Hormone Replacement Therapy (HRT)
Estrogen Replacement Therapy and Effects on Tooth Loss, Gum Disease
The following abstracts from substantial long term research on estrogen and hormone replacement therapy for women indicate without doubt the positive effect on keeping teeth longer and severity of gum disease in women who received HRT.
Estrogen Replacement Therapy Something to Smile About Abstract: Tooth loss and alveolar residual ridge resorption are significant oral health problems in older adults. Although the causes of tooth loss are many, several studies show an association between tooth loss/residual resorption and systemic osteoporosis. Because estrogen replacement therapy (ERT) slows the development of osteoporosis, we investigated the relationship between estrogen use and tooth loss among elderly women who were participating in the Leisure World Cohort Study. Among 3,921 women 52 to 109 years old (median = 81), those who had ever used estrogen retained more teeth than nonusers (21.2 vs 19.2). The age-adjusted risk of having fewer than 25 teeth decreased with increasing duration of ERT' 0.87 for <4 years of ERT, 0.74 for 4 to 14 years, and 0.70 for 15+ years compared to nonusers. Similarly, the risk of edentia was inversely related to estrogen use. If a woman had ever taken ERT, her risk of losing all her teeth was about two thirds that of a woman who had never used estrogen. Long-term users (15+ years) had half the risk of becoming toothless. Despite differences in age, education, methods of obtaining tooth and hormone data, and prevalence of tooth loss, two other cohort studies (the Nurses' Health Study and the Framingham Heart Study) reported similar reductions in tooth loss among estrogen users. The data suggest that tooth retention, in addition to being affected by osteoporosis of alveolar bone, also shares in the benefits of ERT on osteoporosis. Tooth Loss and Hormone Use in Postmenopausal Women Abstract: Nearly 32% of US women aged 65 to 69 have no teeth. Because some tooth loss may reflect systemic osteoporosis, and postmenopausal hormone therapy protects against osteoporosis, the authors examined the risk of tooth loss in relation to hormone use in a prospective study of 42,171 postmenopausal women. Overall, the risk of tooth loss was 24% lower in women who were currently using hormones, although there was little effect for women who had stopped taking hormones. This decreased risk for current hormone users was observed regardless of the duration of use and was similar for a variety of hormone preparations and doses. Although few studies have examined the issue, this research suggests that hormone therapy may reduce tooth loss.Postmenopausal Estrogen Replacement and Tooth Retention Abstract: Loss of underlying supportive alveolar bone is a major cause of tooth loss. Alveolar bone loss appears to be related to the status of the extracranial skeleton, and therapies that preserve skeletal bone may be expected to benefit tooth retention. An association between postmenopausal hormone replacement therapy (HRT) and tooth retention was found in a cohort of 488 elderly women, 72 to 95 years old, who participated in the Framingham Heart Study between 1948 and 1995. There was an association between duration of HRT and tooth retention for total number of teeth remaining and the individual types of teeth (incisors, canines, and premolars, but not molars) retained. The odds of being edentulous were reduced by 6% for each 1-year increase in duration of HRT use. The data suggest that postmenopausal HRT protects against tooth loss and reduces the risk of edentulism. Effect of Estrogen Supplementation on Periodontal Disease Abstract: This article presents evidence of the protective role of estrogen supplementation on periodontal disease in postmenopausal women. A total of 412 women, 236 postmenopausal (50 to 75 years old) and 176 premenopausal (25 to 49 years old), were included in this study. The postmenopausal group included 59 women receiving estrogen replacement therapy (ERT) and 177 who did not receive ERT (non-ERT). Periodontal disease was assessed from two independent but highly correlated measures: clinical attachment loss (CAL) and alveolar bone loss (ABL). Severe periodontal disease was arbitrarily defined as mean CAL or ABL -> 3 mm. Data adjusted for age effect were compared for various groups of pre-menopausal and postmenopausal women. Non-ERT women were twice as likely as their ERT counterparts, and three times more likely than premenopausal women, to exhibit severe attachment loss. Individual percentages of women affected by severe attachment loss were 18.6%, 11.9%, and 6.3% for non-ERT, ERT, and premenopausal women, respectively. On the other hand, severe ABL was detected in 34%, 20.3%, and 9.7% of the non-ERT, post-menopausal ERT, and premenopausal women, respectively. Similar to CAL, when ABL was used as a measure of disease, almost twice as many non-ERT women compared to their ERT counterparts and four times compared to premenopausal women exhibited severe ABL. Therefore, ERT appears to have a protective effect on the severity of periodontal disease and the periodontium. Source: Compendium, Vol. 19, Supplement No. 22, 1998,
Compendium, Jan. 99, Vol. 20, No. 1