Oral discomfort and hormone replacement therapy in the post-menopause

Unstimulated Salivary Estrogen in Postmenopausal Women With and Without Oral Dryness: A Prospective Study

Objective:

This study aimed to compare the unstimulated salivary estrogen levels in postmenopausal women with and without oral dryness.

Methodology:

A study was carried out on 70 selected postmenopausal women, out of which 35 were in the case group and 35 were in the control group. A questionnaire related to oral dryness was given to all the patients to evaluate their response to oral dryness. Patients were asked to spit in a plastic container, and their unstimulated saliva samples were obtained and analyzed for estimation of salivary estrogen levels by ELISA technique. After analyzing the results of salivary estrogen levels, the patients in the case group with low levels of estrogen were subjected to HRT under the guidance of a gynecologist. The patients were followed after 3 months of therapy for their response to oral dryness by the questionnaire, and salivary estrogen levels were again reevaluated after the therapy. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc, Chicago, IL, version 15.0 for windows). The Pearson’s correlation and Student’s unpaired t-test were used for comparisons.

Results:

Before hormone replacement therapy, the mean estrogen level of the case group was 1.0031, and the mean estrogen level of the control group was 4.0080 pg/ml. This suggested that the reduced levels of estrogen hormone after menopause were associated with the complaint of oral dryness in these females. The mean salivary estrogen levels in the case group after HRT were more than the levels before HRT.

Conclusion:

Estrogen levels were reduced in patients with oral dryness. Further, the patients receiving HRT showed significant improvement in symptoms of oral dryness.

Role of hormone replacement therapy in relieving oral dryness symptoms in postmenopausal women: a case control study

BACKGROUND

To evaluate the efficacy of hormone replacement therapy in relieving oral symptoms in postmenopausal women presenting with genitourinary symptoms along with oral dryness.

METHODS

A case-control study was conducted after selecting 60 postmenopausal women. Oral dryness status of all the patients was evaluated with the help of questionnaire related to oral dryness. These subjects were divided into case group and control group on the basis of response to questionnaire of oral dryness. Unstimulated saliva samples were obtained and analyzed for estimation of salivary estradiol levels by enzyme linked immune sorbent assay technique. After analyzing the result of salivary estradiol levels, case group was subjected to hormone replacement therapy (HRT). The patients were followed up for their response towards oral dryness as well as salivary estradiol levels after the therapy.

RESULTS

The mean salivary estradiol level before HRT was significantly more among control group as compared to case group (p value < 0.001). Most of the patients complained of dry mouth (26 out of 30); reduced amount of saliva in the mouth (25 out of 30); dry mouth at night (28 out of 30); dry mouth during the day (25 out of 30) before HRT. These complains were significantly reduced after the therapy. The mean salivary estradiol in the case group levels increased significantly after HRT (p value < 0.001).

CONCLUSION

The salivary estradiol levels were reduced in post menopausal women with the complain of xerostomia as compared to those without the complain of xerostomia. Further these levels can be recovered with the help of hormone replacement therapy.

Neuropathic Pain and Burning Mouth Syndrome: An Overview and Current Update

Burning mouth syndrome/glossodynia and trigeminal neuropathic conditions can have serious negative impact on a patient's overall quality of life. These conditions are often hard to diagnose and even harder to fully treat and manage, but it is important for dentists/oral and maxillofacial surgeons to be aware of these conditions and modalities of their treatment. Often the only method for arriving at the proper diagnosis is for patients to undergo traditional approaches for treatment of presenting signs and symptoms, and it is the unexpected failure of interventional therapies that leads ultimately to a proper diagnosis.

Characterization of burning mouth syndrome profiles based on response to a local anaesthetic lozenge

OBJECTIVE

Burning mouth syndrome (BMS) is a chronic oral pain condition with unknown aetiology but assumed to involve peripheral/central neuropathological and immune-mediated inflammatory factors. We aimed at characterizing inflammatory and neurogenic profiles and oral symptomatology of patients with BMS based on response to a local anaesthetic lozenge.

