# Prevent osteoporosis. The body cannot absorb calcium from food or supplements without an adequate intake of vitamin D. If calcium levels in the blood are too low, the body will steal the mineral from the bones and supply the muscles and nerves with the amount they need. Over time, the loss of calcium in the bones can lead to osteoporosis, a disease in which bones become porous and prone to fractures. After menopause, women are particularly at risk for developing this condition. Vitamin D taken along with calcium plays a critical role in maintaining bone density.

In a study of 176 men and 213 women over age 65 done at Tufts University, those who took 500 mg of calcium and 700 IU of vitamin D daily for three years experienced a decrease in bone density loss. Moreover, the incidence of fractures was cut in half. In another study, of 3,270 healthy elderly French women, a daily dietary supplement of 1,200 mg calcium plus 800 IU of vitamin D lowered the incidence of hip fractures by 43% in just two years.

National Women's Health Network Fact Sheet Osteoporosis    Introduction   In the United States, fractures from osteoporosis are an important health  problem. White women have a 16% chance of hip fracture; in contrast,  the risk for African-American women is a much lower 6%. Risks for  Asian American and Native American women are believed to be in  between these two extremes. Hip fractures occur at an average age of 80  and recovery is very difficult. Many women who survive the initial  treatment are unable to live independently after a hip fracture. Vertebral  fractures occur more frequently and at slightly younger ages and can  also result in pain and limited mobility. More About Bone Density Both men and women begin to lose bone at about age 35 and lose  steadily as they get older. Only about 15% of the bone lost by women is  believed to be sensitive to estrogen. Estrogen-related bone loss occurs  relatively quickly in the first few years after menopause. Bone density  screening performed around this time can accurately measure bone  density, but should not be relied upon to predict ultimate risk of fracture,  which typically occurs 25-30 years later. Bone density screening can more accurately predict the risk of fracture  for white women in their 60's or older. The older models developed so far  have been based on white women, and have not yet been shown to  accurately predict risk in women of color. For example, Asian women are  not as likely to fracture as are white women at the same bone density.       Do You Need Bone Density Screening? The NWHN disagrees with recommendations to screen all  post-menopausal women. Women who are considering bone density  screening should first evaluate their risk of fracture. If risk is increased,  modifiable risk factors like diet, exercise, and home safety should be  addressed first. If a significant number of non-modifiable risks exist,  particularly the use of bone-thinning drugs, family history, and loss of  ovarian function before age 40, bone density screening may be useful to  assess the precise level of risk faced by an individual woman. Currently, "low" bone density is defined as levels significantly less than  normal for healthy young adults, which results in nearly all older women  eventually being diagnosed with osteoporosis. The NWHN disagrees with  this definition and recommends that women ask for their bone density  levels to be compared with women of the same age when predictions of  risk are made. Women of color are less likely to need bone density screening than are  white women. If it is used, results should be interpreted cautiously. How To Increase Bone Density or Slow Bone Loss Without Drugs    * Exercise - weight bearing activity builds bone  * Eat a high calcium diet  * Avoid excessive protein, caffeine  * Keep your ovaries as long as possible  * Stop smoking How To Prevent Fractures * "Fall proof" your home  * Avoid long-acting tranquilizers  * Exercise - can improve balance  * Avoid excessive alcohol Credit: Women's Health Network

FAMILY GENTLE DENTAL CARE  DR. DAN PETERSON  1415 SAGE STREET   GERING, NEBRASKA 69341  308-436-3491  MENOPAUSE AND DENTAL HEALTH

      Approximately 36 million women in the United States are in the postmenopausal phase of life. The vast majority of these women experienced spontaneous cessation of menses between the ages of 47 and 55 years when the production of estrogen decreased because of an inadequate number of functioning follicles within their ovaries.

     Fewer women entered menopause after surgical removal of both ovaries. 
This procedure usually is performed preventively to prevent ovarian cancer in conjunction with a hysterectomy, which is required to treat abnormal bleeding, endometriosis or pelvic inflammatory disease.

     The physiological changes associated with spontaneous or surgical menopause cause some women to experience uncomfortable symptoms such as hot flashes, night sweats and vaginal dryness. In addition, estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of: 

•  developing cardiovascular disease ( myocardial infarct, stroke)
• osteoporosis
• Alzheimer's disease 
• oral disease. 

