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Background
Periodontitis and osteoporosis are two diseases found worldwide and increase in intensity with increasing age of the patients. The severity of osteoporosis and periodontitis are found to be more in women during menopause. The aim of this study was to assess and correlate osteoporosis and periodontal disease among post-menopausal women....
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Citations
... Contrastingly, a narrative review by Ciesielska 35 and others states that the menopausal condition increases the risk of caries and periodontitis. Similar results were obtained by Mashalkar, 36 Romandini et al., 8 Bertulucci, 37 Michaud, 38 Haas et al., 39 Zhu et al., 10 and Tarkkila et al. 40 Previous studies have reported a decreased perception of sucrose and an increased threshold for salt and sweet perception in PMW. 14,44 In addition, inverse correlations between body mass index (BMI) and oral fat sensitivity have been observed among PMWs. ...
Background
In postmenopausal women (PMW), vasomotor symptoms, emotional oscillations and sleep disturbances can affect physiological and psychological functioning. However, the effect of menopause on oral health‐related parameters is not been thoroughly studied.
Objective
To evaluate oral health, taste perception, eating habits, nutritional status and emotional well‐being in PMW compared with a group of young and healthy pre‐menopausal women (PrMW).
Materials and Methods
Two groups (Group I: PMW and Group II: PrMW) with 30 participants each, participated in the cross‐sectional study. The study proforma contained measures of oral health, taste perception, nutritional status and anxiety levels of the women in both groups using validated and previously used tools were designed and implemented. The data were analysed with student t , Mann–Whitney U , and chi‐squared tests to evaluate the differences between the two groups.
Results
The cross‐sectional study indicates no major differences in oral health, taste perception, nutritional and emotional status between PMW and PrMW. Nonetheless, there was a significant difference in perception of ‘front teeth lengthening in size’ and change in hot and cold sensations between the groups. Furthermore, the study group with PMW tends to have fewer natural teeth than the reference group.
Conclusion
Overall, menopause does not appear to affect oral health, taste perception, nutrition or emotional health. It is suggested that oral health and taste perception, as well as nutritional and emotional status, are associated with gradual aging processes that may or may not be affected by menopause.
... Results of the current investigation demonstrated a positive connection between clinical data (CAL) and linear assessments of radiographic BL at six sites around the most severely damaged tooth in each of the three groups. Correspond to a study by Mashalkar et al. 2018, on 94 women in post menopause aged 45e60 with affected teeth (CAL > 5 mm on 30% of the site) [30]. ...
... Results of the current investigation demonstrated a positive connection between clinical data (CAL) and linear assessments of radiographic BL at six sites around the most severely damaged tooth in each of the three groups. Correspond to a study by Mashalkar et al. 2018, on 94 women in post menopause aged 45e60 with affected teeth (CAL > 5 mm on 30% of the site) [30]. ...
... Periodontitis, the sixth most prevalent disease worldwide, is multifactorial inflammatory disease mediated by host response and dysbiotic plaque biofilms, resulting in periodontal tissue destruction, alveolar bone loss and eventually tooth loss (Tonetti et al., 2017;Papapanou et al., 2018). • Both osteoporosis and periodontitis are prevalent inflammation-associated bone disorders that have common features of bone resorption, being silent and asymptomatic (Mashalkar et al., 2018;Ayed et al., 2019). These diseases remain a major public health problem particularly in the aging population (Yu & Wang, 2022). ...
Osteoporosis and periodontitis are two major chronic diseases of postmenopausal women. The association between these two diseases are evident through systemic bone loss and alveolar bone loss. Both postmenopausal osteoporosis and periodontitis impose a considerable personal and socioeconomic burden. Biphosphonate and hormone replacement therapy are effective in preventing bone loss in postmenopausal osteoporosis and periodontitis, but they are coupled with severe adverse effects. Phytoestrogens are plant-based estrogen-like compounds, which have been used for the treatment of menopause-related symptoms. In the last decades, numerous preclinical and clinical studies have been carried out to evaluate the therapeutic effects of phytoestrogens including bone health. The aim of this article is to give an overview of the bidirectional interrelationship between postmenopausal osteoporosis and periodontitis, summarize the skeletal effects of phytoestrogens and report the most studied phytoestrogens with promising alveolar bone protective effect in postmenopausal osteoporosis model, with and without experimental periodontitis. To date, there are limited studies on the effects of phytoestrogens on alveolar bone in postmenopausal osteoporosis. Phytoestrogens may have exerted their bone protective effect by inhibiting bone resorption and enhancing bone formation. With the reported findings on the protective effects of phytoestrogens on bone, well-designed trials are needed to better investigate their therapeutic effects. The compilation of outcomes presented in this review may provide an overview of the recent research findings in this field and direct further in vivo and clinical studies in the future.