METHODS

Patients with BMS were divided into an Effect (n = 13), No effect (n = 8) or Unspecified (n = 2) group according to their response to a local anaesthetic lozenge on oral pain. Inflammation was assessed in blood plasma and saliva by analyses of IL-6, IL-8, IL-17A, IL-23 and TNF-α levels. The degree of inflammation and distribution of oestrogen receptor, NGF, NGF-receptor, TRPV-1 and IL-17F in buccal mucosal tissue were investigated by immunohistochemistry.

RESULTS

Immunoreactivity to the oestrogen receptor was most intense in the Effect group, whereas the No effect group tended to have higher plasma levels of the pro-inflammatory cytokines.

CONCLUSIONS

Our findings indicate that the response to treatment with local anaesthesia enables subgrouping of patients with BMS according to the potential pathogenic mechanisms. Effect of local anaesthesia indicates a peripheral neuropathology involving lack of oestrogen and upregulation of oestrogen receptors, and no effect indicates a systemic inflammation-induced mechanism leading to increased levels of plasma cytokines.

Burning Mouth Syndrome

Burning mouth syndrome (BMS) is multifactorial in origin which is typically characterized by burning and painful sensation in an oral cavity demonstrating clinically normal mucosa. Although the cause of BMS is not known, a complex association of biological and psychological factors has been identified, suggesting the existence of a multifactorial etiology. As the symptom of oral burning is seen in various pathological conditions, it is essential for a clinician to be aware of how to differentiate between symptom of oral burning and BMS. An interdisciplinary and systematic approach is required for better patient management. The purpose of this study was to provide the practitioner with an understanding of the local, systemic, and psychosocial factors which may be responsible for oral burning associated with BMS, and review of treatment modalities, therefore providing a foundation for diagnosis and treatment of BMS.

Menopause and oral health

Different phases of a woman's life: Puberty, menses, pregnancy, and menopause have varied influence on her oral health. During the menopause, women go through biological and endocrine changes, particularly in their sex steroid hormone production, affecting their health. Because the oral mucosa contains estrogen receptors, variations in hormone levels directly affect the oral cavity. A few oral conditions and or diseases are seen more frequently during post menopausal years. Role of hormones affecting the health of oro-dental tissues, as well as treatment by HRT in ameliorating these conditions is not clear. There is paucity of randomized controlled trials in this field and more data is needed, before the recommendations for oral health care in post menopausal women can be made. A gynecologist sitting in menopausal clinic should be aware of oral changes happening during this period, and dental needs of these women and should refer them to the dental specialists accordingly. On the other hand, a dentist should also be sensitized about the menopausal status of the woman, her HRT status and special preventive and treatment needs.

K, K. J, D. D, T.V. S, Dinesh P. Evaluation of Salivary Flow Rate, pH and Buffer in Pre, Post & Post Menopausal Women on HRT

BACKGROUND

Climateric is considered to be a natural phase of life which by definition is the period of life starting from decline in ovarian activity until after the end of ovarian function. It is accompanied by various health consequences that include the changes in saliva too. This study was carried out to evaluate the salivary flow rate, pH, buffering capacity in pre-menopausal, post-menopausal and post-menopausal women on HRT.

AIMS AND OBJECTIVES

(1) To evaluate the salivary flow rate, pH of resting saliva and stimulated saliva and buffer capacity of stimulated saliva in pre-menopausal, post-menopausal and post-menopausal women on Hormone Replacement Therapy (HRT). (2) To compare the above salivary findings between pre-menopausal, post-menopausal and post-menopausal women on HRT.

MATERIALS AND METHODS

The study was carried out on 60 patients. These patients were divided into three groups of 20 patients: Group 1: Pre-menopausal women (control), Group 2: post-menopausal women (case), Group 3: post-menopausal women on HRT (case). The control group consisted of 20 women volunteers, having regular ovulatory menstrual cycles with no known systemic illness and deleterious habits and Group 2 consists of 20 post-menopausal women and Group 3 will consist of 20 post-menopausal women on HRT. After clearing the mouth by swallowing, stimulated saliva was collected after chewing paraffin for 10 mins in to a glass centrifuge tube graded in 0.1 mL increments up to 10mL.in rare cases the collection time will be reduced or extended (5-15 min), salivary flow rate will be determined as ml/min, immediately after collection, pH was determined by dipping pH test paper directly into the sample of oral fluid, salivary buffer capacity was determined by using saliva check buffer kit (GC corporation). The data obtained was statistically evaluated using chi-square test, fisher exact test ANOVA analysis.

