The link between general and oral health has been widely explored in the literature, and as clinicians, we see the impact in front of us every day. We know and understand the importance of holistic approaches to dentistry, but there is a widespread change to health that still isn’t spoken about enough within the profession, especially regarding how it can affect implant surgery and restoration.
I’m talking about menopause, a natural part of ageing that traditionally affects women between the ages of 45 and 55, though it can occur earlier. The impact on an individual’s life is significant. Clinicians must consider how it changes a dental treatment plan by looking at some of the larger systemic issues.
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.
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. Losing the antibacterial properties of the saliva may accelerate the development of cavities, tooth decay and oral disease. Saliva also facilitates chewing, swallowing food and speech – a reduction because of hormonal changes that can evidently begin to affect everyday life.
However, I want to focus on the significant impact of osteoporosis primarily. In particular, on dental implant success. The Royal Osteoporosis Society says that around 3.5m people in the UK live with the condition, and half of women over 50 will suffer from it. 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. This leads to the upregulation of immune cells and osteoclasts and further increases the production of bone-resorbing cytokines. 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. The literature has made links between osteoporosis and the progression of tooth loss, 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.
The consensus across the literature suggests that osteoporosis has no detrimental effect on implant failure and the percentage of osseointegration. Despite this, the presence of the condition does interfere with the mechanical stability of an implant. 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 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.
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 – modifications to the regenerative abilities of bone tissues are a commonly cited reason. Other reports find no significant influence on implant success at all. 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.
Providing a solution
There is still the opportunity to 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. The material used may differ between patients; autogenous bone or bone-like substitutes are suitable options.
This should only be used in the appropriate cases – some postmenopausal patients may still retain sufficient bone density in their jaw for a successfully placed implant. 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 but to deliver the best possible result for the patient.
Developing your skillset and providing care to patients like those going through 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.
References available on request.