Oral health and menopause: a comprehensive review on current knowledge and associated dental management

Deciphering the influence of gut and oral microbiomes on menopause for healthy aging

Menopause is characterized by the cessation of menstruation and a decline in reproductive function, which is an intrinsic component of the aging process. However, it has been a frequently overlooked field of women's health. The oral and gut microbiota, constituting the largest ecosystem within the human body, are important for maintaining human health and notably contribute to the healthy aging of menopausal women. Therefore, a comprehensive review elucidating the impact of the gut and oral microbiota on menopause for healthy aging is of paramount importance. This paper presents the current understanding of the microbiome during menopause, with a particular focus on alterations in the oral and gut microbiota. Our study elucidates the complex interplay between the microbiome and sex hormone levels, explores microbial crosstalk dynamics, and investigates the associations between the microbiome and diseases linked to menopause. Additionally, this review explores the potential of microbiome-targeting therapies for managing menopause-related diseases. Given that menopause can last for approximately 30 years, gaining insights into how the microbiome and menopause interact could pave the way for innovative interventions, which may result in symptomatic relief from menopause and an increase in quality of life in women.

Association Between Age at First Birth and Long-Term Dental Caries Experience Among Women in the United States

Background: Pregnant women are at a higher risk of caries compared to nonpregnant women, and higher parity is a risk factor for untreated caries and tooth loss. However, it is unknown whether the timing of birth is associated with dental caries experience over time. Materials and Methods: This study is a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES), 2011-2018. The study population included nonpregnant women 20 years of age or older, who had available data on the oral health examination and age at first birth (AFB). Dental caries experience was defined as the DMFT score (sum of the number of decayed, missing due to caries, and filled permanent teeth). The associations between AFB and DMFT scores were assessed using Poisson regression to compute incidence rate ratios (IRRs) and the associated 95% confidence intervals (CIs). Results: This study included 6,553 women (mean age 53.4 years, SD 15.7). The mean DMFT index score was 13.1 ± 7.4, with younger AFB groups generally having higher mean scores. After adjusting for sociodemographic variables, time since last dental visit, and reproductive health factors, women with an AFB of <18 years (IRR, 1.10; 95% CI, 1.01-1.21) or 18-20 years (IRR, 1.11; 95% CI, 1.01-1.21) had significantly higher DMFT index scores compared to those with an AFB of 30-32 years. Conclusions: This study suggests that younger maternal AFB may be associated with greater dental caries experience. More rigorous studies are necessary to determine how to improve oral health outcomes during pregnancy and postpartum.

Association of endogenous sex hormone levels with tooth loss due to periodontitis in men and post-menopausal women: The multi-ethnic study of atherosclerosis

AIM

To investigate the association between endogenous sex hormone levels and history of tooth loss related to periodontitis in healthy middle-aged to older men and post-menopausal women.

METHODS

This cross-sectional study included 5649 participants aged 45-84 (mean age, 63 ± 10 years) from the Multi-Ethnic Study of Atherosclerosis cohort who had sex hormone levels measured and answered a questionnaire regarding perceived periodontal status at exam 1. Multivariable logistic regression was used to examine the association of sex hormones (exposure) with history of tooth loss (outcome), stratified by sex.

RESULTS

Among post-menopausal women, higher free testosterone (per 1SD) was associated with a greater prevalence of tooth loss [OR 1.49 (95% CI, 1.08-2.05)], whereas higher sex hormone binding globulin (SHBG) was associated with a lower prevalence of tooth loss [OR 0.74 (0.58-0.94)], after adjustment for cardiometabolic risk factors and reproductive factors. In men, higher free testosterone and lower SHBG were associated with a lower prevalent probability of tooth loss in unadjusted analysis, but these associations lost significance after covariate adjustment.

CONCLUSION

A higher androgenic sex hormone profile in post-menopausal women (i.e., increased free testosterone, lower SHBG) was associated with an increased prevalence of tooth loss, after adjusting cardiometabolic risk factors. No such association was found in men. These findings suggest that sex hormones may influence or serve as a marker for periodontal health.

Evaluation of oral health, taste perception, nutritional status and emotional well-being in post-menopausal women

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.

Salivary Calprotectin Levels and Bone Mineral Density in Post-Menopausal Women With and Without Chronic Periodontitis - An Evaluative Study

INTRODUCTION

Menopause is a normal developmental stage in a woman's life marking the permanent cessation of menstruation. Periodontitis and osteoporosis are noteworthy health concerns in post-menopausal women. Calprotectin is an inflammatory biomarker for precise diagnosis of periodontal disease.

MATERIALS AND METHODS

This study was performed to evaluate the variations in salivary calprotectin levels and bone mineral density in post-menopausal women with and without chronic periodontitis. The study included 24 post-menopausal women aged 45-57 years and was divided into group 1 (12 post-menopausal women without chronic periodontitis) and group 2 (12 post-menopausal women with chronic periodontitis). Unstimulated salivary samples, panoramic radiographs and clinical examination were performed.

RESULTS

The collected samples were combined with CALPRO antibody with horseradish peroxide (HRP) that results in the formation of antigen-antibody complex. Tetramethylbenzidine (TMB) solution was added that turned blue. Colour change was measured at 450nm. A human ELISA kit was used. Data collected were sent for statistical analysis.

DISCUSSION

There was a statistically significant difference in salivary calprotectin levels between groups 1 and 2 ( P = 0.016) and no statistical difference in mean bone mineral density levels between the two groups ( P = 0.235). A positive correlation was seen between salivary calprotectin levels and bone mineral density in group 2 ( P = 0.013).

Nonsurgical Treatment of Periodontitis in Menopausal Patients: A Randomized Control Trial

Background

Menopause is typically accompanied by significant systemic and oral manifestations, including hormonal changes and increased susceptibility to periodontal disease, which may involve inflammatory biomarkers like aspartate aminotransferase (AST) and osteocalcin in gingival crevicular fluid (GCF). The study is aimed at evaluating the effectiveness of regular inoculation of polyunsaturated fatty acids (PUFAs) as an adjunctive treatment for menopausal women's periodontitis.

