Effect of Menopause on Periodontium-Is There A Link?

Introduction: Menopause is associated with important systemic and oral changes. Many researchers have tried to evaluate the influence of hormonal changes associated with menopause in the periodontium, however results are still contradictory. Objective: The aim of the present study was to evaluate the effect of menopause on the severity of periodontal destruction. Methods: In the present study 25 systemically healthy women age ranges from 30 to 65 with generalised chronic periodontitis were included. They were divided into 2 groups based on their menstrual history. Group I (control group) included 8 women with normal menstrual cycle and Group II (test group) included 17 postmenopausal women. Clinical parameters Plaque Index, Gingival Index, periodontal probing pocket depth (PPD) and DMFT Index was recorded. The level of bone present was evaluated radiographically. Results: There were no significant differences between subjects of both the control and test groups in the percentages of sites for presence of plaque (p > 0.37), gingival index (p > 0.161) and DMFT index (p > 0.099). However deeper pockets (p < 0.001) and reduced bone support (p < 0.00) was observed in Group II as compared to Group I. Conclusion: The findings of the present study suggest, that postmenopausal women have more severe periodontal destruction as compared to premenopausal women.


INTRODUCTION
Throughout a woman's life cycle, hormonal influences affect therapeutic decision making in periodontics. Therefore it is imperative that the clinician recognise, customise, and appropriately alter periodontal therapy according to the individual woman needs based on the stage of her life cycle. 1 Hormones are specific regulatory molecules that modulate reproduction, growth and development, maintenance of the internal environment, as well as energy production, utilization, and storage. 2 In woman goes through mainly four stages in her life cycle where hormonal imbalance found are: Puberty, Menstrual cycle, Pregnancy, and Menopause. As women approach menopause, the levels of estrogen begin to drop mainly during the late follicular and luteal phase of the menstrual cycle.
Dr. Ruzuta Khushal Bhai Dabhi, 1 Dr. Aditi Mathur, 1 Dr. Neema Shetty, 1 Dr. Barkha Makhijani, 1  The sudden decrease in estrogen production that occurs in menopause is considered to be the main cause of primary osteoporosis, which also affects jawbones. 8,9 It has been suggested that this reduction in bone mineral density could contribute to periodontal disease progression. 10 Besides their effect on bone, estrogens also interfere with other periodontal tissues (gingiva and periodontal ligament) and influence host immune-inflammatory responses. [11][12][13] Osteoporosis is defined by the World Health Organization (WHO) as a "Bone mineral density (BMD) that is 2.5 standard deviations or more below the average value for young healthy women (a T-score of < attachment formation; Reduced bone mineral content in the jaws; and Increase of periodontitis and tooth loss. [15][16][17] So, the aim of the present study was to evaluate the effect of menopause on periodontal destruction.

RESULTS
After taking a detailed medical, dental and menstrual history.
Patients were divided in two groups according to their menstrual history: Group I (Control group) -8 females with ongoing menstruation.       others have failed to demonstrate such relationship. 25,26 So, the present study was conducted to evaluate the effect of hormonal imbalances that occurs during menopause on periodontium.
For this study when intergroup comparison for plaque index was done it showed non-significant difference in PI (p > 0.376) indicating that menopause don't have any direct correlation with plaque formation. These results were similar to study done by Alves et al. 27 Gingival index also demonstrated non-significant difference (p > 0.161) which is similar to a study done by Alves et al. 27 When DMFT index was compared there was significant difference (p >0.099) was found between two groups, in Group II number of missing teeth was more as compared to teeth that were decayed and restored which may be due to more bone loss in menopause. It was found by LaMonte et al that periodontal disease was responsible for 13% of teeth lost during a five-year follow-up period, although the mean number of teeth lost was quite small. 28 So in present study subjects were diagnosed with generalised chronic periodontitis so it can not be justified that tooth loss that was found was due to effect of menopause or due to the existing periodontitis. These results were similar to the results that was found by Alves et al. 27 However deeper pocket (p<0.001) and reduced bone support (p<0.00) was observed in Group II compared as to Group I.
It was also found that absence of estrogen and progesterone hormones in menopause contributes to changes in the periodontal tissues. 29