Periodontal Healing and Osteoporosis in Postmenopausal Women

This article reviews how menopause and age related hormonal bone changes effect periodontal healing. After menopause, with the cessation of ovarian estrogen production and its bone protecting effects, women become more susceptible to periodontal disease and tooth loss. The inflammatory processes involved in osteoporosis and periodontal disease will be reviewed. Estrogen deficiency results in up regulation of the inflammatory mediators which are common to skeletal bone loss and periodontitis. Periodontitis is one of the two basic oral health problems; destruction to the structures which support teeth, alveolar bone, ligament, and gingiva, is cumulative over time. Progression of the condition rests on peaks and valleys in inflammatory immune response to pathogens contained in plaque biofilm. Chronic inflammation is common to many age-related conditions. Additionally, the article reviews how medications interfere with the inflammatory response. Treatment considerations, objectives and limitations for women living dynamic lives well into menopause will be discussed. Vigilant identification and referral for specialized care are needed to restore comfort, function and esthetics. As women are living longer and more vibrant lives than ever, the needs of this cohort require special attention. The balance between oral-health related quality of life and bioethics of minimalist management versus sometimes costly and time consuming options must be weighed. The clinicians caring for geriatric populations ought to keep in mind the intersections of periodontitis and aging such that each patient can be given appropriate referral and treatment.