Methods

Twenty elderly women with chronic periodontitis were split evenly into two groups by random assignment. Patients in group II (the research group) were given soft gelatin capsules containing PUFAs to be consumed directly once daily for 12 months, as opposed to group I (the control group), who received soft gelatin capsules containing some olive oil (placebo). Scaling and root planning (SRP) were used to address periodontal disease in all cases.

Results

At baseline, six and twelve months after treatment, clinical indicators and AST and osteocalcin amounts in the GCF were noted. By the conclusion of the research period, all observed clinical measurements had changed significantly and improved. In addition, there had been a significant decrease in AST levels and a nonsignificant decrease in osteocalcin levels in group II compared to group I.

Conclusions

Menopausal women with periodontitis who take omega-3 fatty acid supplements in addition to SRP have better oral health. Significant improvements in clinical indicators and a notable decrease in AST levels within the GCF were observed. However, further research with larger cohorts and extended duration is needed to validate these findings and explain potential mechanisms. This trial is registered with NCT06254118.

Peculiarities of local immunity in dry eye disease on the background of hormonal dysfunction

OBJECTIVE

Aim: to determine the state of local immunity in DED on the background of hormonal dysfunction.

PATIENTS AND METHODS

Materials and Methods: Of 32 women, 17 patients with diagnosed SM and 15 women of the control group were examined. The Ocular Surface Disease Index and the state of local immunity were defined by determining Ig As in lacrimal fluid (LF) by radial immunodiffusion in Mancini agar.

RESULTS

Results: During the OSDI questionnaire, a mild degree of DED was detected in 21 (65.6%) women, and an average degree was observed in 11 (34.4%) patients with SM. On average, OSDI was 34.54 ±2.01. As a result of studies of the state of local immunity in patients with SM, a tendency to increase Ig As was noted, compared with the control group. An increase in Ig As in the lacrimal fluid in patients with SM to 0.34 ±0.09 g/l was found, compared with the control group (0.24 ±0.03 g/l).

CONCLUSION

Conclusions: Using the OSDI questionnaire, the presence of DED was detected in women with SM, mainly mild and moderate degree. The obtained results of the state of local immunity indicate in favor of a nonspecific inflammatory process, accompanied by a decrease in local immune protection and leading to further changes in the ocular surface.

Is Burning Mouth Syndrome Associated with Extraoral Dryness? A Systematic Review

Burning mouth syndrome (BMS) is characterized by a persistent intraoral burning sensation, often experienced by postmenopausal women. The etiology of BMS remains partially understood, and consequently, treatments remain suboptimal. Extraoral manifestations of BMS, such as extraoral dryness, are less studied. However, it has been suggested that the identification of the frequency and patterns of extraoral dryness and potential underlying mechanisms are essential to optimize treatment strategies and reduce the burden of disease. Therefore, we conducted this systematic review to provide existing evidence about extraoral dryness in BMS. The guidelines for the conduction and reporting of systematic reviews were followed. An electronic search was conducted in four major databases-PubMed, Web of Science, COCHRANE Library, and EBSCOhost-and the grey literature was assessed through Google Scholar. From each included article, information on extraoral dryness in BMS was extracted, and odds ratios were calculated for extraoral dryness among BMS patients compared with non-BMS controls. The findings demonstrated higher odds of the prevalence of extraoral dryness in BMS, which was found to a high degree in the lips, eyes, skin, and genitalia. The pattern of spread and locations of extraoral dryness propose a potential central mechanism. Based on our findings, we encourage the standardization of the assessment, recording, and reporting of the extraoral characteristics of BMS, including extraoral dryness, which can lead to better management strategies and enhance the quality of life of the affected patients.

Value of gingival crevicular fluid TREM-1, PGLYRP1, and IL-1β levels during menopause

OBJECTIVE

This study aimed to investigate the association of GCF TREM-1, PGLYRP1, and IL-1β levels with periodontal health in pre- and postmenopausal women.

BACKGROUND

Triggering receptor expressed on myeloid cells 1 (TREM-1), activated through its ligand peptidoglycan recognition protein 1 (PGLYRP1), stimulates proinflammatory cytokine production, such as interleukin (IL)-1β, during periodontal inflammation. Postmenopausal changes may modulate these immune-inflammatory functions. No clinical study has yet investigated the effect of menopause on TREM-1, PGLYRP1, and IL-1β levels in gingival crevicular fluid (GCF).

METHODS

This cross-sectional study included 148 women (age range = 35-65 years), divided into postmenopausal women (PMW) (n = 76, mean age = 54 ± 5 years) and regularly menstruating premenopausal women (RMPW) (n = 72, mean age = 40 ± 4 years). Clinical periodontal parameters were recorded. TREM-1, PGLYRP1, and IL-1β levels were quantified with enzyme-linked immunosorbent assays. Pearson's Chi-squared test and Mann-Whitney-U test were used to compare categorical and numerical variables, respectively. Spearman's Rho correlation analysis was used to test the linear relationship between variables. Analyte level data were categorized based on the periodontal diagnosis and menopause status (2 × 2 nonparametric factorial ANOVA).

RESULTS

No significant differences in TREM-1, PGLYRP1, and IL-1β levels between PMW and RMPW were observed (p > .05). Mean values of periodontal indexes including probing depth did not differ significantly between PMW and RMPW groups (p = .474). TREM-1 levels were significantly higher in both PMW and RMPW with periodontitis, compared to gingivitis or health (p = .0021).

CONCLUSION

Menopause-related changes have no observable effect on GCF levels of TREM-1, PGLYRP1, and IL-1β. Higher GCF TREM-1 levels in women with periodontitis regardless of their menopausal status indicate that TREM-1 may be an indicator for periodontitis both in premenopausal and postmenopausal women.

Dental Pulp Stem Cells for Salivary Gland Regeneration-Where Are We Today?

