Available via license: CC BY-NC 4.0
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Received: 05 May 2023 Revised: 09 July 2023 Accepted: 09 July 2023
DOI: 10.56501/intjorofacres.v7i1.845
ORIGINAL ARTICLE
Journal Section
Oral Health and Salivary pH Changes in Menopausal Women:
A Cross-sectional Study
Shilpa Prasad, BDS1*| Durgadevi Pancharethinam, MDS1*|
Sabitha Gokulraj, MDS1*| Kumar A, MDS1*
1Department of Oral Medicine and
Radiology, Vinayaka Mission’s
Sankarachariyar Dental College, Vinayaka
Mission’s Research Foundation, Salem,
Tamil Nadu, 636008, India
Correspondence
Dr. Durgadevi Pancharethinam, Assistant
Professor, Department of Oral Medicine
and Radiology, Vinayaka Mission’s
Sankarachariyar Dental College, Vinayaka
Mission’s Research Foundation, Salem,
Tamil Nadu, 636008, India
Email: dr.durgadevi8@gmail.com
Funding information
Nil
Abstract
Introduction: Menopause is a natural process in life of women often associ-
ated with hormonal changes. It affects oral health by influencing the growth of
bacteria and plaque, which can cause tooth decay and gum disease. Menopause
can alter salivary pH by reducing estrogenlevels, which may lead to dry mouth,
inflammation, and increased risk of infections. Therefore, it is important for
women in menopause to monitor their salivary pH and maintain good oral hy-
giene habits. However, there is contradictory evidence about the level of sali-
vary pH and oral symptoms. The present study was carried out to assess the
oral findings and salivary pH in premenopausal and postmenopausal women.
Methods: The study was carried out on 60 patients who reported to the De-
partment of oral medicine and radiology and were divided into two groupscon-
sisting of 30 patients each. Group 1: premenopausal women with no known
systemic illness and deleterious habits. Group 2: postmenopausal women.. Re-
sults: Salivary pH is higher in postmenopausal women than in premenopausal
women. Both pre and postmenopausal women have oral symptoms such as
dry mouth, facial pain, and ulcerative lesions, but they are more frequent in
postmenopausal women. Conclusions:Menopause affects the oral health and
salivary pH of women. Postmenopausal women are more prone to oral dis-
eases and have lower salivary pH than premenopausal women. Salivary pH
may be used as a biomarker for oral health status in postmenopausal women.
KEYWORDS
Salivary pH; Menopause; Dry Mouth; Facial Pain; Dentist; Health
Quality; Well-being
1|INTRODUCTION
Women go through a physiological process called
menopause that results in both systemic and oral adapta-
tions. Menopause, which literally translates as “without
estrogen,” is the point in a woman’s life when her men-
strual cycle stops. Menopause is typically defined as the
day of the last menstrual period and, as such, is a brief
and discrete time (an interruption of 12 months). Dur-
ing the transition period to menopause, there are changes
in hormones.1Studies have observed changes in follicle
*All authors have contributed equally.
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Int J Orofac Res 2023; 7(1): 27-32 Int J Orofac Res ©2023 Published by MM publishers 27
