Abstract
Background:
Women at menopausal period may frequently develop several oral mucosal disorders. Xerostomia is also a common finding among postmenopausal women. The present study was conducted to assess effect of menopause on saliva and dental health.
Materials and Methods:
Forty postmenopausal women (Group I) and 40 control (Group II) underwent Oral Hygiene Index Simplified (OHIS), Decayed, Missing and Filled Teeth (DMFT index), Community periodontal index (CPI), and Loss of attachment (LOA), salivary pH and flow measurement.
Results:
Oral symptoms were normal in 22 and 40, xerostomia in 18 and 0 in Group I and II respectively, salivary pH was normal in 20 and 40, below acidic in 20 and 0, salivary flow was normal in 21 and 40, hyposalivation in 19 and 0 in group I and II, respectively. The difference was significant (P < 0.05). OHI-S was good in 4 and 25, fair in 6 and 10, poor in 30 and 5, DMFT index was decayed was 1.42 and 0.65, missing was 2.84 and 0.26 and filled was 1.06 and 0.52 seen in Group I and II respectively. CPI index mean value was 3.26 in Group I and 1.02 in Group II and mean LOA was 1.42 and 0.46 in Group I and II respectively. The difference was significant (P < 0.05).
Conclusion:
There was decrease in the salivary pH and flow rate in postmenopausal women which in turn leads to increased OHI-S, DMFT, CPI, and LOA.
KEYWORDS: Oral hygiene index simplified, postmenopausal women, salivary pH
INTRODUCTION
The World Health Organization defines menopause as “the permanent cessation of menstruation due to loss of ovarian follicular activity.” During the 5th decade of women life, a physiological process “Menopause” happens, which demands permanent cessation of menstruation. These physiological changes take place due to declining estrogen production by ovaries in women advancing towards menopause.[1]
The etiology of osteoporosis is very complex; nonetheless, it is ostensible that hormonal fluctuations after menopause upsurge the level of bone resorption, leading to an advanced risk of osteoporosis.[2] The brain is furthermore a goal on behalf of estrogen besides additional gonadal steroids. Subsets of neurons possess intranuclear receptors for estrogen. In addition, it is also perceived that complications such as Alzheimer's disease expressed prior in females than in males. This may be supplemented with estrogen loss that occurs with menopause. Numerous studies demonstrate that womenfolk who veteran of initial menopause has a better risk of heart diseases.[3]
Women at menopausal period may frequently develop several oral mucosal disorders. Burning mouth syndrome is considered a frequent oral problem in such patients. Xerostomia is also a common finding among postmenopausal women.[4] Other less common menopause–associated symptoms include altered or bad taste, viscous saliva, and mucosal disorders such as lichen planus, benign mucosal pemphigoid, and Sjogren's syndrome.[5] Women exhibit an increase in oral changes that may be caused by calcium and vitamin deficiency, endocrine disturbances and many psychological factors. Some previous studies showed reduced salivary flow which may result in increased oral discomfort, incidence of root caries, periodontal disease, and taste alterations in post menopause.[6] The present study was conducted to assess the effect of menopause on saliva and oral health.
MATERIALS AND METHODS
The present study consisted of 40 postmenopausal women (Group I) and 40 control (Group II). All were enrolled after obtaining their written consent.
Data such as name, age, etc., were recorded. Clinical assessment was done by Oral Hygiene Index Simplified (OHI-S), Decayed, Missing and Filled Teeth (DMFT index), Community periodontal index (CPI), and Loss of attachment (LOA). Saliva was collected between 9 am and noon. All were instructed not to consume, drink, or brush their teeth for at least 1 h before saliva collection. Salivary trials from the control cluster were composed in the first 3 days of menstruation. The flow rate was measured as ml/min. pH strips were used to determine the salivary pH. P <0.05 was considered statistically significant.
RESULTS
Table 1 shows that Group I was in the age range of 45–60 years and Group II in 21–44 years.
Table 1.
Distribution of patients
| Groups | Group I | Group II |
|---|---|---|
| Age group | 45-60 | 21-44 |
Table 2 shows that oral symptoms were normal in 22 and 40, xerostomia in 18 and 0 in Group I and II respectively, salivary pH was normal in 20 and 40, below acidic in 20 and 0, salivary flow was normal in 21 and 40, hyposalivation in 19 and 0 in Group I and II, respectively. The difference was significant (P < 0.05).
Table 2.
