Watch Your Mouth: Oral Health Matters in Menopause

The menopause transition and aging in general affects the mouth. Here’s how to help protect your oral health.

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Menopause transforms a woman’s body in many ways. Though there’s a lot of focus on obvious symptoms such as hot flashes, weight gain, and sleep problems, reduced estrogen levels impact oral health, too. Aging also influences the risk for cavities, gum disease, and other issues.

How to Curb Cavities

Perhaps it’s been years since you’ve had a cavity, and that’s a good thing. But you’re not out of the woods. You can still experience decay above, and below, the gum line in midlife and beyond.

Enamel coats the crown of the tooth, which shields the tooth’s nerves and blood supply. Enamel is the hardest substance in the body, but years of wear and tear can thin it and make teeth more vulnerable to decay. Cavities happen when harmful bacteria that live in the mouth ferment sugar and other carbohydrates in food and produce acid that makes tiny holes in enamel.

Eating causes enamel to lose calcium and phosphorus, the minerals that provide its strength. However, the body replaces calcium and phosphorus in enamel between meals, but a poor diet and inadequate dental hygiene can still result in cavities.

Exposure to fluoride forms stronger enamel, and fluoride makes it more difficult for bad bacteria to stick to teeth and produce as much acid. Fluoride occurs naturally in food, soil, and ground water. Fluoride isn’t for just for kids and dentists recommend it throughout the lifetime. In people with fillings, fluoride lowers the chances for new cavities along the filling’s edges and protects exposed areas of the tooth near crowns, reducing the risk for decay under the crown.

Gum recession, which is more prevalent with age, exposes the surface of a tooth’s roots and increases the risk for cavities below the gum line. Roots are covered by cementum, which isn’t nearly as cavity-resistant as enamel. Fluoride strengthens cementum and helps it resist decay.

In addition to regular brushing and flossing, protecting teeth and gums includes a constant exposure to fluoride in saliva and on the surface of teeth and gums. Fluoridated water is the easiest way to meet suggested fluoride intakes because it keeps low levels of fluoride in the mouth all day. According to the American Dental Association, community water fluoridation prevents at least 25% of tooth decay in people of all ages. You may not have access to water with added fluoride, and you certainly won’t if you live in certain states. Utah and Florida have banned the addition of fluoride to municipal water supplies.

Dry Mouth

Menopause is likely to blame for mouth discomfort. Research shows that estrogen receptors are present in salivary glands and in tissues in the mouth. When you don’t make enough saliva to keep your mouth wet, dry mouth can occur. Some people don’t notice dry mouth while dry mouth interferes with chewing, swallowing, and speaking in others. Dry mouth can also contribute to cavities, gum disease, and infection.

A 2018 Journal of the International Society of Preventive and Community Dentistry study found that healthy postmenopausal women had a significant decrease in saliva production and lower pH in their mouth than premenopausal women. Saliva protects teeth by helping to keep in check acid-producing bacteria that promote tooth decay. A low pH in saliva means a more acidic environment in the mouth, which encourages cavities.

In addition to the menopause transition, common causes of dry mouth include several types of prescription and over-the-counter medicines including antihistamines and decongestants, and radiation therapy to the head and neck or chemotherapy which damages salivary glands and reduces saliva production. Breathing through your mouth or dehydration can also cause dry mouth. Dry mouth is more common in older adults, and it’s also a symptom of burning mouth syndrome (BMS).

Burning Mouth Syndrome

Burning mouth syndrome is a painful condition that feels like burning, scalding, tingling, altered taste in the mouth, or numbness that comes and goes. The tongue is mostly affected by BMS, but the roof of the mouth and lips may also be involved. According to the Academy of Oral Medicine, menopause contributes to BMS.

There are two kinds of BMS, primary and secondary. Experts say that primary BMS is the result of damaged nerves that control pain and taste. In addition to estrogen loss, there are several reasons for secondary BMS, including grinding your teeth and clenching your jaw. In fact, about one-third of those with BMS have the habit of tooth grinding or jaw clenching. Acid reflux and allergies can also contribute to BMS.

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Bones Anchor Your Teeth

Estrogen helps bones maintain their density and resist fracture, and lower levels of estrogen result in less bone tissue after menopause occurs. Bone mass loss is often associated with broken hips, but you can lose bone mass from your mouth, too. The alveolar bone connects teeth to the jawbone by holding the roots of teeth in place on your top and bottom rows of teeth.

Osteoporosis, a chronic condition characterized by very low bone mass, has been associated with a greater risk for tooth loss. In a 2024 Biomedicines study, researchers found that compared with a group of women without osteoporosis, those with osteoporosis had more alveolar bone loss and more tooth loss.

Look After Your Mouth

Here some tips to improve oral health.

Manage health conditions. Oral health influences overall wellbeing and the opposite can also be true. For example, in prediabetes or diabetes, the body tends to produce less saliva which can make your mouth dry and increase the risk for bacteria build-up and cavities. Higher blood glucose levels increase the amount of glucose in saliva, which may result in greater growth of bad bacteria in the mouth. With time, chronically elevated blood glucose concentrations can lead to gum disease, when your gums become inflamed and infected. In turn, inflamed gums can cause higher blood glucose levels. Control your blood glucose levels to the best of your ability and maintain good oral hygiene habits to reduce the risk for health problems.

Focus on fluoride. Dentists say that fluoridated toothpaste and fluoridated water are a dynamic duo and that the pair offer more protection than either one alone for those at moderate risk for dental decay. (Flossing is also important.) Talk with your dentist to see if you need more fluoride. People with fillings, crowns, gum recession, or dry mouth may benefit from a daily at-home fluoride rinse or fluoride varnish applied in a dentist’s office.

Get a dental check-up one to two times year. Routine visits can alert you about dental health issues that you may not know about. Catching problems early makes it easier to treat them.

Invest in a night guard. If you grind your teeth, a night guard is likely in order. Night guards reduce the chances for decay by protecting enamel. Night guards can be pricey or slightly uncomfortable, but they’re worth every penny and the minor aggravation.

Brush and floss your teeth twice a day. You can floss at any time, but wait at least 30 minutes to brush after eating or drinking to reduce the acidity of your mouth. If you can’t brush, chew gum with xylitol, a sugar alcohol that neutralizes acid and stimulates saliva production, which can help with dry mouth.

Limit snacking. There’s nothing wrong with eating between meals but constant munching on candy, crackers and chips - high carbohydrate foods that encourage acid production - can be problematic. Enjoy satisfying meals low in added sugar, and plan healthier snacks such as plain nonfat Greek yogurt and fresh fruit. A balanced eating plan with adequate protein, calcium, and vitamin D also helps preserve the bone tissue that holds teeth in place.

Limit carbonated drinks. Carbonated drinks reduce the pH in the mouth resulting in a more acidic environment that’s ideal for the proliferation of cavity-causing bacteria. Drinking sugary carbonated drinks makes matters worse by introducing food for the bacteria to consume. You don’t need to give up on Diet Coke or sparkling water, but drink small portions of carbonated soft drinks within a 15 to 20-minute time frame rather than sipping on them slowly throughout the day.

Stay hydrated. Drink plain water and suck on ice chips to relieve dryness in the mouth. Include foods that are mostly water, such as fruits and vegetables.

Did the menopause transition cause oral health problems for you? Let me know in the comments!