Aim: The aim of this study was to assess oral manifestations, periodontal status, and vitamin D levels in postmenopausal women.
Materials and methods: Seventy systemically healthy postmenopausal women were included in this cross-sectional study. To determine the periodontal status, clinical parameters such as clinical attachment level (CAL), probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were used. Oral manifestations were recorded using a standard questionnaire. The unstimulated salivary flow rate was recorded using the modified Schirmer test strips. The collected salivary samples were analyzed using commercially available enzyme-linked immunosorbent assay (ELISA) kits to estimate the salivary levels of vitamin D. Results were then subjected to statistical analysis. Statistical significance was defined as p < 0.05. Spearman's correlation was used to correlate vitamin D levels and the periodontal parameters.
Results: More than 50% of the participants reported xerostomia and burning mouth syndrome, with 72.08% reporting hyposalivation. A total of 78% had insufficient salivary vitamin D levels. More than 50% of the sites with BOP and mean CAL of 2.89 ± 0.79 was detected. A statistically significant strong negative correlation was observed between salivary vitamin D levels and the periodontal parameters (p < 0.001).
Conclusion: The majority of postmenopausal women exhibited oral discomfort in the form of xerostomia, burning mouth, taste alterations, and hyposalivation. There was a marked insufficiency in vitamin D levels. A significant negative correlation was demonstrated between vitamin D levels and periodontal status, owing to the increased risk of development of periodontitis in the subjects.
Clinical significance: The majority of women in the postmenopausal period experience oral symptoms related to estrogen deficiency. However, due to a lack of sufficient awareness, these issues have not been adequately addressed. Vitamin D deficiency is also commonly encountered at this stage, which complicates systemic as well as periodontal health.
AlJehani YA. Risk factors of periodontal disease: review of the literature. Int J Dent 2014;2014:182513. DOI: 10.1155/2014/182513
Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim) 2017;11(2):72–80. PMID: 28539867; PMCID: PMC5426403.
Mascarenhas P, Gapski R, Al-Shammari K, et al. Influence of sex hormones on the periodontium. J Clin Periodontol 2003;30(8):671–681. DOI: 10.1034/j.1600-051x.2003.00055.x
Güncü GN, Tözüm TF, Çaglayan FE. Effects of endogenous sex hormones on the periodontium—review of literature. Aust Dent J 2005;50(3):138–145. DOI: 10.1111/j.1834-7819.2005.tb00352.x
Patil SN, Kalburgi NB, Koregol AC, et al. Female sex hormones and periodontal health-awareness among gynecologists—a questionnaire survey. Saudi Dent J 2012;24(2):99–104. DOI: 10.1016/j.sdentj.2011.12.001
Soory M. Hormonal factors in periodontal disease. Dent Update 2000;27(8):380–383. DOI: 10.12968/denu.2000.27.8.380
Markou E, Eleana B, Lazaros T, et al. The influence of sex steroid hormones on gingiva of women. Open Dent J 2009;3:114–119. DOI: 10.2174/1874210600903010114
Meeta M, Digumarti L, Agarwal N, et al. Clinical practice guidelines on menopause: *an executive summary and recommendations: Indian menopause society 2019–2020. J Midlife Health 2020;11(2):55–95. DOI: 10.4103/jmh.JMH_137_20
Abraham A, Pullishery F. The effect of menopause on the periodontium—a review. J Interdiscipl Med Dent Sci 2015;3(2):1–4. DOI: 10.4172/2376-032X.1000170
