Menopause and oral health: what changes

What changes in the mouth at menopause

Oestrogen falls at menopause, and that fall reaches further than bone and sleep. The lining of the mouth, the salivary glands and the gums all respond to oestrogen. After the mid-forties many women notice that the mouth feels dry, that the tongue burns, or that the gums bleed more readily than they used to. The changes come on slowly, over years, which is why they are so often put down to age alone.

Why the mouth turns dry

Salivary glands make less saliva when oestrogen drops. In the same years, tablets taken for blood pressure, sleep or low mood can reduce saliva too, and the two effects stack up. Dryness is not just thirst. Saliva rinses the tooth surface, buffers acid and carries minerals back into enamel; when it thins out, all three jobs suffer.

• Waking at night with a dry mouth and keeping water by the bed
• Needing a sip of water to swallow dry bread or crackers
• The tongue sticking to the palate, and the voice tiring during long conversations
• A denture rubbing the palate or slipping during the day

Where decay appears once saliva drops

In a dry mouth, decay does not turn up where you learnt to expect it. As the gum recedes, the root surface is exposed, and root surface is far softer than enamel. So after menopause cavities often start at the neck of the tooth, right at the gum margin. That strip is easy to miss with a brush and hard to see in a mirror. Someone who has not had a cavity in twenty years can suddenly collect several; that is the saliva, not carelessness.

Burning mouth syndrome is real

Some women feel a steady burning at the tip of the tongue, on the palate or in the lips. There is no visible sore; the tissue looks normal when a dentist examines it. This is burning mouth syndrome, and it turns up more often around menopause. Because nothing shows, it gets dismissed as psychological for years. The burning actually comes from the way the sensory nerves of the mouth behave. It is typically mild in the morning, builds towards evening, and often eases while eating.

A burning tongue is not always about menopause; iron and B12 deficiency, uncontrolled diabetes and a fungal infection produce the same feeling.

Why gums bleed more easily

Gum tissue becomes thinner and more responsive to hormonal change. The same amount of tartar that caused no bleeding at forty can cause it at fifty-five. In some women the gums look pale, shiny and tight, and hot or spicy food is uncomfortable. That pattern is uncommon, but it needs to be recognised when it appears. Recession can also speed up: the tooth looks longer and cold drinks start to sting.

The jawbone and bone-density medicines

Bone density falls after menopause, and the jaw is part of that. If gum disease advances in a jaw that has lost bone, teeth loosen sooner. If you take a medicine for bone loss, your dentist needs to know before any extraction or implant, because some of these medicines slow the way the jawbone heals. Do not stop the medicine on your own: stopping, like starting, is a decision for the doctor looking after you.

Which signs should not wait

Most menopausal changes move slowly and can be dealt with at a planned check-up. A few findings in the mouth, though, are not explained by menopause at all. They are uncommon, but it is worth knowing what they look like.

• An ulcer on the tongue or in the mouth that has not healed in two weeks: seek dental or medical care the same day.
• A white or red patch on the cheek or tongue that does not wipe away.
• Unexplained numbness, one-sided pain or difficulty swallowing.
• Swelling of the face or jaw together with a fever: get seen without delay.

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