Xerostomia is the phenomenon of dry mouth and is mostly caused by hypofunction of the salivary glands. This hypofunction can be caused by tumors, head and neck irradiation, hormonal changes, inflammation or autoimmune disease such as Sjögren's syndrome. It is associated with a tremendous decrease in health-related quality of life due to impairment of articulation, ingestion and oral immune defenses. Current treatment concepts mainly consist of saliva substitutes and parasympathomimetic drugs, but the outcome of these therapies is deficient. Regenerative medicine is a promising approach for the treatment of compromised tissue. For this purpose, stem cells can be utilized due to their ability to differentiate into various cell types. Dental pulp stem cells are adult stem cells that can be easily harvested from extracted teeth. They can form tissues of all three germ layers and are therefore becoming more and more popular for tissue engineering. Another potential benefit of these cells is their immunomodulatory effect. They suppress proinflammatory pathways of lymphocytes and could therefore probably be used for the treatment of chronic inflammation and autoimmune disease. These attributes make dental pulp stem cells an interesting tool for the regeneration of salivary glands and the treatment of xerostomia. Nevertheless, clinical studies are still missing. This review will highlight the current strategies for using dental pulp stem cells in the regeneration of salivary gland tissue.

Impact of Menopausal Duration on Salivary Flow Rate, Tooth Loss, and Oral Health-related Quality of Life in Indian Communities

Background

Diminishing hormonal levels after menopause evoke physiological changes in a woman's body. Their effects on the oral cavity are noteworthy, considering symptoms of dry mouth, altered taste perceptions, and tooth loss that may be attributed to reduced salivary flow and alveolar density changes.

Aim

The purpose of this study was to assess changes in salivary flow rate, tooth loss, and oral health-related quality of life (OHRQoL) as menopausal duration increased.

Materials and Methods

A total of 327 women fulfilling the eligibility criteria were chosen from two villages in the Mysuru district, Karnataka. They were categorized into three groups based on menopausal durations. Salivary flow rates, number of teeth lost, and OHRQoL after menopause were assessed and compared at different menopausal durations. Sociodemographic characteristics and oral hygiene practices were recorded to identify potential confounders.

Results

Multivariate analysis demonstrated a significant association between menopausal duration and salivary flow rates (adjusted odds ratio = 2.269). However, no such associations were observed with tooth loss and OHRQoL.

Conclusion

Menopausal duration significantly affects salivary flow rate. Its influence on tooth loss and OHRQoL is, however, less evident. Although strong associations cannot be established, the inevitability of the menopausal state advocates consideration of other major yet modifiable factors to improve oral health.

Assessment of Periodontal Status in Pre- and Postmenopausal Women with Chronic Periodontitis: A Cross-Sectional Study

INTRODUCTION

Periodontitis is inflammation of periodontium. Periodontal disease is associated with various risk factors among which female hormonal alterations such as menopause have been found to be connected with periodontal breakdown and osteoporosis in women. The aim of this study was to determine the periodontal status in pre- and postmenopausal females.

MATERIALS AND METHODS

In this study, 60 female patients were analyzed aged between 40 and 60 years. Group 1 (test) comprised 30 premenopausal women with/without chronic periodontitis and Group II (control) comprised 30 postmenopausal women with/without chronic periodontitis. After recording clinical parameters, the scores were provided using Orthopantomograph for each patient. Paired t-test was applied for intragroup comparison and independent sample t-test was applied for intergroup comparison. The value of P < 0.05 was considered statistically significant.

RESULTS

The mean plaque index, gingival index, calculus index, pocket probing depth, and clinical attachment loss scores in the premenopausal group were less as compared to postmenopausal group. Both the groups showed statistically significant differences with T=15.28 and P = 0.01.

CONCLUSION

Postmenopausal women are more susceptible to periodontitis. Hence, precaution and initial management of oral diseases should be the utmost priority in women's health. The effect of sex hormones can be reduced with regular dental examination, maintaining good oral hygiene, and hormonal replacement therapies.

Influence of Micronutrient Intake, Sociodemographic, and Behavioral Factors on Periodontal Status of Adults Assisted by a Public Health Care System in Brazil: A Cross-Sectional Multivariate Analysis

The lack of access to a balanced diet, rich in vitamins and minerals, can predispose people to inflammatory diseases such as obesity, diabetes mellitus, and periodontitis. We aimed to evaluate the relationship between micronutrient intake, sociodemographic behavioral characteristics, and periodontal health in adults assisted by a public health care system. Participants (n = 450) answered a food frequency questionnaire and were submitted to anthropometric and oral clinical examinations. Principal component analysis was used to summarize the number of components emerging from 17-micronutrient intake. Subsequently, cluster analysis was employed. The prevalence of at least one periodontal pocket ≥ 4 mm was 67.4%. Three clusters were identified according to periodontal status. Cluster 1 "poor periodontal status" was characterized by older individuals (n = 202; 85% females) with poor periodontal status, lower education level, mainly smokers with non-transmissible chronic diseases (NTCD), with lower energy, omega-3, fiber, Zn, K, Cu, and vitamin C intake. Cluster 3 "healthy periodontal status" included younger individuals (n = 54) with the healthiest periodontal status, a higher education level, without NTCD, and with higher energy, omega-3, fiber, Zn, calcium, retinol, and riboflavin intake. Cluster 2 was labeled as "intermediate periodontal status". Micronutrient ingestion was associated with periodontal status and may be considered in health promotion actions for low-income populations.

Mesenchymal stem cells enhance AQP1 expression in the sublingual salivary gland of ovariectomized menopausal rat model

BACKGROUND

Ovariectomized menopausal rat model was used to investigate the effects of menopause on the sublingual salivary gland (SSG) and the potential therapeutic effect of human umbilical cord blood mesenchymal stem cells (hUCB-MSCs).

