Estrogen therapy after menopause reduces chance of gum disease

After menopause, women who take estrogen therapy may be less likely to develop severe oral health problems than peers who don’t take hormones or other treatments for age-related bone damage, a recent study suggests.

During menopause and afterward, the body slows production of new bone tissue and women face an increased risk of osteoporosis. Falling levels of the hormone estrogen around menopause can contribute to fragile, brittle bones associated with both osteoporosis and periodontal disease, or infections around the teeth and gums.

For the current study, researchers examined data on 492 women in Bahia, Brazil, who had gone through menopause and had bone density scans between 2009 and 2011. The group included 113 women treating osteoporosis with calcium and vitamin D supplements, or with estrogen alone or in combination with the hormone progestin.

Overall, the rate of severe periodontitis - when the inner layer of gums pull away from the teeth - was 44 percent lower among the women taking estrogen for osteoporosis, the study found.

“I imagine that a patient who forgoes osteoporosis treatment with estrogen because of its risks is unlikely to change her mind after learning there is a potential connection to periodontal disease,” said Natalia Chalmers, director of analytics at the DentaQuest Institute in Westborough, Massachusetts.

“But if she is already predisposed to severe periodontitis, it is important for her to know how osteoporosis may make her condition worse,” Chalmers, who wasn’t involved in the study, said by email.

Risks of estrogen therapy can include increased odds of heart disease and breast cancer, Johelle de S. Passos-Soares of the Federal University of Bahia in Brazil and colleagues note in the Journal Menopause. Passos-Soares didn’t respond to requests for comment on the study.

Periodontitis is a leading cause of tooth loss in older adults. As gums pull away from the teeth, debris collects in the mouth that can become infected and plaque can spread below the gum line. In severe cases so much gum tissue and bone are destroyed that teeth become loose and fall out.

Women in the study were 61 years old on average, and ranged in age from 50 to 87. They typically when through menopause when they were around 47 years old.

Women treating osteoporosis averaged about 9 missing teeth, 8 decayed teeth and 2 teeth with fillings or restorations. They were also more likely than women not treating osteoporosis to have visited a dentist within the past two years.

With estrogen treatments, fewer women had periodontal disease, which researchers defined as gaps at least 5 millimeters deep between the gums and the jaw around at least 30 percent of teeth. But the difference from women not using estrogen was too small to rule out the possibility that it was due to chance.

However, osteoporosis treatment was associated with fewer cases of severe periodontitis and significantly fewer teeth that had gaps at least 4 millimeters deep between the gums and the teeth.The study isn’t a controlled experiment designed to show whether estrogen treatment after menopause directly prevents gum disease or severe periodontitis.

Limitations of the study include the fact that researchers looked at women at a single point in time, so they couldn’t determine when the women developed oral health problems relative to when they went through menopause or started estrogen treatments. Women in the study were also recruited from a health center, making it possible the findings might be different in a broader population of patients, researchers note.

It’s also possible that women who seek routine care for one aspect of their health may be more likely to get treatment for other health issues, Chalmers said. That means the connection between osteoporosis treatment and women seeking more preventive care in general might explain a lower risk of periodontal disease.

“The link between osteoporosis and periodontal disease is not clear, and more studies are needed to fully assess this connection,” Chalmers said. “However, we can say that patients affected by each condition share risk factors such as age, smoking, hormonal change and genetics, as well as calcium and vitamin D deficiency.”