The endocrine system is a tough employee. It is a set of glands that produce hormones regulating sleep, temper, metabolism, development, tissue, and sexual perform. Major glands of the endocrine system are the pineal gland, pituitary gland, thyroid and parathyroid glands, adrenal glands, pancreas, thymus, ovaries, and testes.

Common ailments of the endocrine system embody kind 1 and kind 2 diabetes, Cushing’s and Addison’s ailments, osteoporosis, and thyroid issues. A option to perceive the endocrine system is to consider it just like the nervous system. The nervous system makes use of neurotransmitters to speak, and the endocrine system makes use of hormones.

For girls, estrogen is taken into account the grasp regulator. Estrogen isn’t a single hormone. There are three subtypes: estradiol, estriol, and estrone. Estradiol is made by the ovaries through the reproductive years; estriol is generally produced throughout being pregnant; and estrone is essentially the most predominant estrogen in postmenopausal girls. Estrone is made by adipose fats reasonably than the ovaries. Estrone is just not almost as potent as estradiol, which is what causes imbalances and signs.

Also by Anne O. Rice:

Salivary diagnostics: The 411

Do you really know what oral-systemic means?

Ask most girls over 50 and they’ll share that in perimenopause and menopause, the lower in hormones, estrogen, and progesterone causes an imbalance within the physique that’s arduous to overlook. This contains sizzling flashes, evening sweats, poor sleep, and a number of different alterations.

But feminine hormones do a complete lot extra in a lady’s general well being than these inconvenient truths. The biochemical perform of hormones promotes good cardiovascular well being, protects bone density, and regulates respiratory perform. With all of the relationships between hormones and general well being, are we lacking any reference to oral well being?

Xerostomia

The most important oral discomfort in girls going by menopause is oral dryness or xerostomia. Some girls additionally complain of burning mouth syndrome and altered style buds. Occasionally bouts with oral lichen planus can rear their head.¹

Progesterone and estrogen ranges appear to be related to that oral dryness. Not solely is there a discount in salivary circulate, but additionally in composition. When cortisol ranges enhance within the saliva, it adjustments the composition of the saliva; a 2012 examine investigating salivary cortisol ranges had been checked in opposition to oral dryness in postmenopausal girls and located a direct relationship.² It’s good for all sufferers to be looking out for signs of dry mouth, nevertheless it’s particularly warranted for ladies of their menopausal years.

Burning mouth syndrome (BMS)

This syndrome is recognized by exclusion after ruling out a pathological lesion, vitamin deficiencies, systemic illness corresponding to kind 2 diabetes, anemia or hypothyroidism, and autoimmune situations corresponding to lichen planus or Sjögren’s. Medications used for hypertension and coronary heart failure corresponding to lisinopril or different ACE inhibitors may cause BMS. If it’s all of the sudden occurring three to 12 years after menopause, the trigger might merely be that. Unfortunately, hormone alternative remedy doesn’t appear to assist these sufferers. Antidepressants might be useful with neuropathic ache in addition to anticonvulsants corresponding to gabapentin.

That’s a dialog it’s best to counsel the affected person have with their doctor. BMS can come up with melancholy and nervousness, however the particulars of the connection are unclear.³ Concerns with anxiolytics that calm nerve fibers embody habit and fall danger within the aged, limiting their worth. When cortisol ranges are elevated as they’re with stress, burning mouth is one other situation that will happen.⁴

Mucosa

Menopausal gingivostomatitis is when the gums are dry, shiny, and bleed simply. Gums can vary in shade from pale to deep purple. There additionally could also be indicators of candidiasis, pemphigus vulgaris, benign mucosal pemphigoid, and lichen planus. Autoimmune issues enhance after menopause. Topical antifungal brokers corresponding to nystatin might present aid, relying on the mucosal dysfunction.

Temporomandibular joint dysfunction (TMD)

Women are twice as more likely to develop TMD, and a few analysis means that the situation could also be influenced by hormone adjustments.⁵ Low ranges of estrogen throughout menopause predisposes the TMJ to degeneration and will increase alveolar bone loss.⁶ The results of estrogen and TMD have been contradictory. However, in recent times outcomes counsel that low ranges of estrogen might potentiate sure sorts of TMD. Menopause is the most typical explanation for osteoporosis, ensuing within the discount of bone high quality—however the roles of osteoporosis and TMJ bone adjustments are wrought with controversy.^7-9

Periodontal illness and bone loss

The American Academy of Periodontology considers osteoporosis a danger issue for periodontal illness. Oral-systemic well being isn’t simply what pathogens can do to the physique—it’s additionally what the physique programs can do to the mouth. Osteoporosis impacts each women and men of all races, however white and Asian girls and older girls who’re previous menopause are extra inclined. Bisphosphonates are a bunch of medication which can be prescribed to assist girls with their osteoporosis. A facet impact is the lack of blood to the bone, which might trigger necrosis.