METHODS

Thirty rats were equally divided into three groups: sham-operated (SHAM), ovariectomized (OVX), and ovariectomized stem cells injected (OVX+ hUCB-MSCs). Expressions of α-SMA, AQP1, Sca-1, PCNA, ssDNA, and caspase-3 were determined. Homing of hUCB-MSCs was detected by fluorescence microscopy and examination of immunostained sections for human CD105 and CD34 was performed. Morphometric data were statistically analyzed using the Kruskal-Wallis test followed by Scheffé's method. Correlation of AQP1 with Sca-1-positive sublingual stem cells was also analyzed.

RESULTS

In the SSGs of the OVX group, ballooned mucus acinar cells, atrophied serous cells, and a decreased number and height of duct lining cells were observed. The interstitial spaces were edematous, and the blood vessels were congested. The significant decrease in the positive area % of α-SMA and AQP1, the number of Sca-1-positive sublingual stem cells, and proliferating cells was associated with a significant increase in apoptotic cells. The OVX+hUCB-MSCs group showed significant structural improvement, manifested by the normal appearance of mucus and serous acini, as well as the number and height of striated duct cells. A significant increase in the positive area % of α-SMA and AQP1 and the number of proliferating and Sca-1-positive sublingual stem cells was observed. Interestingly, a significantly positive Pearson's correlation between the area % of AQP1 and the number of Sca-1-positive sublingual stem cells was also recorded.

CONCLUSION

Our results indicated a positive effect of hUCB-MSCs therapy for SSG pathology in a post ovariectomy rat model as evidenced by an improvement in the histologic architecture, upregulation of the immunostained area % of α-SMA and AQP1, increase in the number of Sca-1-positive sublingual stem cells and proliferating cells, and downregulation of apoptotic cells.

Influence of female sex hormones in different stages of women on periodontium

The primary etiologic factor for periodontal diseases is “Dental plaque.” Although pathogenic bacteria in dental plaque are required for the incidence of periodontal disease, a susceptible host is also very important. The susceptibility of the host can be modified by many systemic factors with hormones level being one. The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormones during puberty, pregnancy, in women taking oral contraceptives, and at the postmenopausal stage. This review provides an in detail analysis of how periodontium is influenced by the fluctuation in sex steroid hormones of females during different phases of their lifetime and to discuss how much the same hormone at different ages and stages shows an exaggerated gingival response to plaque.

Evaluation of Salivary and Serum Total Antioxidant Capacity and Lipid Peroxidation in Postmenopausal Women

Objective

In menopause, reduction of estrogen hormone affects oxidative stress process in serum. Oxidative stress in saliva plays a significant role in the pathogenesis of oral diseases. The aim of this study was to investigate the total antioxidant capacity and lipid peroxidation in the serum and saliva of premenopausal and postmenopausal women.

Methods

In this case control study, 50 postmenopausal women (case group) and 48 premenopausal women (control group) were selected. The unstimulated whole saliva and serum of the postmenopausal and premenopausal women were collected. The total antioxidant capacity (TAC) of the saliva and serum was measured by ferric reducing antioxidant power (FRAP). Also, malondialdehyde (MDA) was measured by thiobarbituric acid reactive substance (TBARS) method for serum and saliva. Then, the obtained data were analyzed by SPSS 17, whereby Mann–Whitney test and Spearman's correlation test were used. P < 0.05 was considered statistically significant.

Results

The postmenopausal group had significantly lower mean serum TAC and higher mean serum MDA than the control group (P < 0 < 001 and P < 0.01, respectively). The mean salivary TAC and MDA, however, did not differ significantly between the case and control group (P = 0.64 and P = 0.08, respectively).

Conclusion

In postmenopausal women, with elevation of serum MDA and reduction of serum TAC, the extent of serum oxidative stress grows, but MDA and TAC levels of saliva do not change.

Association of periodontitis with leukocyte telomere length in US adults: A cross-sectional analysis of NHANES 1999 to 2002

BACKGROUND

This study examines the association of periodontitis with telomere length (TL) and effect modification by population characteristics.

METHODS

We analyzed data from 3,478 participants from the 1999 to 2002 National Health and Nutrition Examination Survey. Probing depth, attachment loss, and bleed on probing (BOP, available for 1,973 participants only) were examined on the distal, mesial, or mid-facial site of each tooth in two randomly selected quadrants. We defined periodontitis severity according to the Centers for Disease Control/American Academy of Periodontology guideline. TL from leukocytes was measured with qPCR. We used linear and logistic regression to examine the adjusted association of different severity of periodontitis and BOP with continuous TL (bp) and dichotomized short TL (<median), respectively. To assess effect modification, we stratified the analyses by a priori selected population characteristics including sex, age, body weight status, smoking, and cardiometabolic comorbidity.

RESULTS

Moderate BOP (<10% bleeding sites) was significantly associated with a shorter continuous TL (β = -89.0, SE = 37.8). Moderate to severe periodontitis was significantly associated with 47% (95% confidence interval [IL], 1.04 to 2.09) higher odds of shorter TL, compared with those with mild or no periodontitis. The association was stronger in those who were female (adjusted OR, 1.76; 95% CI, 1.10 to 2.83), overweight or obese (adjusted OR, 1.64; 95% CI, 1.12 to 2.41), or had cardiometabolic comorbidities (adjusted OR, 2.13; 95% CI, 1.38 to 3.29).

CONCLUSIONS

Periodontitis was associated with TL, a biomarker of cellular aging. The association was stronger in females, overweight or obese, or those with cardiometabolic diseases. Treatment on periodontitis could potentially protect individuals from aging-related diseases.

Oral Health Status of Middle-Aged (45-55 Years) Rural Women: A Cross-Sectional Study from North India

Aim

This study aimed to assess the oral hygiene practices and oral health status of middle aged (45-55 years) women residing in rural areas of Ambala district (Haryana).

Materials and Methods

In this cross-sectional study, 79 villages were selected using simple random sampling technique through an online randomizer. The study participants (780) were selected through convenience sampling and oral health status was (dental caries, periodontal status, prosthetic needs, and dental fluorosis) recorded on a self-structured format based on World Health Organization Criteria (WHO, 1997). Group comparisons were done by using Chi-square test for categorical data.

