How does the menopause change your dental surgeries?

A variety of challenges

The menopause can put a patient’s dentition at severe risk of infection and decay. Several hormonal changes occur which can make the gingiva more susceptible to plaque, with an increased risk for gingivitis and periodontitis.[ii]

The weakened response from the body may be consistent with the increased presence of xerostomia in many patients, with studies observing reduced salivary flow in menopausal women.[iii] Losing the antibacterial properties of the saliva may accelerate the development of cavities, tooth decay and oral disease.ⁱⁱⁱ Saliva also facilitates chewing, swallowing food and speech[iv] – a reduction because of hormonal changes can evidently begin to affect everyday life.

However, I want to primarily focus on the significant impact of osteoporosis, in particular, on dental implant success. The Royal Osteoporosis Society says that around 3.5 million people in the UK live with the condition, and half of women over 50 will suffer from it.[v] The menopause creates a deficiency of oestrogen, which is key to the regulation of bone remodelling by controlling the production of cytokines and growth factors from the bone marrow and cells.^iv This leads to the upregulation of immune cells and osteoclasts, and further increases production of bone-resorbing cytokines.^iv In turn, patients develop significantly weaker bones during and following this time period.

In the oral cavity, the osteoporotic alveolar bone has diminished tooth support.[vi] The literature has made links between osteoporosis and the progression of tooth loss,[vii] which may create a greater need for dental implant restorations – but also a change of approach.

Chances of success

The success rate of dental implant surgery is affected by bone quality and quantity at the dental implant site.[viii]

The consensus across the literature suggests that osteoporosis has no detrimental effect on implant failure and the percentage of osseointegration.[ix] Despite this, the presence of the condition does interfere with the mechanical stability of an implant.[x] Each patient and implant site must be treated for its unique qualities, and closely monitored in the years following placement to identify potential signs of failure.

Clinicians must also consider any other medical treatments their patients are receiving. As a result of the menopause, some individuals could choose to undergo hormonal replacement therapy (HRT). This increases oestrogen in a bid to prevent osteoporosis, and is particularly important in the event of early menopause.[xi]

However, despite its promise, HRT has a mixed range of effects on implant success. Some studies find that HRT can seriously derail implant osseointegration, with lower implant success rates and increased bone loss around implants in HRT-treated individuals[xii] – modifications to the regenerative abilities of bone tissues is a commonly cited reason.[xiii] Other reports find no significant influence on implant success at all.^xiii It is not a contraindication for treatment, but patients taking HRT must be informed about their potentially greater risk of osseointegration failure and choose whether to continue from there.^xiii

Providing a solution

There is still the opportunity provide excellent results in the face of these challenges. A bone graph may be required in some cases. It could be carried out prior to or simultaneously with implant placement, and has become a reliable technique for restoring bone loss.[xiv] The material used may differ between patients; both autogenous bone or bone-like substitutes are suitable options.[xv]

This should only be used in the appropriate cases – some post-menopausal patients may still retain sufficient bone density in their jaw for a successfully placed implant. However, when judged to be ideal, placement can provide an excellent foundation for an implant treatment.

Clinicians must be well-trained and confident in placing both the implant and the bone graft, not only to follow GDC guidelines,[xvi] but to deliver the best possible result for the patient.

Developing your skillset and providing care to patients like those going through the menopause is possible with One To One Implant Education. The Postgraduate Diploma in Implant Dentistry helps clinicians tackle the core elements through an excellent peer mentoring system, whilst the Postgraduate Diploma in Advanced Techniques in Implant Dentistry focuses on hard and soft tissue augmentation for a comprehensive understanding of some of the most complex procedures in the field.

Menopause can be a difficult time of change for many women. The development of osteoporosis is one of a variety of challenges that dental professionals must be aware of, but, with tailored care from knowledgeable clinicians, brilliant solutions can and will be provided.

To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.

Author bio:

Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice.

Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20^thyear. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.