Bhardwaj A, Bhardwaj SV. Effect of menopause on women's periodontium. J Midlife Health 2012;3(1):5–9. DOI: 10.4103/0976-7800.98810
Meurman JH, Tarkkila L, Tiitinen A. The menopause and oral health. Maturitas 2009;63(1):56–62. DOI: 10.1016/j.maturitas.2009.02.009
Aryeh HB, Gottlieb I, Ish-Shalom S, et al. Oral complaints related to menopause. Maturitas 1996;24(3):185–189. DOI: 10.1016/s0378-5122(96)82008-1
Malabanan AO, Holick MF. Vitamin D and bone health in postmenopausal women. J Womens Health 2003;12(2):151–156. DOI: 10.1089/154099903321576547
Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008;87(4):1080S–1086S. DOI: 10.1093/ajcn/87.4.1080s
Amano Y, Komiyama K, Makishima M. Vitamin D and periodontal disease. J Oral Sci 2009;51(1):11–20. DOI: 10.2334/josnusd.51.11
Jagelavičienė E, Vaitkevičienė I, Šilingaitė D, et al. The relationship between vitamin D and periodontal pathology. Medicina 2018;54(3):45. DOI: 10.3390/medicina54030045
Pinto JPNS, Goergen J, Muniz FWMG, et al. Vitamin D levels and risk for periodontal disease: a systematic review. J Periodontal Res 2018;53(3):298–305. DOI: 10.1111/jre.12531
LeBlanc ES, Desai M, Perrin N, et al. Vitamin D levels and menopause-related symptoms. Menopause 2014;21(11):1197–1203. DOI: 10.1097/gme.0000000000000238
Bergdahl J, Anneroth G. Burning mouth syndrome: literature review and model for research and management. J Oral Pathol Med 1993;22(10):433–438. DOI: 10.1111/j.1600-0714.1993.tb00120.x
Agha-Hosseini F, Mirzaii-Dizgah I, Mirjalili N. Relationship of unstimulated saliva cortisol level with severity of oral dryness feeling in menopausal women. Aust Dent J 2011;56(2):171–174. DOI: 10.1111/j.1834-7819.2011.01320.x
Kumar NN, Panchaksharappa MG, Annigeri RG. Modified Schirmer test—a screening tool for xerostomia among subjects on antidepressants. Arch Oral Biol 2014;59(8):829–834. DOI: 10.1016/j.archoralbio.2014.05.008
Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry 2015;57(Suppl 2):S222–S232. DOI: 10.4103/0019-5545.161483
Suri V, Suri V. Menopause and oral health. J Midlife Health 2014;5(3):115–120. DOI: 10.4103/0976-7800.141187
Lerchbaum E. Vitamin D and menopause—a narrative review. Maturitas 2014;79(1):3–7. DOI: 10.1016/j.maturitas.2014.06.003
Yalcin F, Gurgan S, Gul G. Oral health in postmenopausal Turkish women. Oral Health Prev Dent 2006;4(4):227–233. PMID: 17153644.
Massler M. Oral manifestations during the female climacteric (the postmenopausal syndrome). Oral Surg Oral Med Oral Pathol 1951;4(10):1234–1243. DOI: 10.1016/0030-4220(51)90081-3
Wardrop RW, Hailes J, Burger H, et al. Oral discomfort at menopause. Oral Surg Oral Med Oral Pathol 1989;67(5):535–540. DOI: 10.1016/0030-4220(89)90269-7
Santosh P, Nidhi S, Sumita K, et al. Oral findings in postmenopausal women attending dental hospital in Western part of India. J Clin Exp Dent 2013;5(1):e8–e12. DOI: 10.4317/jced.50928
Yoshida N, Sugimoto K, Suzuki S, et al. Change in oral health status associated with menopause in Japanese dental hygienists. Int J Dent Hyg 2018;16(1):157–164. DOI: 10.1111/idh.12282
Taga T, Ito K, Takamatsu K, et al. Menopausal symptoms are associated with oral sensory complaints in perimenopausal women: an observational study. BMC Womens Health 2021;21(1):262. DOI: 10.1186/s12905-021-01401-6
Kullander S, Sonesson B. Studies on saliva in menstruating, pregnant and post-menopausal women. Acta Endocrinol (Copenh) 1965;48:329–336. DOI: 10.1530/acta.0.0480329
Ship JA, Patton LL, Tylenda CA. An assessment of salivary function in healthy premenopausal and postmenopausal females. J Gerontol 1991;46(1):M11–M15. DOI: 10.1093/geronj/46.1.m11