Results

In the present study, 69.2% of the study participants used toothbrush and toothpaste for cleaning teeth. Women in the age group of 45-50 years had lower mean Decayed, Missing and Filled Teeth (7.80 ± 5.21) when compared with the age group of 51-55 years (9.77 ± 6.16). Ninety-eight percentage of the women were in need of dental prosthesis. Among the study participants, 56.5% had 4-5 mm loss of attachment (LOA) and 23.2% had 6-8 mm of LOA. Difference between the need for multiunit dental prosthesis among the age groups (45-50 years) and (51-55 years) was statistically significant (P < 0.05).

Conclusion

Thus middle-aged women residing in rural area have high oral care need; however, there is quite a gap between the need for dental care and the amount of dental care utilized.

Follicle-stimulating hormone impairs dental pulp stem cells odontogenic differentiation

In addition to bone, the dentin‐pulp complex is also influenced by menopause, showing a decreased regenerative capacity. High levels of follicle‐stimulating hormone (FSH) during menopause could directly regulate bone metabolism. Here, the role of FSH in the odontogenic differentiation of the dentin‐pulp complex was investigated. Dental pulp stem cells (DPSCs) were isolated. CCK‐8 assays, cell apoptosis assays, Western blotting (WB), real‐time RT‐PCR, alkaline phosphatase activity assays, and Alizarin Red S staining were used to clarify the effects of FSH on the proliferation, apoptosis and odontogenic differentiation of the DPSCs. MAPK pathway‐related factors were explored by WB assays. FSH and its inhibitor were used in OVX rats combined with a direct pulp‐capping model. HE and immunohistochemistry were used to detect reparative dentin formation and related features. The results indicated that FSH significantly decreased the odontogenic differentiation of the DPSCs without affecting cell proliferation and apoptosis. Moreover, FSH significantly activated the JNK signalling pathway, and JNK inhibitor partly rescued the inhibitory effect of FSH on DPSC differentiation. In vivo, FSH treatment attenuated the dentin bridge formation and mineralization‐related protein expression in the OVX rats. Our findings indicated that FSH reduced the odontogenic capacity of the DPSCs and was involved in reparative dentinogenesis during menopause.

Reproductive life histories influence cariogenesis: Exploring sex-specific variation in dental caries and survivorship in the human past

OBJECTIVES

Differences in dental caries prevalence between males and females is considered a reflection of diet. However, recent syntheses argue that sex-specific variation in dental caries prevalence also reflects changes in the oral cavity attributable to variation in reproductive life histories. This study explores sex-specific variation in carious lesions using a life history perspective to understand if differences in reproductive ecology influence this process.

MATERIALS AND METHODS

Survival probability between 860 males and females from the Terry Collection was compared using carious lesion manifestation (absent, crown presence, root/cemento-enamel junction [CEJ] presence) and sex as covariates and age as a time series variable. A four-way multivariate analysis of variance (MANOVA) comparing carious lesion type by sex, age, and periodontal disease presence was used to evaluate interaction between these variables.

RESULTS

Individuals with carious lesions have greater survivorship than those without lesions. Males and females with crown lesions do not differ in survivorship from individuals without carious lesions. Females with root/CEJ lesions are characterized by the highest survivorship. A significant interaction was found for root/CEJ carious lesions by age, sex, and periodontal disease presence. Root/CEJ lesion formation in older males was not dependent upon periodontal disease presence, though dependence between these variables characterizes postmenopausal females.

CONCLUSION

Sex-specific variation in crown lesions is not associated with reproductive life histories and likely reflects diet. By contrast, root/CEJ lesions form through pathways attributable to reproductive life histories, particularly age-induced periodontal disease in females. These results suggest the formation of carious lesions is complex, and in some cases, rooted in reproductive life histories.

Factors Associated with Tooth Loss in Postmenopausal Women: A Community-Based Cross-Sectional Study

Many studies have indicated that menopause affects periodontal health and tooth loss. The possible mechanism might due to several hormonal changes and low bone mineral density (BMD) during the transition period. However, few studies have explored the role of oral hygiene in the number of remaining teeth (NRT) in postmenopausal women (PMW). The aim of this study was to explore the prevalence of and factors associated with NRT less than 20 in PMW. A community-based, cross-sectional study was conducted in coastal Yunlin County, Taiwan. NRT was calculated based on natural and filled teeth. BMD was detected by dual-energy X-ray absorptiometry at the collaborating hospital. Logistic regression analyses were used to identify the factors associated with NRT in rural PMW. Six hundred and ten rural PMW with mean age 65.4 years enrolled in this study. The mean NRT was 17.6 (standard deviation [SD] = 10.4), with 43.9% having <20 and 13.9% edentulous. More than half (65.9%) reported that they seldom brushed their teeth after meals, 79.2% rarely used dental floss, and 80% did not regularly undergo tooth scaling by a dentist. The majority of women had low BMD, including 48.7% with osteopenia and 20.7% with osteoporosis. After adjusting for potentially confounding variables, NRT <20 was associated with infrequent tooth scaling (odds ratio [OR] = 2.78, 95% confidence interval [CI] = 1.70–4.56) and dental floss use (OR = 2.01, 95% CI = 1.24–3.26), but not BMD. A high prevalence of NRT <20 was found among rural PMW, but poor oral hygiene rather than low BMD was the major contributing factor. It is an emerging issue for primary healthcare providers and clinicians to initiate oral hygiene promotion programs for these disadvantaged women.

