TEETH - My Latest Obsession.

I’m going to admit an obsession. My teeth. And oral health in general, if you press me on it. I read a statistic that 28% of women are likely to lose a tooth within 5 years of going through menopause. In an effort to empower myself versus freaking out (okay, I freaked out first) I started digging in to learn why this happens and how I can protect the smile I worked really hard for as a kid. Kids these days are so lucky to have Invisalign.

I never smiled like these beauties when I had braces.

In the past few years, since perimenopause began, I’ve noticed a faster buildup of tarter, more frequent dry mouth, a bad taste in my mouth often which ALWAYS makes me worried about halitosis aka bad breath (just ask me about my gum-habit).

It turns out that my symptoms are very common and only scratch the surface of the most common symptoms reported by post-menopausal women. Delta Dental reports that 84% of women 50+ didn't know that menopause affected their oral health. We can safely make the assumption, based on that data, that younger women wouldn't have this knowledge either. We just are not informed. Both female patients and our health providers need to be educated and empowered to better have these conversations.

Common menopause-related oral health concerns include: dry mouth • burning mouth • tooth crowding • tooth loss or decay • gum disease • receding gumlines • decreased jawbone density • and here's a doozy: increased risk of heart disease as a result of declining oral health.

Why does this happen? Declining hormones. Tissues in the gums and mouth are estrogen receptive. Imagine that there are little locks inside of these tissues that no longer have the keys (estrogen) needed to open them. Without estrogen these tissues change, weaken and dry out. Decreased saliva leads to an even drier mouth which, in turn, changes the pH balance in the mouth and allows for potential bacterial build up. Both lead to disease and/or decay. This is what is happening to me. Ugh.

I’ve always been blessed with great enamel but had my first real cavity filled during my last dental visit. Literally, last month. WTF?! I had already stepped up my game to having professional cleanings 3x/year already as I have had more plaque developing on my bottom teeth than I could keep away. Not playing fair, universe! During the same visit my hygienist taught me how to brush better. You know those #todayyearsold posts? While apparently I was 44 years old and re-learning a skill I thought I had mastered in elementary school. I guess we all need a review of Brushing 101. Ask your hygienist to review brushing technique during your next dental visit. I was floored. These tips are in line with my hygienist's recommendations.

GOOD NEWS! WE CAN FIGHT FOR OUR TEETH!

Sorry to have buried the lead.

Experts agree that stepping up your hygiene game is the best way to keep those pearly whites strong and healthy. Here's your checklist, some tips and what I am doing too.

🦷 Step up your brushing game.

🪥 Ask your hygienist for a tutorial!

🪥 Increase to 3x/day brushing. My tip: keep a travel toothbrush and toothpaste in your purse or where you keep your personal items at work. Keeping it handy helps make it happen.

🪥 Replace your toothbrush regularly so that the bristles can do their job.

🦷 Remember flossing? Do it. Don't remember how? Ask your hygienist for a lesson. I promise they'll be thrilled to show you.

🦷 Consider investing in a Waterpik. I always thought that my parent's version back in the 1980's was fascinating. And now I have my own and use it nightly. How is it that even more little crumbs come out at the end of my oral routine with this baby. It never fails in totally grossing me out. My tip: Fill yours with warm (not hot!) water for a gentler experience for any sensitivity.

🦷 Consider a tooth scaler. I use this kit routinely - especially around my bottom front teeth where buildup likes to creep up fastest. I scale, floss, brush, and waterpik nightly - in that order.

🦷 Mouthwash! Worried about coffee/tea/wine staining your teeth? Mouthwash. Dry mouth? Bad breath? Little bits of food stuck in your teeth? Mouthwash. My tip: keep travel bottles of your preferred brand in your purse, at work, etc. Like a toothbrush, if it is handy you are more likely to use it. Tip #2: if you are mouthwash opposed, have a little canker-sore or a scratchy throat, consider gargling with warm salt water instead.

🦷 Routine dental visits and professional cleanings! Don't put these off, anxiety be damned. Like me, you may actually need to increase your frequency. I now go three times per year. Not only has it made my visits easier but it also feels nice to have my teeth so clean.

🦷 Gummy multivitamins. I love a gummy multivitamins too. But you need to treat these like Starbursts. Eat them, love them. But brush your teeth and get that sticky sugar out of your molars after you eat them!

🦷 Good Teeth are a Team Sport 🦷

Oral health is a multidisciplinary activity. Your active participation is key and so is your dental team. Seeing as we are talking about a little known topic in the menopausal space already, let's dive deeper.

HRT.

If you are considering HRT, this is yet another reason that it may be for you. I'll say it again: tissues in the gums and mouth are estrogen receptive. As are our bones. From this angle, HRT can help us be both protective and preventative in menopause related oral health conditions.

Pelvic Floor Physical Therapy +

When I teach patients how to engage their pelvic floor, you’d be hard pressed to guess one of the top compensatory things they do. Clenching their teeth (and holding their breath to boot). TMJ disorder actually one of the top co-morbities with pelvic floor dysfunction. Never heard of the TMJ? The temporomandibular joints connect your lower jaw to your skull. You have one on either side of your face. They are the primary joints that move when you bite and chew. Feel in front of your ears through your cheeks as you open and close your mouth and you'll find them. Shocked that this is all connected? Let's talk about it!

🦷 The TMJ and pelvis are connected through "global body posture" and associated musculoskeletal and fascial tissue connections. Through the transmission of tensions, a problem in the TMJ can negatively impact the pelvic floor and vice versa. (see these 1 and 2 studies for tons of depth)

🦷 Aside from being painful, teeth clenching damages enamel and tooth structure, both of which can lead to tooth disease and decay. (3) Teaching patients to coordinate their breath with pelvic floor contractions while keeping the face, neck, and jaw relaxed can help a lot of patients experiencing both pelvic floor dysfunctions and TMJ pain. Teaching patients to do self bruxal (face and jaw) massage can be a helpful addition to a patient's home treatment program as well. Making bruxal massage part of a patient's bedtime routine is often part of my programming. I also like to teach tension awareness and relaxation with progressive relaxation breathwork. I ask patients to both practice progressive relaxation prior to completing their pelvic floor exercise homework and also as part of their sleep hygiene.

TMJ Specialists

If patients are clenching and grinding, having TMJ pain and tooth damage, seeing a specialist to make an oral appliance can be an important step. While appliances won't make you stop grinding, they will help you save your pretty smile. While custom is best, it can be cost-prohibitive for many people. A cost-effective option you could consider is an over the counter sports-style mouthguard that you mold with hot water. This commercially available slim version is an example of something you could try if attempting this avenue.

Don't take your smiles for granted, ladies. Teach your daughters and grandaughters well. Learn some new tricks yourself too. We can - and need to - learn new tricks. I wish you a lifetime of gorgous teeth and fabulous oral heath. And, to quote my dentist, "don't forget to floss!"