Gum Disease in Postmenopausal Women Increases Risk of Tooth Loss

BUFFALO, N.Y. -- Postmenopausal women need to be especially vigilant about dental health if they wish to avoid tooth loss as they age, a new study by oral biologists at the University at Buffalo has found.

A follow-up of participants in a dental study conducted between 1989 and 1991 in Erie County, N.Y., found that each millimeter of alveolar bone loss -- an indicator of periodontal disease -- measured at baseline was associated with a three-fold increase in risk of tooth loss a decade later, the researchers found.

The study appears in the current (July) issue of the Journal of Periodontology.

"The role of baseline periodontal status on subsequent tooth loss in postmenopausal women has not been assessed in previous studies," said Mine Tezal, Ph.D., research assistant professor of oral biology in the UB School of Dental Medicine and lead author on the study. "Postmenopausal women represent a subpopulation with unique factors that influence tooth loss, such as estrogen deficiency, hormone therapy and lower bone-mineral density.

"Both menopause and periodontal disease, a chronic infection, are related to systemic bone loss independent of each other," said Tezal. "However, if you are postmenopausal and have periodontal disease, you lose alveolar bone faster and therefore lose teeth faster." Alveolar bone is the bone supporting the teeth.

"That is the main point of this study," said Tezal. "Control of periodontal disease can significantly reduce tooth loss in this group. Keeping their teeth helps older women maintain their nutritional status, social life and self-esteem."

Periodontal disease, also referred to as gum disease, is an infection of the tissues surrounding and supporting the teeth. It begins when bacteria in plaque (the sticky, colorless film that constantly forms on teeth and is removed by regular brushing and flossing) causes the gums to become inflamed. Gums separate from the teeth, forming spaces between the teeth and gums that become infected. As the disease progresses, these pockets deepen and more gum tissue and bone are destroyed.

Tezal said the public, and sometimes dentists, often focus more on the teeth than the surrounding tissues. "Periodontal disease may go unnoticed until the late stages, because it usually doesn't cause pain," she said. "Unfortunately, periodontal disease in its advanced stages is much more difficult to treat than cavities."

The current study involved 106 white women who participated in a cross-sectional study between 1989 and 1991, and were eligible and willing to be reassessed 10-13 years later. Dental exams were conducted both at baseline and follow-up. More than half the women had lost at least one tooth during the intervening years, results showed.

After adjusting for the effects of age, income, smoking, hormone therapy, snack consumption and number of decayed teeth, the researchers found that loss of alveolar bone due to periodontal disease was the leading cause of tooth loss in postmenopausal women. The risk of tooth loss increased three-fold with each millimeter of bone loss.

Each millimeter of clinical attachment loss, or gum separation from the teeth, also was associated with a 2.5-fold increase in risk of tooth loss, results showed.

Additional researchers on the study from UB were Jean Wactawski-Wende, Ph.D., of the Department of Social and Preventive Medicine, School of Public Health and Health Professions; Sara G. Grossi, D.D.S., and Robert J. Genco, D.D.S., Ph.D., of the Department of Oral Biology, UB dental school. Jacek Dmochowski, Ph.D., of the University of North Carolina Charlotte also is a co-author.

The study was supported by grants from the U.S. Public Health Service, the National Institute of Dental and Craniofacial Research and the Department of the Army Medical Defense.

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York.