Women’s Oral and Overall Health
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| Leslie R. Halpern, is a Dentist at the Braintree office. |
By Leslie R. Halpern, MD, DDS, PhD, MPH
The oral cavity has been described as the window of systemic disease. Evidence strongly suggests that oral health is especially linked to the general health and well being of women and therefore women should adopt a healthy lifestyle for both optimal oral health and overall health. The association of oral health issues and the overall health of women throughout their life span include:
- A variety of oral health problems can affect women who suffer from eating disorders such as Anorexia Nervosa and Bulimia.
- Sexually transmitted disease and its transmission during pregnancy can affect the oral health of both the mother and child.
- The relationship between gum disease, spontaneous abortion and/or low birth-weight of offspring is a new concern for both the patient and dentists.
- The relationship between and among periodontal infection, loss of bone, and osteoporosis in young and geriatric patients.
- Risk of oral health problems associated with medications that treat osteoporosis, as well as other hormonal therapies during the life span.
- The overall dental health care team’s role in identifying victims of domestic, child, and elder abuse.
- Oral health disparities and substance abuse in women as compared with men.
The oral health issues stated above are associated across the life span of women.
Infancy/Childhood:
In infancy and childhood the development of a cleft of the palate occurs with greater frequency in women. Cleft lip is greater in males. Causes for clefting include substance abuse, i.e. alcohol, tobacco, drugs or risk based upon the environment. The dentist plays an important role in helping children with clefting to have normal nutrition and speech throughout their early years of development.
During adolescence, with the onset of puberty, hormonal changes in girls cause bleeding gums and excess plaque. Both lead to gingivitis and painful gums. There are greater degrees of decayed and filled teeth in females, suggesting a link between puberty and plaque formation. In young adult females, eating disorders such as Anorexia Nervosa and Bulimia are quite prevalent. Oral facial changes are noted such as swollen glands, injured palates and severe breakdown of anterior teeth from acidic stomach contents due to self-induced vomiting. The dentists as well as the hygienist can see and treat these problems.
Pregnancy:
Both physical and emotional changes during pregnancy can affect maternal oral and overall health. Pregnancy is a critical time when maternal health care and nutrition have significant influence over the oral health of the unborn child. The total health and tooth development of their children, therefore, begins with prenatal care. Maternal diet and nutrition can affect the health of the child. Specifically, vitamins A and D affect enamel formation. Deficiencies in these nutrients can cause childhood caries and weak enamel leading to further decay and loss of teeth. Premature birth and/or neonatal death may be related to severe periodontal disease in pre-term mothers. Other examples of oral health consequences in offspring include facial and tooth deformities, low birth-weight, premature birth with developmental challenges, delayed dental development, and poor dentition. The dental professional plays a pivotal role in recommending preventive measures to ensure the health and well being of a mother and her unborn child.
Peri-menopause/Menopause:
The peri-menopausal and post-menopausal stages are associated with a variety of oral and systemic health problems. The marked decline in levels of estrogen and other hormones results in a woman’s predisposition to a variety of diseases including cardiovascular disease, osteoporosis and autoimmune diseases. Xerostomia (dry mouth) and dry eyes are quite prevalent. For instance, Rheumatoid arthritis (RA), common in women, has dental and other oral symptoms. These oral complications set the stage for increased caries, opportunistic fungal infections (Candida), and poor wound healing. Because RA can also cause a variety of gastrointestinal problems, many patients with this disease are referred for consults with medical colleagues.
Osteoporosis is a common disease seen in this patient population. The lifetime risk for osteoporosis in women is 40% and is 15% in men. It is well documented that bone density in women decreases from early childhood to adulthood. It has been especially associated with periodontal disease and tooth loss in women.
Recent attention has been directed to the relationship between the use of medications for the treatment of osteopenia/osteoporosis and other diseases, either orally or by intravenous administration, in female and male patients. Bisphosphonate therapy, especially, has been shown to increase the development of a disease called osteonecrosis (OCN) of the jaw. It is characterized by infection and loss of bone continuity and painful symptoms that prevent good nutrition and oral health. In light of the uncertainty surrounding the incidence of bisphosphonate-associated osteonecrosis of the jaw (BON) and concomitant risk factors, dentists and their medical colleagues have questioned how to manage the care of patients receiving oral bisphosphonate therapy.
The American Dental Association has developed a consensus statement that informs their medical colleagues who send these patients for consult and treatment. These guidelines coupled with the practitioner’s professional judgment and the individual patient’s preferences and needs provide for optimal oral and overall health care in cases of bisphophonate therapy.
Substance Abuse:
Substance abuse such as smoking and alcohol consumption result in severe periodontal disease with loss of teeth and bone in women and men. With respect to tobacco use, however, it is women who have more difficulty in quitting. As of the last five years, lung cancer has killed a greater number of women than breast cancer. With respect to alcohol, women who drink have higher blood alcohol levels than men and can develop liver disease and heart damage at a faster rate. The consumption of alcohol by women during their pregnancy places significant risk to the child with respect to developmental problems and clefting of the lip and palate. Risk of HIV transmission is a global problem with women bearing greater symptomatology than men and transmitting viral infection to their offspring. The risk of opportunistic oral infections is greater. Their dentist must carefully follow this patient population so that preventive methods can be applied to decrease the risk for poor outcomes with respect to the oral cavity and its influence on the body.
In summary, the evidence stated above encourages the dental healthcare provider, along with his/her medical colleagues, to address not only women’s oral health conditions but also total over all health. The interaction between the two will allow for the complete care and well being of our patients whether male or female.