[i] NHS, (2022) Menopause Overview. (Online) Available at: https://www.nhs.uk/conditions/menopause/ [Accessed November 2023]

[ii] Dutt, Poonam, S. R. Chaudhary, and P. Kumar. “Oral health and menopause: a comprehensive review on current knowledge and associated dental management.” Annals of medical and health sciences research 3.3 (2013): 320-323.

[iii] Minicucci, E. M., Pires, R. B. C., Vieira, R. A., Miot, H. A., & Sposto, M. R. (2013). Assessing the impact of menopause on salivary flow and xerostomia. Australian dental journal, 58(2), 230-234.

[iv] Ciesielska, A., Kusiak, A., Ossowska, A., & Grzybowska, M. E. (2021). Changes in the oral cavity in menopausal women—a narrative review. International Journal of Environmental Research and Public Health, 19(1), 253.

[v] Royal Osteoporosis Society, (2022). Women’s Health Strategy needs to go big on osteoporosis emergency affecting one in two women over 50. (Online) Available at: https://theros.org.uk/latest-news/women-s-health-strategy-needs-to-go-big-on-osteoporosis-emergency-affecting-one-in-two-women-over-50/ [Accessed November 2023]

[vi] Majumder, M. I., & Harun, M. A. S. I. (2015). Alveolar bone changes in post-menopausal osteopenic and osteoporosis women: An original research. International Journal of Dental and Medical Specialty, 2(2), 9.

[vii] Anil, S., Preethanath, R. S., AlMoharib, H. S., Kamath, K. P., & Anand, P. S. (2013). Impact of osteoporosis and its treatment on oral health. The American journal of the medical sciences, 346(5), 396-401.

[viii] Ko, Y. C., Tsai, M. T., Fuh, L. J., Tsai, M. J., Wang, X. H., Huang, H. L., & Hsu, J. T. (2020). Association between age of menopause and thickness of crestal cortical bone at dental implant site: a cross-sectional observational study. International Journal of Environmental Research and Public Health, 17(16), 5868.

[ix] Giro, G., Chambrone, L., Goldstein, A., Rodrigues, J. A., Zenóbio, E., Feres, M., … & Shibli, J. A. (2015). Impact of osteoporosis in dental implants: a systematic review. World journal of orthopedics, 6(2), 311.

[x] Diachkova, E., Abramova, E. V., Blagushina, N. A., & Tarasenko, S. (2020). Surgical treatment with dental implants in a patient with secondary loss of teeth and osteoporosis caused by an imbalance of vitamin D. BMJ Case Reports CP, 13(11), e235585.

[xi] NHS, (2023). Benefits and risks of hormone replacement therapy (HRT) (Online) Available at: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/ [Accessed November 2023]

[xii] Sinha, T., Prakash, J., Golgeri, M. S., Aruna, D. S., Sunila, B. S., Shivakumar, G. C., … & Minervini, G. (2023). Does hormone replacement therapy impact implant osseointegration in females-A systematic review and meta-analysis. The Saudi Dental Journal.

[xiii] Koszuta, P., Grafka, A., Koszuta, A., Łopucki, M., & Szymańska, J. (2015). Effects of selected factors on the osseointegration of dental implants. Menopause Review/Przegląd Menopauzalny, 14(3), 184-187.

[xiv] Sghaireen, M. G., Alzarea, B. K., Alam, M. K., Ab Rahman, S., Ganji, K. K., Alhabib, S., … & Maeda, H. (2020). Implant stability, bone graft loss and density with conventional and mineralized plasmatic matrix bone graft preparations-a randomized crossover trial. Journal of Hard Tissue Biology, 29(4), 273-278.

[xv] Pistoia, J. C., Archibald, J. (2023) Can You Get Dental Implants if You Have Osteoporosis? Healthline. (Online) Available at: https://www.healthline.com/health/osteoporosis/osteoporosis-and-dental-implants [Accessed November 2023]

[xvi] General Dental Council, (N.D.) Principle Seven. Maintain, develop and work within your professional knowledge and skills. (Online) Available at: https://standards.gdc-uk.org/pages/principle7/principle7.aspx [Accessed November 2023]