Hormones Can Help Save Your Smile

What could hormones have to do with your smile? Emerging scientific evidence suggests that hormones can impact your teeth and gums in very important ways. 

As a woman ages, her hormone levels decrease - as much as 60% between the ages of 30 and 65. In addition, as many as 32% of women lose their teeth by the time they are 65. It is disconcerting to think that a third of all senior women experience the physical, emotional, and economic effects of tooth loss. Consider the cost of removing and replacing teeth, difficulty chewing and eating, and the feeling of embarrassment that can accompany tooth loss. Are hormone levels a contributing factor? The answer is yes. A woman’s hormone levels can play a significant role in preserving her teeth and gums.

The decreased hormone levels associated with osteoporosis, heart disease, Alzheimer’s and other chronic degenerative diseases that occur as we age, also contribute to compromised oral health. This Hormonal Update takes a look at how hormones can impact your dental health, and some of the measures you can take to protect your teeth and gums.

The ABC's of the Mouth

Most adults have thirty-two permanent teeth they rely on for chewing. However, teeth perform other important functions besides grinding and mashing food. Teeth affect speech, prevent the facial muscles from collapsing inward, and actually begin the process of digestion.

Teeth are alive with nerves, and are supported by the same blood supply that goes to the heart and every other organ of the body. They are attached to bony sockets in the jaw by collagen fibers. The jawbone, consisting of two bones, the mandible (lower) and maxilla (upper), forms the framework of the mouth.

The teeth and jawbones are surrounded by the gingival, or gums. The palate, which forms the roof of the mouth, separates the mouth and the nasal cavity. It is made of bone and is covered by soft tissue. The palate is also used when suction is necessary to support dentures, or false teeth.

Hormones, Bone Loss, and Teeth

Even though bones appear to be solid structures, bone tissue is constantly in a state of renewal. Cells that metabolize old bone are called osteoclasts. The cells that build up new bone tissue are called osteoblasts. Both of these types of cells are constantly at work, building bone (remodeling) and breaking it down (resorption). This process of continual renewal occurs faster in some bones than in others. The mandible, or jawbone, has a much higher rate of renewal than any other bone in the body. Consequently, if the natural balance between breaking down and rebuilding is disturbed, the jawbone can be the first in the body to experience bone loss. Long term or chronic bone loss in the jawbones can lead to tooth loss. Bone loss in the lower jaw can be an early indicator for skeletal bone loss, and osteoporosis.

Estrogen can protect against osteoporosis, not only in the spine, hip and ankle, areas we tend to associate with bone loss, but the jaw as well. When estrogen levels decline, osteoblast activity does too. Estrogen replacement can help preserve the balance between bone breakdown and bone building. But estrogen may not be the only hormone beneficial to dental health. Numerous studies show clinical evidence of improved bone density with testosterone supplementation.

Testosterone is known for its role in helping build strong bones, ligaments, and muscles. It is important to note that bone loss and osteoporosis are also a problem for men. Interestingly, studies have shown that hormone supplementation for testosterone deficiency in men can increase bone density in spinal bones, regardless of their age.

New research also demonstrates a link between bone loss and stress hormones. Cortisol is a stress hormone. It helps increase energy levels during stressful times. In an attempt to provide the body with the extra calcium needed during stressful events, cortisol can also increase bone metabolism. Recent findings show that chronically elevated cortisol can lead to bone loss. Bone loss can lead to endentulism (tooth loss).

Chronically high levels of cortisol can also prevent ovulation, which leads to a decrease in estrogen production. Low estrogen levels leave the door open for increased osteoclast activity, or bone breakdown. Accelerated osteoclast activity without the necessary and balancing effect of osteoblasts can lead to thin, brittle bones.

Hormones and Gum Disease

Estrogen affects the mucous membranes of the body, keeping them moist and flexible. Low estrogen levels can leave mouth tissue dry, disturbing the natural pH, and leaving the oral cavity more vulnerable to bacteria. Gingivitis is an inflammation of the gums caused by bacteria. Women who take estrogen replacement have less gingival bleeding than women who do not.

Peridontitis, or periodontal disease, is an infection of the gums that destroys the gum tissue, membranes, and supporting bones of the mouth. Peridontitis has been linked to increased risk of cardiovascular disease, stroke, and insulin resistance, a precursor of diabetes. Ranked in importance with other well-known risk factors such as age, smoking, diabetes, hypertension, and elevated triglycerides, the link between stroke and periodontal disease should not be ignored.

Infectious bacteria traveling from the gums and entering the circulatory system boost cell and clotting factor production. In addition, the bacteria may damage the lining of cerebral blood vessels, and cause plaque to develop. Some researchers believe that cerebrovascular tissue may be highly susceptible to certain gum bacteria. However, there is no hard evidence to support that theory just yet.

Estrogen deficiency in post-menopausal women with peridontitis can hasten the progression of the disease. Unlike smoking, which can actually initiate the disease, low estrogen doesn’t seem to be the culprit here. But once the disease has begun, sub-optimal estrogen levels can contribute to nearly twice the rate of tooth loss. Menopausal and postmenopausal women who use estrogen replacement experience considerably less gum disease, and tooth and bone loss than women who do not supplement their estrogen levels.

What You Can Do to Protect Your Smile

Healthy, well-balanced hormone levels can help protect your teeth and gums. Even though 20% of postmenopausal women continue to maintain healthy hormone levels without replacement, the majority of women do benefit from HRT. Maintaining a close watch on your hormone levels can help you determine if and when you need to consider hormone replacement. Keeping tabs on your stress hormones can tell you when the stresses of your life have become too much, and are putting your health at risk.

Saliva hormone testing provides reliable, noninvasive hormone level assessment. You can take the test in the privacy and comfort of your own home. Tests are available that can help you keep tabs on your estradiol, progesterone, testosterone, DHEA and cortisol levels.

In the same way that saliva hormone testing can tell you what is happening to your hormones levels, a deoxypyridinoline (Dpd) test can tell you the rate at which your bones are remodeling, and whether or not you are at risk for tooth loss or osteoporosis. Also a simple, noninvasive test that can be done at home, the Dpd test measures the amount of deoxypyridinoline in your urine. Deoxypyridinoline is a byproduct of bone collagen breakdown and is excreted unmetabolized in urine. If you are taking hormone replacement a Dpd test can also tell you how effective your therapy is at slowing down the rate of bone breakdown.

Dentists are increasingly aware that their patients’ mouths can provide early signs of hypertension, heart disease, diabetes, and osteoporosis. Dental x-rays can provide important clues about bone health. Saliva hormone testing and the Dpd urine test provide vital information that can help you protect your bones and teeth.

Remember tooth and bone loss don’t occur overnight. These simple steps can help protect your dental health and save your smile.