If you’re approaching menopause or over the hump, then you know: Plummeting estrogen can lead to a dry vagina. But did you know that it has the same effect on your mouth? “We have a very similar tissue type in the mouth, so it’s no surprise,” says Katie Lee, DDS, a dentist and oral systemic health expert based in Colorado. Additionally, “salivary glands have estrogen receptors,” so when the hormone hightails it, so do its benefits. The result is less saliva, which can set off a host of other issues, from digestive problems to burning mouth and red gums. And there’s another complicating factor: Estrogen loss also leads to weakened bones, which can translate into tooth breakage and loss.
Unfortunately, many dentists haven’t gotten the memo. According to Delta Dental insurance company’s 2024 Oral Health and Menopause Survey, over a third of women 40 and over say their oral health has declined with age. Of those surveyed, 93 percent would like menopause-tailored advice from their dentist, but just 18 percent had discussed it with their provider.
To get to the root of the problem—loss of estrogen—the best solution is (you guessed it) hormone replacement therapy (HRT). There’s a distinct lack of recent studies on HRT and oral health, but research from the past 10 to 15 years suggests a link between hormone therapy and healthier gums, as well as a reduced risk of tooth loss. The main goal, says Lee, is “keeping inflammation down as much as possible—and a really great way to do that is making sure that your hormones are in adequate balance.” The more inflammation we have, she explains, the more potential there is for bacteria from the mouth to get into the bloodstream and damage other parts of the body. “This is multifactorial, because oral bacteria is implicated in Alzheimer’s, dementia, heart disease, gut problems, and arthritis.”
What to do if you’re already having issues? Here are signs to look out for, and how to handle them.
Dry Mouth
What’s happening: “That decrease in saliva is really critical to overall health,” says Lee. “Aside from being terribly uncomfortable, it has a lot of health implications.” Number one? Poor digestion: Because spit contains digestive enzymes that break down carbohydrates, digestion really starts in the mouth, she says. “A lot of women will start to experience digestive issues because their food is not being broken down in the mouth any longer,” she says. “Another big thing is people can start to choke when swallowing, because the food isn’t lubricated properly.”
But wait, there’s more. Menopausal women are also at increased risk of bad breath, altered taste, and tooth decay because “there’s less saliva to wash away the chunks of breakfast and lunch that are still hanging around,” says Chris Salierno, DDS, chief dental officer at Tend. “Tooth decay is essentially the demineralization of your teeth, but if you’re doing a good job of keeping things relatively clean, your body can actually remineralize early cavities.” Saliva contains trace amounts of minerals that aid the process, and so a drop in levels makes it much harder.
What you can do: Lee recommends sugar-free gum or probiotic lozenges, which “let the brain know that you’re getting ready for digestion, so your mouth will produce saliva,” she says. There are also special toothpastes and mouthwashes you can talk to your pharmacist about (Lee recommends products from TheraBreath, PerioSciences, and Tri-ology). For severe cases, your dentist can prescribe medication such as pilocarpine tablets to give your salivary glands a boost.
Burning Mouth
What’s happening: If you’ve noticed that your tongue, mouth, or gums are tingling, you might have burning mouth syndrome. More intense cases can cause a scalding sensation or stinging and numbness. The culprit? You guessed it: decreased saliva levels. “Think of your mouth as a complex ecosystem, like a rainforest,” says Salierno. “There’s a delicate balance of different strains of bacteria and fungus. When you change a major ingredient of that ecosystem, there’s an opportunity for other elements to start running wild.”
What you can do: Treatments for burning mouth are all about increasing saliva, so the same suggestions for dry mouth apply here. Talk to your dentist if you have symptoms.
Menopausal Gingivostomatitis
What’s happening: This oral condition causes painful, inflamed gums. “A lot of women notice that their gums appear red, darkish red, blue, or purple and become very prone to bleeding,” says Lee. “It’s essentially just inflammation of the gingival tissues and the tissues of the mouth.”
What you can do: See your dentist. She may prescribe antibiotics or a therapeutic mouthwash, or swilling your mouth with salt water several times a day to soothe inflammation and irritation.
Tooth Loss
What’s happening: On average, women lose 10 percent of their bone density in the first five years after their last period. And yoo-hoo, teeth are bones. “Periodontal disease can be worsened or accelerated as your jawbone density decreases,” explains Salierno. “The main cause of periodontal disease is not cleaning out plaque, tartar, and bad bacteria. That’s the causative agent for gum inflammation, bleeding, and, ultimately, loss of attachment of the jawbone to the teeth.”
What you can do: “If you’ve been brushing and occasionally flossing, that may have worked for you in your 20s and 30s,” says Salierno. “But with the effects that lower estrogen has on your oral environment, you may begin to see more damage.” This means more thorough brushing, and—ugh—flossing at least once a day. “If you brush twice a day, you also should floss twice a day, because if not, you’re only cleaning about two-thirds of your tooth surface,” says Lee. She recommends ditching the floss picks and using a piece of string floss as long as your arm so that every tooth is cleaned with fresh floss. It’s best to floss and brush before a meal, or at least 30 minutes after, so that the “mouth has time to neutralize and you don’t damage the enamel.” (Another tip: If you have space between the roots of your teeth, double up the floss so it’s thicker.) Water flossers are also good, provided they’re used morning and night.
Lee points out that bacteria repopulate the mouth about every 90 days, so if you’re waiting six months to see the hygienist, you have “about 90 days of potential infection that could cause a lot of damage to your teeth and the rest of your body.” The bottom line: Get thee to the dentist.
Rosie Hopegood is Deputy Health Editor at Oprah Daily. She writes, edits, and assigns stories at the intersection of science, medicine, psychology, wellness, spirituality, and fitness. A Brit in Brooklyn, her ‘to read’ book pile is taller than her toddler, but she’s still pinching herself that she gets to read and write for a living.
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