RESULTS

In our study we found salivary flow rate significantly lower in the post-menopausal women in comparison with the menstruating women and also there was improvement in the flow rate in individuals who were on HRT, it was also observed that salivary pH of the post-menopausal group was significantly lower than that of the control group, statistically significant difference in buffer capacity values was found between the groups however buffer capacity values were higher in the post-menopausal group than the control group.

CONCLUSION

From the above study it is clear that post-menopausal women will present with oral discomfort, while HRT can improve the same. Hence our role as physicians and health care providers is to incorporate preventive dental health care in post-menopausal women and clearly inform patients about both the benefits and the limitations of HRT.

Stimulated and unstimulated saliva progesterone in menopausal women with oral dryness feeling

The aim of this study was to investigate the stimulated and unstimulated salivary progesterone in menopausal women with oral dryness (OD) feeling. A case-control study was carried out on 70 selected menopausal women aged 42-78 years with or without OD feeling (35 as cases with xerostomia and 35 as control without xerostomia), conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences (TUMS). Unstimulated and paraffin-stimulated saliva samples were obtained by expectoration. The salivary concentration of progesterone was determined with an enzyme immunoassay kit. Statistical analysis of the Student's t test was used. The mean stimulated and unstimulated whole saliva progesterone concentrations and unstimulated saliva flow, but not stimulated saliva flow rate, was significantly lower in the case than in the control. The results showed that subjects with dry mouth had decreased unstimulated saliva flow and salivary progesterone compared with those without dry mouth. Thus, salivary progesterone level appears associated with OD feeling in menopause.

The menopause and oral health

OBJECTIVES

To review the literature about oral symptoms and signs at the menopause with an emphasis on hormone replacement therapy (HRT). To give practical guidelines for women and their physicians in menopause-related oral health problems.

METHODS

The PubMed and Cochrane databases was searched until mid January 2009 with key words such as "menopause", "menopausal complaints", "postmenopausal complaints" and "oral diseases", "oral discomfort", "dental health", "dental diseases", "saliva", "burning mouth syndrome", "dry mouth", "xerostomia". Because of a scarcity of controlled studies no systematic review could be conducted.

RESULTS

Oral discomfort is found in many menopausal women in addition to more general climacteric complaints. The principal peri- and postmenopausal symptoms are dry mouth and burning mouth (glossodynia) which, in turn, may increase the occurrence of oral mucosal and dental diseases, such as candidiasis. The mechanisms of hormone-related oral symptoms and signs are not known although oestrogen receptors, for example, have been detected in the oral mucosa and salivary glands. In principle, the histology of oral and vaginal mucosa is very similar and thus their symptoms might share a common cause. Yet, hormone replacement therapy use does not necessarily prevent or help women with oral symptoms.

CONCLUSION

Properly controlled long-term randomized studies are needed to assess the effect of HRT on oral discomfort. Future gene profiling could identify women who may or may not benefit from HRT with regard to oral symptoms.

Total tooth loss and prevalent cardiovascular disease in men and women: possible roles of citrus fruit consumption, vitamin C, and inflammatory and thrombotic variables

BACKGROUND AND OBJECTIVE

Tooth loss has been associated with cardiovascular disease (CVD), but the mechanisms are unclear. We evaluated the association of total tooth loss with prevalent CVD in men and women; as well as with citrus fruit consumption, plasma vitamin C, and inflammatory and thrombotic variables.

METHODS

We used an age-and sex-stratified population survey, of men and women aged 25-74 years, in North Glasgow.

RESULTS

Thirty-eight percent of women and 29% of men were edentulous. Total tooth loss was associated with prevalent CVD in both sexes. After adjustment for major potential confounders (age, sex, smoking, and social class), the odds ratio (95% CI) for prevalent CVD was 1.55 (1.13, 2.13) in the edentulous. Total tooth loss was also associated with low citrus fruit consumption and low plasma vitamin C levels, increased plasma C-reactive protein in men, and with increased plasma interleukin-6, fibrinogen, and factor VIII levels in women.