Minicucci EM, Pires RB, Vieira RA, et al. Assessing the impact of menopause on salivary flow and xerostomia. Aust Dent J 2013;58(2):230–234. DOI: 10.1111/adj.12057
Shigli KA, Giri PA. Oral manifestations of menopause. J Basic Clin Reprod Sci 2015;4(1):4–8. DOI: 10.4103/2278-960X.153514
Friedlander AH. The physiology, medical management and oral implications of menopause. J Am Dent Assoc 2002;133(1):73–81. DOI: 10.14219/jada.archive.2002.0025
Rukmini JN, Sachan R, Sibi N, et al. Effect of menopause on saliva and dental health. J Int Soc Prev Community Dent 2018;8(6):529–533. DOI: 10.4103/jispcd.jispcd_68_18
Mutneja P, Dhawan P, Raina A, et al. Menopause and the oral cavity. Indian J Endocrinol Metab 2012;16(4):548–541. DOI: 10.4103/2230-8210.98007
Scardina GA, Messina P. Oral microcirculation in post-menopause: a possible correlation with periodontitis. Gerodontology 2012;29(2):e1045–e1051. DOI: 10.1111/j.1741-2358.2011.00608.x
Norderyd OM, Grossi SG, Machtei EE, et al. Periodontal status of women taking postmenopausal estrogen supplementation. J Periodontol 1993;64(10):957–962. DOI: 10.1902/jop.1993.64.10.957
Deepa D, Jain G. Assessment of periodontal health status in postmenopausal women visiting dental hospital from in and around Meerut city: cross-sectional observational study. J Midlife Health 2016;7(4):175–179. DOI: 10.4103/0976-7800.195696
Han K, Ko Y, Park YG, et al. Associations between the periodontal disease in women before menopause and menstrual cycle irregularity: the 2010–2012 Korea National Health and Nutrition Examination Survey. Medicine 2016;95(6):e2791. DOI: 10.1097/MD.0000000000002791
Bhat SP, Saloda N, Bhat N, et al. Assessment of periodontal status of postmenopausal women attending dental clinics. Int J Recent Sci Res 2017;8(3):16089–16094. DOI: 10.24327/ijrsr.2017.0803.0072
Wulandari P, Masulili SL, Kusdhany LS, et al. Differences in periodontal severity between perimenopausal and postmenopausal women with chronic periodontitis. Pesqui Bras Odontopediatria Clín Integr 2020;19. DOI: 10.4034/pboci.2019.191.113
Anand N, Chandrasekaran SC, Rajput NS. Vitamin D and periodontal health: current concepts. J Indian Soc Periodontol 2013;17(3):302–308. DOI: 10.4103/0972-124X.115645
Millen AE, Hovey KM, LaMonte MJ, et al. Plasma 25-hydroxyvitamin D concentrations and periodontal disease in postmenopausal women. J Periodontol 2013;84(9):1243–1256. DOI: 10.13039/100000002
Machado V, Lobo S, Proença L, et al. Vitamin D and periodontitis: a systematic review and meta-analysis. Nutrients 2020;12(8):2177. DOI: 10.3390/nu12082177
Khammissa RAG, Ballyram R, Jadwat Y, et al. Vitamin D deficiency as it relates to oral immunity and chronic periodontitis. Int J Dent 2018;2018:7315797. DOI: 10.1155/2018/7315797
Dietrich T, Joshipura KJ, Dawson-Hughes B, et al. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Am J Clin Nutr 2004;80(1):108–113. DOI: 10.1093/ajcn/80.1.108
Stein SH, Tipton DA. Vitamin D and its impact on oral health—an update. J Tenn Dent Assoc 2011;91(2):30–33. PMID: 21748977.
Millen AE, Andrews CA, LaMonte MJ, et al. Vitamin D status and 5-year changes in periodontal disease measures among postmenopausal women: the Buffalo OsteoPerio Study. J Periodontol 2014;85(10):1321–1332. DOI: 10.1902/jop.2014.130686
Pavlesen S, Mai X, Wactawski-Wende J, et al. Vitamin D status and tooth loss in postmenopausal females: the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) Study. J Periodontol 2016;87(8):852–863. DOI: 10.1902/jop.2016.150733