An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives

Burning mouth syndrome (BMS) is a chronic oro-facial pain disorder of unknown cause. It is more common in peri- and post-menopausal women, and sex hormone dysregulation is believed to be an important causative factor. Psychosocial events often trigger or exacerbate symptoms, and persons with BMS appear to be predisposed towards anxiety and depression. Atrophy of small nerve fibres in the tongue epithelium has been reported, and potential neuropathic mechanisms for BMS are now widely investigated. Historically, BMS was thought to comprise endocrinological, psychosocial and neuropathic components. Neuroprotective steroids and glial cell line-derived neurotrophic factor family ligands may have pivotal roles in the peripheral mechanisms associated with atrophy of small nerve fibres. Denervation of chorda tympani nerve fibres that innervate fungiform buds leads to alternative trigeminal innervation, which results in dysgeusia and burning pain when eating hot foods. With regard to the central mechanism of BMS, depletion of neuroprotective steroids alters the brain network-related mood and pain modulation. Peripheral mechanistic studies support the use of topical clonazepam and capsaicin for the management of BMS, and some evidence supports the use of cognitive behavioural therapy. Hormone replacement therapy may address the causes of BMS, although adverse effects prevent its use as a first-line treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) may have important benefits, and well-designed controlled studies are expected. Other treatment options to be investigated include brain stimulation and TSPO (translocator protein 18 kDa) ligands.

Effect of Menopause on Saliva and Dental Health

Aims and Objectives:

This research is intended to observe the influence of menopause on saliva and dental health. Salivary flow rate, pH of stimulated whole saliva, oral hygiene status, dental caries status, and periodontal status were evaluated in frequently menstruating and postmenopausal womankind.

Materials and Methods:

A cross-sectional study was conducted on forty healthy postmenopausal women (case group) and forty regularly menstruating healthy women (control group), who were selected from the Outpatient Department of Dr. Syamala Reddy Dental College and Hospital, Bengaluru. None of them had any systemic disease and not under any medication. Participants were asked to chew on an elastic band of standardized size. The flow rate was measured as ml/min. Salivary pH was measured using pH strips. Oral Hygiene Index-simplified (OHI-S), Decayed Missing and Filled Teeth (DMFT index), Community Periodontal Index (CPI), and Loss of Attachment (LOA) were assessed clinically. The results were analyzed with the Chi-square test and Student's t-test (P < 0.05).

Results:

Salivary pH and flow rate in the case cluster were considerably lesser when related to the control group (P < 0.001). OHI-S, DMFT, CPI, and LOA were found to be greater in postmenopausal women when related to the control group (P < 0.001).

Conclusion:

Here exists a noticeable diminution in the salivary pH and flow rate in postmenopausal womanhood which in turn leads to increased OHI-S, DMFT, CPI, and LOA. The study has presented that the significance of preventive dentistry upsurges with aging in females.

Correlative analysis of plasma and urine neopterin levels in the pre- and post-menopausal women with periodontitis, following nonsurgical periodontal therapy

Context:

Periodontitis is an inflammatory condition which is distinguished by the devastation of the supported tooth structures. In such inflammatory conditions, some biomarkers such as neopterin will be secreted and elevated in the body fluids, which can be used as a diagnostic marker for the present and future disease activity.

Aims:

Assessment of the neopterin as a biomarker in inflammatory conditions such as menopause and periodontitis.

Settings and Design:

A cross-sectional interventional study.

Materials and Methods:

Sixty female individuals with a mean age of 40–60 years with chronic periodontitis were included in this study. All were categorized into two groups of thirty each, depending on their menstrual history: Group I – thirty premenopausal women and Group II – thirty postmenopausal women. Urine and plasma were collected from both groups to estimate neopterin levels. ELISA kit was used to assess the neopterin levels at baseline and after 3 months of nonsurgical periodontal therapy (NSPT).

Statistical Analysis Used:

IBM SPSS version 21 software.

Results:

A significant depreciation in the mean values of all the parameters from baseline to 3 months (P < 0.001), in the intragroup analysis, was observed. Plasma (0.006) and urine (0.004) reduction was seen.

Conclusions:

In both the groups, in 3 months after NSPT, decreased neopterin levels were found, suggesting that the NSPT is the definitive therapy. Further, suggesting that, neopterin levels in the plasma and urine can be used as an index to identify the periodontal inflammation and destruction.

Candida accommodates non-culturable Helicobacter pylori in its vacuole - Koch’s postulates aren’t applicable

The following are the responses to the “letter to the editor” (“Helicobacter is preserved in yeast vacuoles! Does Koch’s postulates confirm it?”) authored by Nader Alipour and Nasrin Gaeini that rejected the methods, results, discussions and conclusions summarized in the review article authored by Siavoshi F and Saniee P. In the article, 7 papers, published between 1998 and 2013, were reviewed. The 7 papers had been reviewed and judged very carefully by the assigned expertise of the journals involved, including the reviewers of the World Journal of Gastroenterology (WJG), before publication. In the review article, 121 references were used to verify the methods, results and discussions of these 7 papers. The review article was edited by the trustworthy British editor of the (WJG), and the final version was rechecked and finally accepted by the reviewers of (WJG). None of the reviewers made comments like those in this “letter to the editor”, especially the humorous comments, which seem unprofessional and nonscientific. Above all, the authors’ comments show a lack of understanding of basic and advanced microbiology, e.g. bacterial endosymbiosis in eukaryotic cells. Accordingly, their comments all through the letter contain misconceptions. The comments are mostly based on personal conclusions, without any scientific support. It would have been beneficial if the letter had been reviewed by the reviewers of the article by Siavoshi and Saniee.

In-vivo assessment of the osteo-protective effects of eugenol in alveolar bone tissues

Estrogen deficiency following menopausal provokes alveolar bone loss, remodeling and inflammation. Eugenol is a phenolic compound with wide dental applications and anti-inflammatory properties. In the present study, the potential protective role of eugenol against alveolar bone deformities was investigated in an ovariectomized (OVX) rodent model. Two doses of eugenol (2.5 and 5 mg/kg/d) were administered to OVX animals for 12 weeks. In Serum, markers of bone metabolism and pro-inflammatory cytokines were estimated using ELISA. Alveolar bone morphometry was analyzed using high-resolution micro-computed tomography (CT). Bone histological analysis (H&E stain) was also performed. Alveolar bone expression of osteoclastogenesis modulating factors, such as osteoprotegerin (OPG), receptor activator of nuclear factor kappa-b ligand (RANKL) and inflammatory mediators, were measured using immunohistochemistry. Eugenol failed to correct elevated body weights and uterine atrophy in OVX rats. The significant elevation of bone metabolic markers and inflammatory cytokines in OVX animals were markedly improved by eugenol treatment, particularly the higher dose. Eugenol treatment considerably attenuated morphometric trabecular alterations of the alveolar bone and improved alveolar resorption and gingival infiltration. Alveolar bone of OVX animals showed augmented expression of RANKL, OPG and inflammatory cytokines, which were corrected by eugenol treatment. Alveolar bone loss and remodeling associated with estrogen insufficiency was ameliorated by eugenol owing to its anti-inflammatory properties, suggesting an extra dental impact for eugenol.