CONCLUSION

Prevalent CVD is associated with total tooth loss. Possible mechanisms include low intake of citrus fruit, and hence, low plasma vitamin C levels, and a predisposition to low-grade inflammation and thrombosis. It may be prudent to ensure adequate vitamin C intake in people with no teeth.

The prevalence of symptoms possibly related to the climacteric in pre- and postmenopausal women in Linköping, Sweden

BACKGROUND

Some extragenital symptoms have been suggested to be associated with the menopause and thus to be affected by estrogen status. In such case extragenital symptoms may be more frequent in postmenopausal women without hormone replacement therapy (HRT) than in premenopausal women or women using HRT.

OBJECTIVE

To assess if the prevalence of a number of extragenital symptoms is higher in postmenopausal women without than with HRT, or in premenopausal women of the same age.

MATERIAL AND METHODS

All women aged 53 and 54 years in the community of Linköping (n=1760) were sent a validated questionnaire about use of HRT, time since last menstruation and about different extragenital symptoms.

RESULTS

1298 (73.8%) women answered the questionnaire and answers from 1180 (67%) women were possible to analyze. Postmenopausal women woke up significantly more often during night than premenopausal, and those without HRT often due to hot flushes and sweating. Women with HRT reported more muscular pain than the others. We found no other significant difference in prevalence of extragenital symptoms between the three groups of women.

CONCLUSIONS

Sleeping disorders, arthralgia, xerophthalmia, xerostomia and dry skin are not more prevalent in 53 and 54 years old postmenopausal women without HRT than in women with HRT or in premenopausal women of the same age. It may still be that some of these symptoms are related to estrogen deficiency, but do not develop until some years after menopause. It may also be that women with the most severe symptoms decided to use HRT and thereby decreased symptoms to the same level as in non-users.

Effect of hormone replacement therapy on salivary flow rate, buffer effect and pH on perimenopausal and postmenopausal women

The effects of hormone replacement therapy (HRT) on salivary gland functions were examined in a longitudinal study. The flow rate, buffer effect and pH of paraffin-stimulated whole saliva were analysed in 8 perimenopausal and 19 postmenopausal women. The saliva samples were collected 1-2 days before as well as 3 and 5 months after the start of HRT. Salivary flow rates were higher (p <0.033) in the perimenopausal than in the postmenopausal group. The flow rates increased significantly (p <0.001) during HRT in both groups. Similarly, buffer effect and pH showed significant (p = 0.004 and p = 0.009, respectively) time-related changes without any differences between the groups. It appears that HRT improves both the quantity and the quality of salivary gland function in peri- and postmenopausal women.

Efficacy of hormone replacement therapy in postmenopausal women with oral discomfort

The increase in incidence of oral discomfort among women in a menopause is probably due to hormone modifications. This study evaluated the efficacy of hormone replacement therapy in 27 postmenopausal patients, aged 48 to 58 years, with oral discomfort and no local irritants and in 47 postmenopausal women with no oral discomfort. Patients were treated with conjugated estrogens for 21 days and medroxyprogesterone acetate from day 12 through day 21. Hormone-replacement therapy had no effect on oral cytology in the 40 symptom-free postmenopausal women compared with a group of 47 postmenopausal women who had no oral symptoms and were not treated. Hormone-replacement therapy relieved symptoms and improved oral cytohormonal features in 15 of 27 patients with symptoms. Nuclear estrogen receptors were found by immunohistochemical assay in 8 of 10 randomly selected patients with symptoms who responded to hormone-replacement therapy, but not in 2 patients who did not benefit from hormone-replacement therapy. Estrogen receptors were also found in 6 of 10 fertile women with no oral disease. Our results suggest that oral discomfort may be related to steroid hormone withdrawal only in some postmenopausal women and that replacement therapy may improve the clinical picture and cytologic features in this group of patients. Immunohistochemical identification of estrogen receptors may help to identify patients for whom hormone-replacement therapy may be beneficial.