Menopause Flashcards
Define menopause and its age of onset
- Permanent cessation of menstrual flow confirmed when a woman has no menstrual period for 12 consecutive months
- Generally occurs between ages of 47 and 55 years
- End of fertility due to decreased production of sex hormones by ovaries
List the physiological characteristics of menopause (not oral)
Vasomotor reactions
Mucosal changes
Emotional disturbances
Describe the vasomotor reactions that occur during menopause
- Hot flushes (surges of heat involving whole body)
* Night sweats cause sleep disturbances
Describe the mucosal changes that occur during menopause (3)
- Dryness
- Thinning of tissue
- Irritation
Describe the emotional disturbances that occur during menopause
- Altered oestrogen levels may result in mood swings/ depression
- Anxiety
- Tension
- Irritability
- Feeling useless
Explain the relationship between osteoporosis and periodontal disease by answering the following:
- Definition of osteoporosis
- Age of onset, affected genders
- Three main causes
- Risk factors for osteoporosis and periodontal disease
Definition of osteoporosis:
• Involves loss of mineral content and bone mass
Age of onset, affected genders:
• Can occur at other ages
• Occurs in men, but most often in postmenopausal women
Causes:
• Hormonal disturbances (endocrine)
• Depletion of oestrogen
• Calcium deficiency or absorption issues
Risk factors for osteoporosis and periodontal disease:
They have mutual risk factors, for example
• smoking
• family history
Discuss osteoporosis, menopause and medication.
Explain how hormone replacement therapies work.
List the types of hormone replacement therapies and/ or medications (5)
Osteoporosis and menopause:
• Osteoporosis in postmenopausal woman who are not receiving Hormone Replacement Therapy (HRT) will affect bone metabolism in both the maxilla and mandible
How hormone replacement therapies work:
• May decrease bone resorption
• May increase bone formation
• May do both
Types of hormone replacement therapies:
• Calcitonin - inhibit bone resorption
• Parathyroid Hormone: stimulates bone formation
• Bisphosphonates
• Selective estrogen receptor modulators
• Simultaneous intake of calcium and vitamin D
Describe bisphosphonates, define BRONJ and state the location of BRONJ lesions
Bisphosphonates:
• They inhibit osteoclast-mediated bone resorption
• However, their prolonged use is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ)
BRONJ:
• Exposed bone in the maxillofacial area showing no evidence of healing for at least 8 weeks in patients on BP therapy
BRONJ lesion locations:
• Occurs most frequently in the mandible than maxilla
• Mostly posterior region
• 60% occur after invasive dental surgery e.g. tooth extraction
Describe BRONJ related lesions
- Asymptomatic or painful
- Pus-filled discharge
- Oedematous
- Associated with tooth mobility
Describe the diagnosis and treatment for BRONJ lesions
Diagnosis:
• Radiographic evaluation is usually inconclusive for early lesions in advanced cases
• Advanced cases: a poorly defined moth-eaten radiolucency
Treatment:
• No single effective treatment for BRONJ
• Hyperbaric oxygen treatment for the management BRONJ is inconclusive
• Best way to treat as an OHT is debridement, antibiotics and CHx
Discuss the oral conditions often associated with post-menopause, specifically:
- Gingiva
- Mucous membranes and tongue
- Alveolar bone loss (causes and patterns)
Gingiva:
• Exaggerated response to biofilm
• Irritation of gingiva
• Menopausal gingivostomatitis may develop
Mucous Membranes and Tongue (appearance):
• Tissue may appear shiny and vary in color
• Burning mouth syndrome -> xerostomia
• Atrophic and thin epithelium
• Altered taste perception
Alveolar Bone Loss (causes):
• Due to systemic osteoporosis
• Caused from hormonal disturbances (endocrine), depletion of estrogen or calcium deficiency or absorption
Alveolar Bone Loss (patterns):
• Ridge resorption
• Loss of teeth may occur
Discuss the role of the Oral Health Therapist when treating patients post-menopause
• Consider the effects of BRONJ
Treat BRONJ:
• Debridement
• Antibiotics
• CHx to limit the extent of the damage and to facilitate wound healing