     Your dentist  needs to consider this stressful phase of life that you may be experiencing.  He may look for the following postmenopausal problems at your dental examination which may include: 

• decrease in saliva flow
• increased dental caries
• dysesthesia
• taste alterations
• gingivitis
• periodontal disease -at least 23 percent of women ages 30-54 have periodontitis and 44 percent of women ages 55-90 who still have their teeth have periodontitis. 
• osteoporotic jaws unsuitable for conventional prosthetic devices or dental implants. 

 Panoramic dental radiographs may reveal calcified carotid artery atheromas. 
 

      Your dentist thus have an opportunity to refer women who are not under the care of a gynecologist for an evaluation to determine the appropriateness of HRT for its systemic and oral health benefits * because estrogen supplements may offer:

gum tissue benefits 

helps relieve the above symptoms 

help prevent against osteoporosis 

protect against losing your teeth.  
 

Menopause Dental UPDATE: 

Periodontal Disease and the Incidence of Tooth Loss in Postmenopausal Women

The study population included 106 dentate white postmenopausal women who participated in a cross-sectional study between 1989 and 1991 who were willing and eligible to have a repeat examination after 10 to 13 years. At baseline, full-mouth assessment of periodontal status was performed clinically and radiographically. Assessment of tooth loss during follow- up was assessed clinically by a periodontist. Odds ratio (OR) and its 95% confidence interval (CI) for each periodontal variable was obtained from separate multiple ;ogistic regression analyses adjusting for the effect of age, household income, smoking, hormone therapy, snack consumption, and number of decayed teeth. 
Periodontal disease, especially measured by alveolar bone loss, is a strong and independent predictor for incident tooth loss in postmenopausal women.Journal of Periodontology 2005, Vol. 76, No. 7,  Dr. Mine Tezal et al.J Periodontol 2005;76:1123-1128.

Effect of Alendronate on Periodontal Disease in Postmenopausal Women:

We investigated the effect of oral alendronate (ALN) treatment on radiological and clinical measurements of periodontaldisease in postmenopausal women without hormone replacement therapy. ALN treatment improved periodontal disease and bone turnover in postmenopausal women. 
 J Periodontol 2004; 75:1579-1585.Journal of Periodontology 2004, Vol. 75, No. 12, Pages 1579-1585 
 

Ladies Home Journal states: "Japanese researchers found that an X-ray known as a panoramic  radiograph detected signs of osteoporosis up to 87% of the time in  post menopausal women. 'What affects the quality of bone in the spine also affects the quality of bone in the rest of the body, including the jaw.'  " 
 

Oral Cancer Increasing In USA Oral cancer is on the increase among women over 40 because the numbers who smoke has increased. There is some evidence to suggest that tongue cancer among males under 40 could also be increasing. Early detection is key.  According to the American Cancer Society, oral cancer occurs almost as frequently as leukaemia and claims almost as many lives as melanoma cancer. The stage of an oral cancer diagnosis is critical. When detected at its earliest stage, oral cancer is more easily treated and cured. When detected late, its five-year survival rate is about 50 percent. Testing is painless and there is no question that early detection saves lives. 
 

 http://www.dentalgentlecare.com/menopause_and_dental_health.htm

Burning Mouth Syndrome  
Burning mouth syndrome (also called stomatopyrosis, stomatodynia, and oral dysesthesia) occurs most commonly among women after menopause. The most commonly affected part of the mouth is the tongue (glossodynia). Burning mouth syndrome is not the same as the temporary discomfort that many people experience after eating irritating or acidic foods. Burning mouth syndrome is poorly understood. It probably represents a number of different conditions with different causes but a common symptom. 

A common cause is use of antibiotics, which alters the balance of bacteria in the mouth, leading to an overgrowth of the fungus Candida (a condition called thrush). Ill-fitting dentures and allergies to dental materials may be causes as well. Overuse of mouth rinses and sprays may lead to burning tongue syndrome, as can anything that leads to a dry mouth. Sensitivities to certain foods and food additives, particularly to sorbic acid and benzoic acid (which are food preservatives), propylene glycol (found as a moisturizing agent in foods, drugs, and cosmetics), chicle (found in some chewing gums), and cinnamon, may play some role. Deficiencies of vitamins, including B12, folic acid, and B-complex, can cause burning mouth syndrome. Iron deficiency has also been implicated. 