Assessment of parameters
| Parameters | Variables | Group I | Group II | P |
|---|---|---|---|---|
| Oral symptoms | Normal | 22 | 40 | 0.04 |
| Xerostomia | 18 | 0 | ||
| Salivary pH | Normal | 20 | 40 | 0.01 |
| Below acidic | 20 | 0 | ||
| Above acidic | 0 | 0 | ||
| Saliva flow | Normal | 21 | 40 | 0.01 |
| Hyposalivation | 19 | 0 | ||
| Hypersalivation | 0 | 0 |
Table 3 shows that OHI-S was good in 4 and 25, fair in 6 and 10, poor in 30 and 5, DMFT index was decayed was 1.42 and 0.65, missing was 2.84 and 0.26 and filled was 1.06 and 0.52 seen in Group I and II respectively. CPI index mean value was 3.26 in Group I and 1.02 in Group II and mean LOA was 1.42 and 0.46 in Group I and II respectively. The difference was significant (P < 0.05).
Table 3.
Comparison of indices
| Parameters | Variables | Group I | Group II | P |
|---|---|---|---|---|
| OHI - S | Good | 4 | 25 | 0.02 |
| Fair | 6 | 10 | ||
| Poor | 30 | 5 | ||
| DMFT | Decayed | 1.42 | 0.65 | 0.01 |
| Missing | 2.84 | 0.26 | ||
| Filled | 1.06 | 0.52 | ||
| CPI | 3.26 | 1.02 | 0.01 | |
| LOA | 1.42 | 0.46 | 0.01 |
OHI - S: Oral hygiene index simplified, DMFT: Decayed, missing and filled teeth, CPI: Community periodontal index, LOS: Loss of attachment
DISCUSSION
Saliva is indispensable tool for maintaining good oral health of tissues and it is a noninvasive source of metabolism investigation. However, it draws attention when its quantity drops off or its quality is altered. The hormonal changes occurring prior to menopause affects teeth and gums and decreases body immunity.[7] Taking everything into account, understanding oral health of patients approaching menopause or experiencing these changes is important to avoid complications. The emphasis on females' well-being researchers and health policy planners has also moved toward postmenopausal women, and latest developments propose an surge in their number and life expectancy.[8] For centuries, uncertainties of temperament and behavior have been associated with reproductive endocrine system variation in womankind. Long–standing disquiets of variations in ovarian hormonal intensities comprise morbidities interrelated with age such as vascular diseases, osteoporosis, complications linked to memorization, urinary incontinence, and skin aging.[9] The present study was conducted to assess the effect of menopause on saliva and dental health.
In the present study, Group I was in the age range of 45–60 years and Group II in 21–44 years. We found that oral symptoms were normal in 22 and 40, xerostomia in 18 and 0 in Group I and II respectively, salivary pH was normal in 20 and 40, below acidic in 20 and 0, salivary flow was normal in 21 and 40, hyposalivation in 19 and 0 in group I and II respectively. Rukmani et al.[10] conducted a crosssectional study on forty healthy postmenopausal women (case group) and forty regularly menstruating healthy women (control group). The flow rate was measured as ml/min. Salivary pH was measured using pH strips. OHI-S, DMFT index, CPI, and LOA were measured clinically. Salivary pH and flow rate in the case cluster were substantially lesser when related to the control group (P < 0.001). OHIS, DMFT, CPI, and LOA were found to be greater in postmenopausal women when related to the control group (P < 0.001).
We found that OHI-S was good in 4and 25, fair in 6 and 10, poor in 30 and 5, DMFT index was decayed was 1.42 and 0.65, missing was 2.84 and 0.26 and filled was 1.06 and 0.52 seen in Group I and II respectively. CPI index mean value was 3.26 in Group I and 1.02 in Group II and mean LOA was 1.42 and 0.46 in Group I and II respectively. Parakh et al.[11] 40 healthy postmenopausal women and premenopausal women (controls) respectively were included in the study. A remarkable decrease in the salivary pH and salivary flow rate, which could be credited to the high values of DMFT and OHI-S in both groups. The study also showed a significant difference in physiological changes and DMFT, OHI-S, PI, and GI score in premenopausal women and postmenopausal women.
Minicucci et al.[12] in a study found that the salivary flow showed a reduction in menopause group but without clinical symptoms of dry mouth. Similar results were observed by Saluja et al.[13] were taste perception intensity for sucrose and salivary pH in postmenopausal women was low when compared to other groups.
Bhat[14] study on 43 healthy pre and postmenopausal females reported that there were no changes in the quantity of saliva; hereafter signifying that among healthy women, salivary gland function is not significantly influenced by menopause or HT. A study comparing stimulated and unstimulated salivary progesterone in menopausal women with oral dryness feeling showed that women with dry mouth had decreased unstimulated saliva flow and salivary progesterone compared with those without dry mouth. Thus, salivary progesterone level appears to be associated with oral dryness feeling in menopause. In postmenopausal women, estrogen deficiency leads to monocytes and macrophages producing greater pro-inflammatory cytokines.
CONCLUSION
Authors found that there was decrease in the salivary pH and flow rate in postmenopausal women which in turn leads to increased OHI-S, DMFT, CPI, and LOA.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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