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Oral hygiene is regarded as a local, perhaps not so important issue. The immediate associative thoughts while talking about oral hygiene relate either to ‘Do I have a foul mouth odor’ or ‘A visit to the dentist is going to be painful and costly’. The mere fact is that many have severe, untreated periodontal problems. Most people perhaps understand that poor oral hygiene has adverse consequences, primarily social (bad breath smell, loss of teeth), but very few are aware of the fact that severe, prolonged periodontitis is not confined to the oral cavity, but might have many systemic outcomes which potentially impact mortality risk. A nice overview by Cardoso and colleagues summarizes the literature on the association of systemic illnesses with chronic periodontitis [1]. The main focus of the article was cardiovascular issues and diabetes mellitus, but the scope of related health problems is much larger. The underlying mechanisms seem to be a combination of higher expression and activity of pro-inflammatory mediators, and possible extra-oral dissemination of certain microbes, or an immunologic response to periodontal pathogens. The bottom line is that there is an association between chronic periodontitis and cardiovascular disease, HbA1C levels, respiratory problems, osteoporosis, rheumatoid arthritis, neuro-degenerative situations and cancer [1].

Menopause, as part of aging, as well as an estrogen deficiency period in life, is associated with thinner, atrophic gingival epithelium, and with less production of saliva. The oral cavity then becomes more vulnerable to inflammation and infection, which could lead to chronic periodontitis [2, 3]. Whether or not menopause per se has any effect on periodontal disease is controversial. A small-scale study, which compared premenopausal to postmenopausal women with chronic periodontitis, did not demonstrate a difference in severity of disease or in tooth loss after adjusting for various confounders, such as age and smoking [4]. Few studies addressed the issue of potential effects of HRT on oral health. In a study from Brazil, women receiving HRT for osteoporosis had less periodontal probing depth, less clinical attachment loss, and less gingival bleeding than untreated women, indicating a lower prevalence of severe periodontitis [5]. Another female-specific perspective lies in a suggested link between periodontal disease and reproductive health, mainly higher risks for miscarriage, premature delivery and low birth weight [6].

Unfortunately, some of the clinical evidence is not robust enough, but it should suffice to raise awareness for achieving a good oral health. Also, as highlighted by a Cochrane review, it is still not clear whether an intervention in people with chronic periodontal disease will lead to systemic benefits and reduction in risks following a treatment which improves the local situation [7]. Two very recent studies that showed duplication of cancer risk (mainly colorectal, pancreas and lung) in persons with severe periodontitis make this topic even more important [8, 9]. Although better understanding of relevant pathophysiology is mandatory, more attention by the health-care providers to discuss with their patients the need for maintaining optimal oral hygiene should be encouraged and implemented. Indeed, a small-scale interventional study from India showed that regular dental check-ups and good plaque control had clear periodontal benefits in both pre- and postmenopausal women with chronic periodontitis [10].


  • Amos Pines
    Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel


  1. Cardoso EM, Reis C, Manzanares-Céspedes MC. Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases. Postgrad Med 2018;130:98-104 Friedlander AH. The physiology, medical management and
  2. Friedlander AH. The physiology, medical management and oral implications of menopause. J Am Dent Assoc 2002;133:73-81
  3. Suri V, Suri V. Menopause and oral health. J Midlife Health 2014;5:115-20
  4. Alves RC, Félix SA, Rodriguez-Archilla A, Oliveira P, Brito J, Dos Santos JM. Relationship between menopause and periodontal disease: a cross-sectional study in a Portuguese population. Int J Clin Exp Med 2015;8:11412-19
  5. Passos-Soares JS, Vianna MIP, Gomes-Filho IS, et al. Association between osteoporosis treatment and severe periodontitis in postmenopausal women. Menopause 2017;24:789-95
  6. Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes–systematic review. J Periodontol 2013;84:S181-94
  7. Li C, Lv Z, Shi Z, et al. Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis. Cochrane Database Syst Rev 2017;11:CD009197
  8. Michaud DS, Lu J, Peacock-Villada AY, et al. Periodontal disease assessed using clinical dental measurements and cancer risk in the ARIC study. J Natl Cancer Inst 2018 Jan 12. Epub ahead of print
  9. Heikkilä P, But A, Sorsa T, Haukka J. Periodontitis and cancer mortality: register-based cohort study of 68,273 adults in 10-year follow-up. Int J Cancer 2018 Jan 11. Epub ahead of print
  10. Prasanna JS, Sumadhura C, Karunakar P. A comparative analysis of pre- and postmenopausal females with periodontitis and its response to a non-invasive clinical approach. J Menopausal Med 2017;23:202-209
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