treatment of oral diseases and osteoporosis”.
Using this information, patients and prescribers can conclude that there is a strong association between postmenopausal osteoporosis and periodontal disease. Since Hormone Replacement Therapy (HRT) with products like Bi-Est (Estriol/Estradiol) can prevent osteoporosis brought on by menopause, prescribers can consider improvement in oral health as an added benefit to this therapy. Patients currently taking HRT can be pleased that they are not only putting their hormones in balance to improve the way they feel but preserving their oral health which will lead to healthier smiles as well.
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