PostMenopausal Patient & Women's Oral Health

What is menopause

When a women cycle stops for a whole year straight,

The end of fertility due to decreased production of estrogen.

At what age does menopause start

47-55

Absence of spontaneous menstrual periods in a female of reproductive age

Amenorrhea

Define hormone

A chemical product of an organ that has a specific regulatory effect upon cells elsewhere in the body

Treatment to correct/prevent undesirable symptoms of menopause

Hormone replacement therapy

what gland secretes hormones and maintains body homeostasis

Endocrine gland

Hormones regulate and augment the following:

• growth and development

• energy production

• food metabolism

• reproductive processes

• responses of the body to stress

What is the master gland

anterior pituitary

What are 2 functions of ovaries

1. Production of estrogen and progesterone

2. Ovulation, which is the release of an egg(s) needed for reproduction

What is the function of estrogen and progesterone

Prepare the inner lining of the uterus in case a pregnancy takes
place

When does peri-menopause begin

This stage begins 3-5 years before the last menstrual period.

Some signs and symptoms of menopause may appear during this phase.
may appear during this phase

Whats the purpose of estrogen

• Regulates menstrual cycle

• Stimulates the development of female secondary characteristics

• Promotes the growth and maintenance of the female reproductive system

• Maintains bone health

Estrogen may affect……

• Cholesterol levels

• Increases elasticity in arteries

• Increases elasticity in skin

• Improves memory

true or false: Smokers often begin menopause earlier

than non-smokers

true

Signs of Menopause

• Hot flashes/night sweats

• Vaginal changes-dryness, infection, discomfort

• Emotional Disturbances

• irregular cycle

• overeactive bladder

• migraines

• sleeping disorder

gingival changes Related to Menopause

• exaggerated response to plaque

• altered tolerance to pain due to estrogen decline

• menopausal gingivostomatitis

mucuos membrane and tongue changes

• burning sensation

• altered taste

• glossodynia

• xerostomia

• shiny tissue

• thin atrophic epithelium tissue

List all the names for burning mouth syndrome

Scalded mouth syndrome

Burning tongue syndrome

Burning lips syndrome

Glossodynia

HRT may also protect against

osteoporosis

HRT risks

increase breast cancer, heart disease and stroke

What medication slows the rate of bone thinning

Bisphosphonates and Calcitonin

Can we see a patient in a clinic that takes IV bisphosphonates

no

List 4 Postmenopausal effects

• Reproductive organs atrophy

• Skin and mucous membranes decrease in thickness and

keratinization

Predisposition to systemic conditions including:

› Oral health manifestations

› Diabetes

• Hypothyroidism

• Bone problems/Osteoporosis

• Cardiovascular diseases

Atherosclerosis

• Cancer

Explain what Osteoporosis is

A bone disease resulting in a reduction in
bone mass (density) due to loss of calcium

What 2 minerals are essential for normal bone

Calcium and phosphate

At what age can you get osteoporosis

Women over age 50 and men over age 70 have a higher risk due to the decrease in estrogen and testeosterone

What are other causes to osteoporosis

• being confined to the bone

• chronic rheumatoid arthritis/kidney disease

• taking corticosteroid medications more than 3m

• taking antiseizure medication

• hyperparathyroidism

• vitamin D deficiency

Risk Factors Associated with Osteoporosis

• Female

• Caucasian, Asian

• Family historyLow calcium and vitamin D intake

• Early menopause

• Early removal of ovaries

• Sedentary lifestyle

• Alcohol abuse

• Corticosteriod use

• Cigarette smoking

• High Caffeine intake

How to treat osteoporosis

Bisphosphonates

What causes Osteonecrosis of the Jaw

Non Nitrogenous bisphosphonates

do biphosphonate have a short or long half life?

long half life of 10 yrs

What causes ONJ?

Why some patients taking antiresorptive therapy get ONJ is

unknown. It may be due to:

1) a decrease the bone’s ability to repair itself

2) a decrease in blood vessel formation

3) possible effects of infection

When does ONJ occur?

Occurs after extractions (highest incidence) or periodontal and

implant procedures, endodontic therapy or spontaneously ; where

there is poor or delayed wound healing

ONJ is most common in

the mandible

Symptoms of Osteonecrosis

• Jaw Pain

• Soft tissue inflammation and infection

• Mobile teeth

• Exudate

• Symptoms may occur spontaneously or more commonly at site of previous tooth extraction

Explain the relationship between osteoporosis and perio

• reduced bone mineral density and oral bone loss in skeletal and mandible bone

• bone becomes more pourous

• Residual ridge loss in edentulous person

Treatment Recommendations for Xerostomia

• Avoid sugary drinks and caffeine

• chew surgarless gum to stimulate saliva

• Avoid salty/spicy foods

• use humidifier at night

Which of the following conditions can develop in patients receiving chemotherapy and bisphosphonates for more than three years?

a. Bacteremia

b. Osteonecrosis of the jaw

c. Infective endocarditis

d. Kidney failure

b. Osteonecrosis of the jaw

For which of the following medical/dental conditions is a

bisphosphonate indicated?

a. Multiple myeloma

b. Type 2 diabetes mellitus

c. Stomach ulcers

d. Periodontal abscess

a. Multiple myeloma

Which of the following cells are inhibited by bisphosphonates?

osteoclast

There is more concern when a bisphosphonate is taken:

a. Intramuscularly

b. Orally

c. Topically

d. Intravenously

IV

Which of the following features is prominent in osteonecrosis of the jaws (ONJ)?

a. Necrotic bone

b. Fistula (sinus tract)

c. Bleeding

d. Edematous gingival

a. Necrotic bone

Which of the following features is characteristic of bisphosphonates?

long half life

A common nutritional deficiency that accompanies the onset of

menstruation is

iron

Which of the following conditions can develop in patients receiving chemotherapy and bisphosphonates for more than three years?

b. Osteonecrosis of the jaw

Also, bisphosphonates reduce ____ caused by cancer.

high blood calcium levels