Hormonal fluctuations and its effect on the physiology of the individuals has often been discussed in newsrooms and newspapers. However, less attention has been paid to the subject of oral health, which is equally important, during such discussions. it thus becomes pertinent that some time is spent delving on what hormonal changes imply for certain sets of individuals, in particular.
Individuals born with a womb, (women, non-binary individuals, transgender men among others) experiencing hormonal changes may be more susceptible to oral health problems. These hormonal fluctuations may include puberty, menstruation, or when using oral contraceptives, during pregnancy and at menopause. The people experiencing such biological cycles need to pay extra attention to their oral health during these stages as hormones affect the body’s response to toxins that result from plaque build up leading to the development of periodontal disease.
For example, during Puberty- raging hormones can leave a teenager's gum red, swollen and bleeding. This is known as GINGIVITIS. Some teenagers may also find themselves developing canker sores which usually heal on their own.
For menstruating women, there is an increase in levels of hormone progesterone due to which some individuals may experience oral changes that can include bright red swollen gums, swollen salivary glands, and development of canker sores or bleeding gums. Menstruation gingivitis usually occurs a day or two before the start of period and clears up shortly after period has started.
On the other hand, birth control pills (hormonal contraceptives) contain progesterone, which increases the level of that hormone in the body. These hormone changes can bring about an inflammatory response in the gums leading to sore, swollen or bleeding gums.
According to Journal of ADA (American Dental Association) women who use oral contraceptives are nearly twice as likely to experience dry socket after having a tooth extracted.
However, Pregnancy continues to remain one of those biological periods when a mentruator’s body is in hormonal hyperdrive. Changing hormonal levels accentuates the gingival response to plaque. Nearly 60-75% of pregnant people have gingivitis that occurs when gingival becomes red and swollen and sometimes has a raspberry like appearance. There is an increased tendency to bleed, however it is usually painless. In some cases, the inflamed gingival forms discrete tumour-like masses which are referred to as pregnancy tumours. It is most common between second and the eight months of pregnancy (first and third trimester respectively). Partial reduction in severity of gingivitis occurs by 2 month postpartum, and, after 1 year, the condition of the gingiva is comparable to that of patients who have not been pregnant.
Approximately 40% of pregnant women have some form of periodontal disease (inflammatory disease of tissues surrounding and supporting the teeth). They may also be at risk for cavities due to changed eating habits.
Further, during menopause, the usual rhythmic hormonal fluctuations of the menstrual cycle end. There is a huge change in menstruating individual’s lives, and this has direct implications for oral health. The oral symptoms include altered taste, burning sensation and increased sensitivity to hot and cold foods. The gingival and remaining oral mucosa are dry and shiny, they vary in colour from abnormal paleness to redness, and they bleed easily.
There are two critical changes to be aware of: Dry mouth and Bone loss. Dry mouth, also known as xerostomia, can result in the development of tooth decay and gum disease because saliva is not available to moisten and cleanse the mouth. It is important to know that dry mouth can also result from many prescription and over-the-counter medications.
The gradual loss in estrogen that occurs with menopause also puts older individuals at risk for loss of bone density (a condition called osteoporosis) which can lead to tooth loss. Receding gums, which expose more of the tooth surface to potential tooth decay, can be a sign of bone loss in the jawbone.
Mouth is a gateway to the body. A healthy mouth can help you maintain a healthy body. Researchers have discovered a connection between declining oral health and underlying systemic conditions. Oral bacteria and the inflammation associated with a severe form of gum disease known as periodontitis might contribute to various diseases and conditions, including Endocarditis, Cardiovascular diseases and Diabetes as Research shows that people who have periodontitis have a harder time controlling their blood sugar levels. Regular periodontal care can improve diabetes control.
Further, pregnant individuals with periodontal diseases have been reported to be at increased risk of adverse pregnancy outcomes, including preeclampsia, preterm delivery and low birth weight. There is a two-fold increased risk for preeclampsia (hypertensive disorder) in the presence of periodontal disease and it is a major cause of perinatal and maternal morbidity and mortality. Other conditions that might be linked to oral health include pneumonia and other respiratory disorders, rheumatoid arthritis, eating disorders and an immune system disorder that causes dry mouth (Sjögren’s syndrome).
Hormones are a fact of life, but they don’t have to interfere with an individual’s ability to maintain a healthy smile at every age and stage of life. The best ways to keep your teeth and gums healthy involve basic care habits like brushing your teeth at least twice daily ( preferably with a fluoride toothpaste). Floss your teeth at least once a day, clean your tongue to remove bacteria at least once a day, rinse mouth with antiseptic mouthwash at least once a day. When it comes to diet, decrease intake of sugars and eat a high-fibre, low fat diet that includes plenty of fruits and vegetables; drink fluoridated water, avoid tobacco products; replace toothbrush every three to four months; have your teeth cleaned by a dental professional every six months.
Taking everything into account,the broader societal impact of improving oral systemic health cannot be overemphasized. We need to only educate ourselves and implement small logical changes in our practice.
The Author is an Intern at Government Degree College, Srinagar, Kashmir.