A painful burning sensation may affect the entire mouth (particularly the tongue, lips, and roof of the mouth [palate]) or just the tongue. The sensation may be continuous or intermittent and may gradually increase throughout the day. Symptoms that commonly accompany the burning sensation include a dry mouth, thirst, and altered taste. Other possible symptoms include changes in eating habits, irritability, depression, and avoidance of other people. 

The condition is easy for doctors to diagnose but difficult to treat. Frequent drinks of water or use of chewing gum may help keep the mouth moist. Antidepressants, such as nortriptylineSome Trade Names AVENTYL or anti-anxiety drugs, such as clonazepamSome Trade Names KLONOPIN are sometimes helpful, although these drugs may make the symptoms worse by causing dry mouth. Sometimes symptoms disappear without treatment, although they may return later.

More: 
A small percentage of older men and women (mostly women), generally at, or around the age of menopause develop a problem with chronic burning pain and phantom tastes in their mouths.  It often centers on the tongue. The tongue itself looks perfectly normal.  It just develops a burning sensation that progresses throughout the day.  These patients may have seen numerous doctors to try to rid themselves of the annoying, and sometimes painful symptoms, but generally to no avail.  The problem has been ignored for centuries because there seemed to be no physical reason for the symptoms, and because it was believed that it was a hysterical symptom brought on by emotional distress.  In fact, the problem sometimes does respond to antidepressant drugs like Elavil. 

11/5/2007 - EDWARDS AIR FORCE BASE, Calif. -- Burning mouth syndrome is a common problem that causes patients to experience a burning or scalding pain on the lips, tongue and sometimes throughout the mouth. 

There are often no visible signs of irritation, and the syndrome may be caused by various factors such as the onset of menopause, psychological dysfunctions and vitamin deficiencies. 

BMS may affect up to five percent of Americans and usually occurs in people age 60 and above. 

Although members of both sexes are susceptible to BMS, it occurs more frequently in older women. Between 18 and 33 percent of post-menopausal women are estimated to have BMS. 

There are a variety of symptoms associated with BMS. The main symptom is a moderate to severe burning sensation in an individual's mouth, throat, lips and tongue. Many patients have described the feeling as "scalding." Other symptoms include dry mouth or a bitter or metallic taste. 

Patients with BMS often say the pain is gradual, intensifying as the day moves along. The discomfort and restlessness associated with BMS may cause difficulty in sleeping, mood changes, irritability, anxiety and depression. 

The cause of BMS is difficult to determine. In 30 percent of cases, it is caused by a variety of existing conditions that affect oral and systemic health. Some conditions include the onset of menopause, diabetes and deficiencies in nutrients such as iron, zinc, folate, thiamine, riboflavin, vitamins B6 and B12, and complications from cancer therapy. 

In majority of cases, no specific diagnosis for the symptoms can be made. BMS symptoms may occur from dry mouth, tongue thrusting, bruxism or teeth grinding, irritating or ill-fitting dentures and thrush. 

Some research points to nerve disorders and damage; psychological factors, particularly depression and anxiety; allergies; acid reflux; and medications that cause dry mouth. 

It's not unusual for a patient suffering from BMS to have more than one cause attributed to the ailment, or to have health care providers fail to find any cause at all. 

About one-third of patients say BMS symptoms first appeared shortly after a dental procedure, recent illness or medication course. 

BMS is difficult to diagnose because its cause can stem from any number of physical and psychological conditions. For this reason, it's important to consult with your dentist and physician to develop an appropriate treatment plan. Your dentist may refer you to a general physician or specialist for blood, allergy, liver or thyroid tests. 

Treatment for BMS depends on the patient and the cause. If the cause is related to the oral cavity, your dentist has a variety of ways to provide relief. 

For dry mouth, your dentist may advise that you drink more fluids or may prescribe medicine that promotes the flow of saliva. 

Thrush, marked by white patches in the oral cavity, may be treated with oral antifungal medications such as nystatin or fluconazole. 

If dentures are the culprit, your dentist can make adjustments so they won't irritate the mouth or replace them with better-fitting dentures. Topical capsaicin, the natural chemical in cayenne pepper, may provide pain relief for some patients with BMS. 

If dentists determine there are no oral conditions causing BMS, they may refer you to your family physician or a specialist. The physician will most likely start with a complete blood test to determine the best course of treatment. If menopause is to blame, hormone replacement therapy may be recommended. They may also recommend other medicines or treatments to provide relief. 

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