Nina Farmer explains the effect of hormones and diet on oral health.

Dentistry has always been something of a ‘Cinderella sector’ in healthcare discussions: often talked about, but rarely given its due priority.

Even now, with NHS nurse and ambulance strikes dominating the headlines, the accompanying (and equally severe) crisis in UK dentistry has received only marginal coverage in comparison. This is a serious blind spot, especially given that the effects of poor oral health tend to stretch far beyond the mouth.

Indeed, the role of the mouth as ‘the gateway to the body’ is widely recognised in clinical practice. Our teeth and gums can give us an insight into whole-body health issues. And it is a two-way street: wider health problems manifest in the mouth, whilst poor oral health has a knock-on effect in the wider body.

Take women’s health as an example. Across various stages of a woman’s life – from puberty and menstruation to pregnancy and the menopause – hormonal surges can interrupt and compromise the healthy functioning of the oral biome.

In 2020, a literature review by Sidra Medicine, Qatar, found that complex hormonal changes in pregnancy can “increase the susceptibility of the woman to various infections including periodontal (gum) disease”. These problems include cavities, dental erosion, and even tumour-like growths during pregnancy, called epulis, which mostly disappear once the baby is born.

These hormonal changes help ligaments to relax and improve the formation of blood vessels, both of which benefit the foetus. But what’s good for the baby can wreak havoc on the gums. In extreme cases, they can even contribute to more serious issues.

Last year, a study on pregnant women in Malawi sketched a tentative link between periodontitis and adverse outcomes in pregnancy – including preterm birth, preeclampsia, and low birth weight babies. Notably, these outcomes were reduced by almost 24 per cent amongst participants who were asked to regularly chew sugar-free gum – which offers a small but important oral health boost.

Nor is the impact of hormonal change limited to pregnancy. During menstruation, changes in a woman’s body can have unwanted side effects, including ulcers and puffy bleeding gums. Higher rates of inflammation and gingivitis/periodontitis are also associated with menopause, adding to the long list of symptoms women experience during this life stage.

Research connecting oral and general health has been of interest for decades and is ever evolving – and such findings underline how connected our mouths are with the wider body. It is, therefore, only sensible that effective oral care should be treated as a necessity rather than an afterthought.

Policymakers may be slow on the uptake, but from a dental perspective, there are a number of simple measures that can quickly make a difference.

As always, education is key. Patients must always be armed with the knowledge of how to preserve their teeth and gums, especially when they are most at risk – such as during times of acute hormonal change. The promotion of healthy habits like brushing, flossing, and in some cases, using mouthwash are all crucial preventative measures.

Diet is important as well. As a nutritional therapist, my headline message to patients is to prioritise healthy nutrition and lifestyle changes. Stopping smoking, limiting alcohol consumption, and maintaining a balanced diet full of fresh, nutrient-dense food with a focus on hydration, are great ways to increase resilience in the body and reduce the chances of gum disease.

Even chewing sugar-free gum can have a profound impact, which has been shown to alleviate inflammation and dry mouth by stimulating saliva production by up 10 to 12 times the norm. This saliva neutralizes acid and helps to rid the mouth of harmful bacteria and plaque by removing food debris – and because of the anti-microbial properties of saliva.

Beyond this, individuals should, of course, visit dentists, dental therapists and hygienists regularly. Doing so can offer an early-warning system for a litany of potential issues and can provide extra support to patients when they need it most. Prevention is the best form of treatment.

If policymakers are serious about improving health outcomes for vulnerable patients – including women who are undergoing profound physiological and hormonal changes – they need to take a more holistic view which acknowledges dental care as a crucial plank of whole-body health.

In the meantime, however, my colleagues and I will continue to emphasise the value of small, preventative measures in safeguarding the mouths of vulnerable patients.

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