... On the other hand, as a chronic inflammatory disease, periodontitis is mainly caused by bacterial plaque biofilms, and local periodontal tissue usually has an immune response that increased the production of cytokines associated with periodontal disease, which may accelerate systemic bone resorption (Hong et al., 2021;Xu et al., 2021). So periodontitis may be also a risk factor affecting systemic bone resorption, particularly for postmenopausal women (Mashalkar et al., 2018;Hong et al., 2021). So far, the association between these two resorptive bone diseases is still controversial. ...
The treatment of periodontitis can be very challenging due to its complex etiologies. A new pharmacologic strategy entitled “host-modulation therapy,” has been introduced to improve periodontal treatment outcomes. Supposedly, a multifunctional drug with the potential for bacterial infection prevention, host-response modulation and bone healing promotion would be a promising option for periodontitis therapy, but related studies remain substantially lacking. In this study, we successfully conjugated tetracycline with odanacatib (a selective inhibitor of cathepsin K) to construct a multifunctional drug (TC-ODN). We discovered that TC-ODN could promote macrophages polarizing toward anti-inflammatory phenotype and promote osteogenesis of PDLSCs under inflammatory microenvironment. In vivo, TC-ODN could be absorbed and distributed specifically to the bone after systemic administration, and accumulation of TC-ODN increased bone mineral density in ovariectomized rats. Importantly, periodontal administration of TC-ODN could successfully promote bone healing in periodontitis rats with alveolar bone loss. The findings in our study uncovered the excellent biocompatibility and multifunction of TC-ODN, including bone-targeted accumulation, immunoregulation, anti-inflammatory activity and promotion of bone healing, which might contribute to the clinical treatment of periodontitis.
... [2] It is characterized by a low bone mass leading to an increased risk of bone fragility. [3] Periodontitis is an inflammatory disease characterized by tooth-supporting alveolar bone destruction, connective tissue attachment loss, and formation of periodontal pockets. [3,4] Both periodontitis and osteoporosis are chronic diseases characterized by an imbalance between bone resorption and formation. ...
... [3] Periodontitis is an inflammatory disease characterized by tooth-supporting alveolar bone destruction, connective tissue attachment loss, and formation of periodontal pockets. [3,4] Both periodontitis and osteoporosis are chronic diseases characterized by an imbalance between bone resorption and formation. They both require prevention, early detection, and adequate treatment to minimize the risk of complications such as bone fracture and tooth loss. ...
... It is a physiologic condition in postmenopausal women when the decrease in estrogen levels results in an accentuated bone loss rate. [3] The hormonal imbalance and decreased bone density affecting postmenopausal women have been attributed to the increase in the incidence, severity, and progression of periodontal disease among them. [1,3,4,[6][7][8][9][10][11][12][13][14] Moreover, studies have found a relationship between bone mineral density (BMD) and higher degrees of the cementoenamel junction, alveolar-crest distance (CEJ-AC) as a linear measurement of alveolar crestal height loss. ...
Background:
This study aimed to assess the relationship between the osteoporotic condition and periodontitis in postmenopausal women.
Materials and methods:
Ninety-four women aged 50-80 years were studied in this cross-sectional study. Bone mineral density (BMD) of lumbar vertebra BMD (LBMD), total hip BMD (HBMD), and neck of femur BMD (NBMD) was assessed using standardized dual-energy X-ray absorptiometry (DXA) (normal: T-score ≥-1, osteopenic: -2.5 ≤ t-score <-1, osteoporotic: T-score <-2.5). Bleeding point index (BI), O'Leary plaque index (PI), and clinical attachment loss (CAL) were recorded. Cementoenamel junction, alveolar-crest distance (CEJ-AC) was measured from cone-beam computed tomography images. Periodontitis severity was represented by CAL and CEJ-AC distance. One-way analysis of variance followed by Post hoc Tukey was performed for examining differences among the groups for different variables. Pearson correlation coefficient® and backward regression analysis were used to investigate the effect of confounding variables on CEJ-AC as the dependent variable. Significance was considered at P < 0.05.
Results:
Mean CEJ-AC was significantly higher in the osteoporotic and osteopenic groups compared to the normal group (P = 0.001). There was a significant positive correlation between CEJ-AC and NBMD and LBMD (P < 0.001). The associations between LBMD and CEJ-AC existed even after adjusting for confounding factors (P = 0.002). The differences in BI, PI, and CAL were not statistically different between the groups (P > 0.05).
