Dental Health Week: the oral health issues facing older women

While many oral health issues are common to both genders, there are some that are more prevalent in older women. The Australian Dental Association reports that approximately 60 per cent of menopausal and postmenopausal women will experience some form of oral health concern, which can be related to the introduction of specific medications or attributed to a fluctuation in hormones. 

Dentists are trained to be aware of signs of disease and issues that can impact female patients. Here are the main oral health issues to look out for in older women.

1. Dry mouth

Signs include a sensation of oral dryness and burning, difficulty articulating words and
swallowing dry foods like crackers, crisps or bread. It’s normally related to medications such as antidepressants, antihistamines and blood pressure drugs.

The risk of dry mouth also increases as the number of medications taken increases. Reducing or stopping medication can help, however, this should only be done under close medical supervision. 

Dry mouth can increase the risk of oral infections such as thrush as well as leading to an increased risk of
tooth decay. Saliva has enzymes in it that help to protect the teeth and act as a buffer to help neutralize acids produced by bacteria in dental plaque.  

Symptoms can be alleviated by frequent sips of water, use of over-the-counter dry mouth products and oral lubricant sprays and gels. Some people chew sugar-free gum to stimulate saliva, while avoiding or
limiting caffeine intake, or using specialised dry mouth toothpastes and mouth rinses can help.

2. Oral discomfort and burning

This mainly affects women in their forties and fifties. It’s characterised by oral discomfort and a burning sensation affecting the inside of the cheeks, tongue, gums, lips, palate and sometimes the throat. It’s diagnosed in the absence of any observable alteration in the appearance of the affected areas which could indicate other issues. 

The exact cause of Burning Mouth Syndrome (BMS) is unknown, although dentists have identified a correlation between symptom severity and hormonal changes during menopause. It is possible that BMS can also be triggered by anxiety and/or depression.
 
Dentists suggest that haematinic deficiencies (iron, vitamin B12, folate) should be investigated as a possible cause via blood tests. Sometimes the condition resolves itself spontaneously without medical intervention and in other cases, when the condition becomes chronic, ongoing medication is required. 

3. Gum disease

Hormonal changes increase the likelihood of developing gum disease, known as gingivitis in its milder form or in its more severe form periodontitis. Symptoms include bleeding of the gums when brushing, changes in the appearance of the gums (redness, puffiness or gums shrinking away from the teeth in places), bad breath or loose teeth. 

Gum disease can be managed with meticulous oral hygiene including flossing daily, brushing the teeth for two minutes twice a day and regular dental visits. Sufferers also need to be vigilant about sugar intake, as overconsumption is known to compromises oral hygiene. 

The good news is that gum disease will almost certainly improve with regular personal oral hygiene habits and reviews with your dentist or oral medicine specialist. It can be controlled and the damage
halted - though existing damage cannot be reversed. If mild gum disease is allowed to worsen, a person may require intervention from a periodontist.

4. Osteoporosis and medication-related complications

Osteoporosis (brittle or porous bones) is unfortunately common among menopausal and postmenopausal women, the Australian Institute of Health and Welfare reports that at 2022 over a quarter (26 per cent) of Australian women over 75 are affected by osteoporosis. 

Some of the medications prescribed to treat the chronic condition have been implicated in medication-related osteonecrosis of the jaws or MRONJ, symptoms include pain in affected areas, gum swelling and pus. In severe cases patients are at risk of jawbone fracture.  

MRONJ is a complication that may occur following an oral surgical procedure such as tooth extraction
or implant placement, although it can occur after trauma to the oral tissues, or even spontaneously. It will typically present with an area of exposed, non-healing jawbone, which may become infected. 

The key is prevention – comprehensive dental assessment before starting medication for
osteoporosis, meticulous oral hygiene and regular dental visits.

For more information on how to manage oral health in older people visit the Australian Dental Association website or contact your local dental practice.