Influence of Oral and Gut Microbiota in the Health of Menopausal Women

Sex differences in gut microbiota are acknowledged, and evidence suggests that gut microbiota may have a role in higher incidence and/or severity of autoimmune diseases in females. Additionally, it has been suggested that oral, vaginal, and gut microbiota composition can be regulated by estrogen levels. The association of vaginal microbiota with vulvovaginal atrophy at menopause is well described in the literature. However, the relevance of oral and gut microbiota modulation in the immune system during estrogen deficiency and its effect on inflammatory diseases is not well explored. Estrogen deficiency is a condition that occurs in menopausal women, and it can last approximately 30 years of a woman’s life. The purpose of this mini- review is to highlight the importance of alterations in the oral and gut microbiota during estrogen deficiency and their effect on oral and inflammatory diseases that are associated with menopause. Considering that hormone replacement therapy is not always recommended or sufficient to prevent or treat menopause-related disease, we will also discuss the use of probiotics and prebiotics as an option for the prevention or treatment of these diseases.

Original Research. Candida in Oral and Maxillofacial Pathology: Clinical Findings and Risk Factors

Background: Candida, and especially Candida albicans, colonizes the oral mucosa and becomes invasive when the immune system weakens. Therefore, frequently, oral and maxillofacial pathology can be associated with Candida. Objective: The qualitative and quantitative assessment of Candida colonization of the oral cavity in patients with oro-maxillo-facial conditions; to establish an association between the different contributing factors and colonization. Material and methods: Samples were collected from 70 patients hospitalized in the Clinic of Oral and Maxillo-Facial Surgery, by rinsing the mouth with sterile saline; historical data were also collected. The samples were analyzed at the Microbiology Laboratory of the University of Medicine and Pharmacy of Tîrgu Mureș, using Sabouraud agar medium. For each isolate, the antifungigram for Fluconazole and Voriconazole was performed following the CLSI standards. Results: From the 70 samples 45.7% were positive for 11 different yeast species. Regarding predisposing factors, most importantly, smoking was significantly associated with Candida colonization (OR = 2.34; 95% CI = 1.42-3.84; p <0.05). Other factors, such as radiotherapy, oral hygiene or antibiotics, are related, but not statistically significant in our study. Candida albicans was the predominant species (38.8%). The testing of Candida albicans and non-albicans to Fluconazole showed an increased resistance (52.4%) in both cases, while the resistance to Voriconazole was 50% and 12.5%, respectively. Conclusions: Colonization of the oral cavity with Candida is present in about half of the patients with OMF conditions, and this is probably not only due to classical predisposing factors, but also due to chronic oral pathology and to several risk factors like smoking or radiotherapy.

Comparative Evaluation of Salivary Neopterin Levels and Its Effects to Periodontal Therapy in Pre- and Post-Menopausal Women

OBJECTIVES

Neopterin is a valuable diagnostic biomarker, which is elevated in inflammatory conditions like periodontitis, that is characterized by destruction of the supporting structures of the teeth. Among the biomarkers, neopterin occurs in body fluids, and acts as a diagnostic marker for present and future disease activity.

METHODS

Thirty female subjects with chronic periodontitis, mean age 50 years (40-60 years) were included in this study. Depending upon their menstrual history, subjects were categorized into two groups of fifteen each. Group I 15 pre-menopausal women, and Group II 15 post-menopausal women. Saliva was collected, and neopterin levels were assessed by enzyme-linked immunosorbent assay in both the groups, at base line and after three months of nonsurgical periodontal therapy (NSPT). Periodontal parameters like pocket probing depth (PD) and Russell's periodontal disease index (PDI) were assessed before treatment as well as after three months of scaling and root planning.

RESULTS

Intra group analysis showed significant markdown in the mean values of all the parameters from baseline to three months (P < 0.001), for all patients. The intergroup comparison, from baseline to 3 months also showed no significant change in PD and PDI values, but there was a statistically significant difference in the salivary neopterin levels (P = 0.04).

CONCLUSIONS

Neopterin levels were found to be reduced in three months after NSPT in both the groups, suggesting that the NSPT is the gold standard therapy, and also that neopterin levels in saliva can be used as an indicator to identify periodontal inflammation and destruction.

Linking medical and dental health record data: a partnership with the Rochester Epidemiology Project

PURPOSE

The purpose of this project was to expand the Rochester Epidemiology Project (REP) medical records linkage infrastructure to include data from oral healthcare providers. The goal of this linkage is to facilitate research studies examining the role of oral health in overall health and quality of life.

PARTICIPANTS

Eight dental practices joined the REP between 2011 and 2015. The REP study team has linked oral healthcare information with medical record information from local healthcare providers for 31 750 participants who have resided in Olmsted County, Minnesota. Overall, 17 718 (56%) participants are women, 14 318 (45%) are 40 years of age or older and 26 090 (82%) are white.

FINDINGS TO DATE

A first study using this new information was recently completed. This resource was used to determine whether the 2007 guidelines from the American Heart Association affected prescription rates of antibiotics to patients with moderate-risk cardiac conditions prior to dental procedures. The REP infrastructure was used to identify a series of patients diagnosed with moderate-risk cardiac conditions by the local healthcare providers (n=1351), and to abstract antibiotic prescriptions from dental records both pre-2007 and post-2007. Antibiotic prescriptions prior to dental procedures declined from 62% to 7% following the change in guidelines.