Conclusion:
Although osteoporosis is not the main cause of periodontitis, it can indirectly affect periodontal status by increasing CEJ-AC. Early diagnosis of osteoporosis followed by early referral to a dentist for the treatment of potential existing periodontal diseases is important to avoid complications among postmenopausal women.
... Mashalkar et al. [13] used dual-energy X-ray absorptiometry (DXA) to measure the BMD of 98 Indian menopausal women aged 45-65 years and found that periodontal pocket depth (PD) and CAL were higher in the osteoporosis group. In a study by Penoni et al. [14] including 134 Brazilian menopausal women aged 65-80 years, the osteoporosis group showed a 2.49 higher risk of periodontal disease and higher gingival recession and CAL than the normal group. In a 6-year prospective study by Mau et al. [12] using Taiwanese national health insurance data, the risk of mild, severe, and mild periodontitis was 1.56, 2.09, and 2.08 times higher in the osteoporosis group, respectively. ...
Background
This cross-sectional study aimed to investigate the association between osteoporosis and periodontal disease among Korean menopausal women, as well as the association between osteoporosis and periodontal disease according to duration after menopause.
Methods
Of a total of 22,948 subjects who participated in the Korea National Health and Nutrition Examination Survey, from 2013 to 2015 the final study population was limited to 2,573 subjects with no missing values. The subjects were divided into two groups, normal bone mineral density (BMD) and osteoporosis, according to the T-score obtained from bone densitometry. Scores of ≥ 3 points for the community periodontal index of treatment needs were reclassified as periodontal disease. Moreover, after stratification of the variable ‘duration after menopause’ into 0–4, 5–9, and ≥10 years, binary logistic regression analysis was performed to investigate the association between osteoporosis and periodontal disease according to the duration after menopause.
Results
There was an association between osteoporosis and periodontal disease. The osteoporosis group had an adjusted odds ratio [OR] of 1.25 (95% confidence interval [CI]: 1.00–1.56) for periodontal disease compared to the normal BMD group. Of note, the osteoporosis group in the menopausal transition stage (0–4 years after menopause) showed an adjusted OR of 2.08 (95% CI: 1.15–3.77) for developing periodontal disease.
Conclusions
Osteoporosis was associated with periodontal disease and the association was strongest among women in the menopausal transition stage, 0–4 years after menopause. Oral health promotion, including regular oral examination and oral hygiene care, is particularly useful for menopausal transition women with osteoporosis.
... The severity of osteoporosis is more in women during menopause 8 . ...
Osteoporosis is more common in women, particularly after menopause and may be associated with oral health alterations. The aim of this study was to determine the relationship between periodontal disease and osteoporosis in postmenopausal women. Materials and method: During 2018-2020, 97 menopausal patients were studied, aged between 47 and 76 years: (1) with osteoporosis, mean age 62.42±7.85 years and (2) control group without osteoporosis, mean age 56.80±7.00 years. In group (1), the regions of interest were lumbar spine (L1-L4), proximal femur and mandible. Results: Mean lumbar BMD was 0.87 in group 1, 0.96 in group 2, femoral neck BMD 0.80 in group 1 and 0.88 in group 2, mandibular BMD 1.22 in group 1 and 1.27 in group 2 (p<0.05). Conclusions: Postmenopausal women with osteoporosis are six times more likely to have periodontal disease. Decreased bone mineral density is negatively correlated with the risk of developing periodontal disease.
... The same finding was observed between CPI and PI in the control group, but there was a positive correlation between CPI and PI in the group with OP, which demonstrates the role of PI in periodontal disease in this group. In fact, previous findings have shown the positive correlations between the periodontal indices and BMD and other findings showed that there were no significant associations between these variables, i.e., there is no link between osteoporosis and periodontal disease (24)(25)(26). ...
In the pathogenesis of chronic periodontitis, there are general systemic factors which play a major role, such as osteoporosis, with menopause as the most common etiological factor, and other pathological determining conditions for osteoporosis as well (ovary, thyroid and malignant tumors). The aim of the present study was to assess the correlations between periodontal indices and osteoporosis. The study was performed on 35 patients with periodontal disease aged between 45 and 79 years. These patients were divided into two groups: a study group with osteoporosis and periodontal disease (n=25) and a control group with periodontal disease (n=10) only. The periodontal assessment included community periodontal index (CPI), gingival inflammation index (GI), plaque index (PI), body mass index (BMI), bone mineral density (BMD), tooth mobility and tooth loss. Osteoporosis was assessed by dual-energy X-ray absorptiometry. Results were statistically analyzed with Microsoft Excel software and XLSTAT. The results showed that patients in the study group had higher values of periodontal indices, and a highly significant inverse correlation was observed between the CPI and the tooth loss. Inverse correlations between BMI and tooth mobility, as well as BMI and CPI were determined for the study group. In conclusion, the positive association between BMD and GI shows that the gingival index can be a predictive factor in the occurrence of osteoporosis.