Here is the double-edged sword: the administration of bisphosphonates along side scaling and root planing confirmed come medical efficacy.¹⁰ Our immune system is without doubt one of the most complicated programs we now have, and as we age, immune exercise declines. Estrogen, progesterone, and testosterone discount have been attributed to a point to a decline in immune perform, and rising older provides us a bigger susceptibility to infectious illness.^11,12 As an instance, 10%-15% of ladies over 60 endure from elevated frequency of urinary tract infections, and that is partially as a result of adjustments within the protection system of the urogenital tract. Low estrogen manufacturing postmenopause has been related to elevated manufacturing of interleukin 1 (IL-1), IL-6, IL-8, IL-10, and tumor necrosis issue alpha (TNF1α).¹³ Then add the immune system compromise that should battle the periodontal pathogens, and an ideal storm of illness awaits.

From puberty to postmenopause, each feminine affected person’s oral well being might be totally different. Women’s hormones and their results can mark oral well being transformations that clinicians have to know to distinguish remedy and proposals. Six thousand girls enter menopause daily—that’s two million per 12 months. I’d suspect there are a couple of in your follow, or maybe in your individual household, who would profit from a higher understanding of their systemic well being.

Editor’s word: This article appeared within the November 2022 print version of RDH journal. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Mohan RP, Gupta A, Kamarthi N, Malik S, Goel S, Gupta S. Incidence of oral lichen planus in perimenopausal girls: a cross-sectional examine in Western Uttar Pradesh inhabitants. J Mid-life Health. 2017;8(2):70-74. doi:10.4103/jmh.JMH_34_17

2. Agha-Hosseini F, Mirzaii-Dizgah I, Mirjalili N. Relationship of stimulated complete saliva cortisol degree with the severity of a sense of dry mouth in menopausal girls. Gerodontology. 2012;29(1):43-47. doi:10.1111/j.1741-2358.2010.00403

3. Tait RC, Ferguson M, Herndon CM. Chronic orofacial ache: burning mouth syndrome and different neuropathic issues. J Pain Manag Med. 2017;3(1):120.

4. Amenábar JM, Pawlowski J, Hilgert JB, et al. Anxiety and salivary cortisol ranges in sufferers with burning mouth syndrome: case-control examine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(4):460-465. doi:10.1016/j.tripleo.2007.10.002

5. Robinson JL, Johnson PM, Kister Ok, Yin MT, Chen J, Wadhwa S. Estrogen signaling impacts temporomandibular joint and periodontal illness pathology. Odontology. 2020;108(2):153-165. doi:10.1007/s10266-019-00439-1

6. Bueno CH, Pereira DD, Pattussi MP, Grossi PK, Grossi ML. Gender variations in temporomandibular issues in grownup populational research: a scientific overview and meta-analysis. J Oral Rehabil. 2018;45(9):720-729. doi:10.1111/joor.12661

7. Bäck Ok, Ahlqwist M, Hakeberg M, Björkelund C, Dahlström L. Relation between osteoporosis and radiographic and medical indicators of osteoarthritis/arthrosis within the temporomandibular joint: a population-based, cross-sectional examine in an older Swedish inhabitants. Gerodontology. 2017;34(2):187-194. doi:10.1111/ger.12245

8. Jagur O, Kull M, Leibur E, et al. Relationship between radiographic adjustments within the temporomandibular joint and bone mineral density: a inhabitants primarily based examine. Stomatologija. 2011;13(2):42-48.

9. Dervis E. Oral implications of osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(3):349-356. doi:10.1016/j.tripleo.2005.04.010

10. Muniz FWMG, Silva BFD, Goulart CR, Silveira TMD, Martins TM. Effect of adjuvant bisphosphonates on remedy of periodontitis: systematic overview with meta-analyses. J Oral Biol Craniofac Res. 2021;11(2):158-168. doi:10.1016/j.jobcr.2021.01.008

11. Gavazzi G, Krause KH. Ageing and an infection. Lancet Infect Dis. 2002;2(11):659-666. doi:10.1016/s1473-3099(02)00437-1

12. Giefing-Kröll C, Berger P, Lepperdinger G, Grubeck-Loebenstein B. How intercourse and age have an effect on immune responses, susceptibility to infections, and response to vaccination. Aging Cell. 2015;14(3):309-321. doi:10.1111/acel.12326

13. Pacifici R. Estrogen, cytokines, and pathogenesis of postmenopausal osteoporosis. J Bone Miner Res. 1996;11(8):1043-1051. doi:10.1002/jbmr.5650110802