FUTURE PLANS

Dental data from participating practitioners will be updated on an annual basis, and new dental data will be linked to patient medical records. In addition, we will continue to invite new dental practices to participate in the REP. Finally, we will continue to use this research infrastructure to investigate associations between oral and medical health, and will present findings at conferences and in the scientific literature.

Helicobacter is preserved in yeast vacuoles! Does Koch's postulates confirm it?

The manuscript titled “Vacuoles of Candida yeast behave as a specialized niche for Helicobacter pylori (H. pylori)” not only has not been prepared in a scientific manner but the methodology used was not adequate, and therefore the conclusion reached was not correct. First of all, “yeast” is a broad terminology covering a great number of genera and species of unicellular micro-organisms. The authors should have defined the organism with its binary scientific name. This measure would allow experiment reproduction by the scientific community. Moreover, the criteria established by Robert Koch to identify a specific microorganism or pathogen was not adopted in the methodology used. Regarding the methodology applied, use of the chicken egg-yolk (IgY) antibody and PCR of the apparently tainted yeast population to prove H. pylori existence in the yeast vacuoles might be main factors for their wrong conclusions. Bacterial tropism toward yeast extract is a known phenomenon, and yeast extract is one of the main ingredients in culture media. Their internalization through phagocytosis or similar pathways does not seem possible or practical because of the thick and cellulosic yeast wall. While the small size of yeast cells does not support their ability in harboring several H. pylori, other observations such as inefficiency of anti-fungal therapy as anti-Helicobacter therapy strongly reject the conclusion reached by the above-mentioned article.

Quality of Life and Poor Oral Health: A Comparison of Postmenopausal Women

Inter-relationships between traditional dental variables are becoming more evident in far reaching aspects of life, such as psychosocial interaction, self-esteem, overall health and even occupational performance. This study compares quality of life (QoL) in postmenopausal women (PMW) with poor oral health (POH) with QoL in PMW with good oral health. A total of 200 randomly recruited PMW received a dental evaluation and completed the Utian Quality of Life Survey. The participants were divided into POH and healthy groups based on a dental exam. Mean scores were calculated for each QoL item, domain and the overall summary score. For each of the four parameters for periodontitis diagnosis, periodontitis b s patients’ QoL outcomes were compared to those of healthy patients using a T-test with a threshold of significance at p < 0.05. QoL in all fields measured was significantly poorer in the POH patients compared to the healthy patients: occupational score (19.95 ± 5.35 vs. 27.56 ± 6.13), health score (18.02 ± 8.23 vs. 26.59 ± 6.45), emotional score (15.68 ± 10.22 vs. 21.15 ± 9.15), sexual score (6.2 ± 5.98 vs. 10.02 ± 5.35), and total score (60.21 ± 25.85 vs. 84.26 ± 22.35). This study finds that PMW with POH report significantly poorer quality of life. Clinicians caring for PMW should be aware that oral health impacts QoL and make appropriate referral decisions for patients’ dental care.

Assessment of periodontal health status in postmenopausal women visiting dental hospital from in and around Meerut city: Cross-sectional observational study

Background:

Puberty, menses, pregnancy, and menopause are the different phases of a woman's life which have a varied influence on oral health. During the menopause, women go through biological and endocrine changes, particularly in their sex steroid hormone production which affects their health. Because the oral mucosa contains estrogen receptors, variations in hormone levels can be seen directly in the oral cavity leading to a few oral conditions and diseases seen more frequently during postmenopausal years.

Objective:

The objective of this study is to assess periodontal health status in postmenopausal women in and around Meerut city.

Materials and Methods:

The study sample comprised ninety postmenopausal women. History of menopause was recorded, and the dental examinations were done by measuring the following parameters of periodontal health: plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket probing depth, and Russell's periodontal index. The collected data were subjected to statistical analyses.

Results and Conclusion:

In the study group, mean age was 55 years, mean missing teeth were 10.3, mean duration of menopause was 9.23. Eleven percent females were completely edentulous, and 5 females had never brushed. Mean PI-s was 1.99, mean GI-s was 1.74, mean BOP was 52.85, and mean Russell's periodontal index was 4.34. Eleven patients were at the initial stages of destructive periodontal disease, 34 had established destructive periodontal disease while thirty patients had the terminal periodontal disease. These findings suggest that females after menopause are at a risk of developing destructive periodontal disease if proper oral hygiene practices are not followed.

Study of the association between the interleukin-1 β c.3954C>T polymorphism and periodontitis in a population sample from Bahia, Brazil

BACKGROUND

Periodontitis is an inflammatory disease characterized by the loss of connective tissue and alveolar bone. Different factors are associated with the onset and prognosis of this disease, both environmental and genetic. The latter particularly relate to molecules secreted as a function of the host immune response, such as pro-inflammatory cytokines. Studies indicate that the polymorphism c. 3954C > T in the interleukin-1 β encoding gene (IL1B) can be considered as an aggravating factor in the periodontitis condition.

AIMS

This study aimed to evaluate whether there is an association between the IL1B c. 3954C > T gene polymorphism and the prevalence of periodontitis in the population from Vitória da Conquista-Bahia, Brazil.

MATERIALS AND METHODS

A total of 347 subjects (134 cases and 213 controls) who provided epithelial tissue of the oral cavity and saliva samples for DNA extraction and quantification of IL1B, respectively, were selected. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism followed by electrophoresis in agarose gel. The evaluation of the cytokine concentration was performed by enzyme-linked immunosorbent assay.

STATISTICAL ANALYSIS

Statistical calculations involved in this work include Chi-square test, Fisher Exact test, Mann-Whitney and Kruskal-Wallis tests.

RESULTS

Our findings revealed that: (i) No statistically significant relationship between periodontitis and the polymorphism studied was observed; (ii) no significant difference between the concentrations of IL1B in saliva between the case and control subjects and between the genotypes of these individuals and the concentrations of this cytokine.

CONCLUSIONS

We conclude that, in the sample evaluated, the IL1B c. 3954C > T polymorphism did not present as an etiological factor for periodontitis.