... Дослідження за участю 94 жінок у постменопаузі віком 45-65 років також підтвердило достовірний прямий зв'язок (р = 0,045) між наявністю остеопорозу, визначеного за Т-критерієм на основі подвійної рентгенівської абсорбціометрії, та розвитком пародонтиту. На думку авторів, лікарі загальної практики повинні тісно співпрацювати зі стоматологами, своєчасно виявляючи обидва ці процеси з метою зниження захворюваності в цього контингенту пацієнток [26]. P.R. Svedha та співавт. ...
The purpose of this review was to analyze and summarize the available literature data on changes of oral tissues in menopausal/postmenopausal women. We searched for the relevant references in Pubmed database using appropriate key words. We had revealed about 3,500 references on these topics and analyzed the most relevant.
Postmenopausal women have an increased risk of the decrease of bone mineral density due to estrogen deficiency. Estrogens induce osteoclast apoptosis and intensity of this protective mechanism decreases after the cessation of menstruation. Most cross-sectional radiographic studies have confirmed an association between age-related osteoporosis and decreased alveolar bone height. It has been established that postmenopausal women with generalized chronic periodontitis are characterized by severe destruction of the periodontium, which progresses in parallel to a decrease in bone mineral density. Sex hormones maintaining bone integrity and strength, involved in regulating the proliferation, differentiation, and growth of keratinocytes and fibroblasts of the gums. The effect of low estrogen levels on keratinization of the gum epithelium and decreased salivation can lead to menopausal gingivostomatitis.
Estrogen deficiency also adversely affects the microenvironment of gingival sulcus, including the composition and circulation of crevicular fluid. Postmenopausal women have lower salivary pH and lower salivation, which is associated with deterioration of periodontal tissues. In addition, the postmenopausal period is characterized by the changes in the microbial composition of the oral cavity, IgG decreases in the crevicular fluid and prooxidant changes of saliva.
Conclusions. The oral cavity status in menopausal and postmenopausal women undergoes significant changes: a decrease in bone mineral density, dryness of mucous membranes, microbiome changes, and activation of oxidative and immune processes. These changes necessitate regular examinations, timely treatment and application of all measures of preventive dentistry. There is also a need for randomized clinical trials and create standardized guidelines for the management of postmenopausal patients with periodontal disease.
... A study by Mashalkar et al. involving 94 postmenopausal women aged 45-65 years showed that the level of osteoporosis is correlated with the level of periodontitis. After prior measurement of bone mineral density (BMD), all examined women were assessed as normal, osteopenic and osteoporotic on the basis of the obtained result and subjected to a detailed periodontal examination using clinical parameters, such as the oral hygiene index (OHI), the dental plaque index (PI), probing pocket depth and clinical attachment loss to check the severity of periodontitis [75]. Additionally, subsequent studies conducted by Zhu et al. in 2020 on a wider group of female participants (195 postmenopausal women aged 50-65 years) including periodontal examination and bone mass density (BMD) confirmed that postmenopausal women with osteoporosis have a greater chance of presenting severe periodontal attachment loss [76]. ...
Oral health awareness during the menopausal period is essential to minimize the inevitable inconveniences which may occur due to hormonal changes. The decrease in estrogen hormone concentration impacts the oral mucosa in a similar way to the vaginal mucosa due to the presence of estrogen receptors in both of these structures. An estrogen deficiency also affects the maturation process of the oral mucosal epithelium and can lead to its thinning and atrophy, making it more susceptible to local mechanical injuries, causing a change in pain tolerance and problems in the use of removable prosthetic restorations. Mucosal epithelium during the menopausal period is more vulnerable to infections, candidiasis, burning mouth syndrome, oral lichen planus (OLP), or idiopathic neuropathy. Moreover, salivary glands are also hormone-dependent which leads to changes in saliva secretion and its consistency. In consequence, it may affect teeth and periodontal tissues, resulting in an increased risk of caries and periodontal disease in menopausal women. Due to the large variety of complaints and symptoms occurring in the oral cavity, menopausal women constitute a significant group of patients who should receive special preventive and therapeutic care from doctors and dentists in this particular period.