28 Prasad et al.
stimulating hormone (FSH) and estrogen in menopausal
women.2These changes in hormones are responsible for
several physical and psychological changes, such as hot
flashes, sleep disruption, lower energy, emotional insta-
bility, and weight gain.3These often lead to a decrease
in productivity and quality of life.4Not only do hormonal
changes affect the body, but they also have an impact on
the oral cavity. The studies have observed changes in oral
mucosa in early or start of menopause, such as dry mouth
(xerostomia) and mucosal infections.5
Oral Mucosa and salivary gland expresses the estro-
gen receptors on cells through which estrogen exert its
actions.6Further, these hormones also interact on with
fibroblast.7These changes usually are of inflammatory
in nature such as gingivitis, mucosal ulceration. It was
suggested that hormones could alters the salivary flow
through their action in estrogen receptors; although, stud-
ies have contradicted these findings.8Reduced salivary
flow is responsible of oral discomfort, root caries, peri-
odontal disease, and taste changes after menopause. Fur-
ther, these symptoms can aggravate menopause symp-
toms in women. Therefore, it is important to take iden-
tify them in early stages as well as address them to re-
duce the discomfort and improve quality of life. Saliva is
most often affect component of oral cavitythrough action
of hormones on salivary gland. It can give the early sign
of menopause in women. Further, studies have observed
the decrease in salivary flow rate, pH in postmenopausal
women compared to premenopausal women.9However,
Laine et al study did not find any difference in salivary pH
in pre and post menopause women.10 Salivary pH play sig-
nificant role in oral health maintenance and can prevent
oral disease such as gingivitis, dental caries. Hence, it is
important to understand the change in salivary pH. Fur-
ther, being non-invasive it is ideal fluid of routine exami-
nation. Therefore, the present study was carried out to as-
sess the oral findings and salivary pH in pre-menopausal
and post-menopausal women.
2|METHOD
The study was conducted in the Department of Oral
Medicine and Radiology, Vinayaka Mission Sankarachari-
yar Dental College and Hospitals and in Central Research
Laboratory. The study sample consisted of 60 women,
divided into two groups: Group A (n=30) included pre-
menopausal women with regular menstrual cycles, and
Group B (n=30) included post-menopausal women who
had experienced menopause for more than one year.
Written consent was obtained from all participants before
the study.
2.1 |Eligibility criteria
2.1.1 |Inclusion criteria
•Women between 30 and 70 years old
•30 pre-menopausal women with regular periods
•30 post-menopausal women having episodes of
menopause more than one year
•Women who do not use tobacco, alcohol or other
harmful substances
2.1.2 |Exclusion criteria
•Women with diabetes, chronic infections or salivary
gland disorders that cause dry mouth
•Women taking medications that affect salivary flow
•Women with autoimmune diseases
•Women who have undergone radiotherapy or
chemotherapy
•Women who have become amenorrhoeic due to
surgery
Investigator collected 2 ml of unstimulated saliva
from each women between 9 AM to 12 PM using the
spitting method, after ensuring they met the inclusion
and exclusion criteria. Further, pH of the saliva sam-
ples was measured using a digital pH meter that was cal-
ibrated with buffer solutions of pH 7 and 4. Investigator
asked the individuals about their dry mouth, taste and
breath changes, mucosal/facial pain, burning sensation,
and burning mouth syndrome symptoms, and examined
their oral cavity for any signs of ulceration, white and red
lesions. All the relevant information was recorded in a
proforma. The descriptive statistical analysis and Mann-
Whitney U test was used to analyze the results with the
statistical significance at p<0.05.
3|RESULTS
The average age of women having menopause was
39 years, with a standard deviation of 5.86 years, while
Prasad et al. 29
the average age of women who have reached menopause
was 54.20, with a standard deviation of 6.98. The data in-
dicates a higher variation in the postmenopausal group
than in the premenopausal group (Table 1).
TA B L E 1 Mean age in premenopausal and
postmenopausal women
Groups N Mean age
(year)
SD
Pre-
menopausal
30 29 5.86
Post-
menopausal
30 54.20 6.98
In this present study, we measured the salivary pH
of premenopausal and postmenopausal women. The av-
erage salivary pH was 6.32 ±0.50 for premenopausal
women and 6.93 ±0.58 for postmenopausal women.
We used a 95% confidence interval (CI) to estimate the
range of the true population mean. The CI was 5.88 -
6.82 for premenopausal women and 6.35 - 7.51 for post-
menopausal women. We also performed a statistical test
to compare the mean salivary pH of the two groups. The
P value less than 0.01, was considered as a significant
difference (Table 2).
In context to oral health symptoms and salivary pH,
the study observed that postmenopausal women had a
higher prevalence of oral symptoms than premenopausal
women. Specifically, we found a statistically significant
difference between the two groups in terms of salivary
pH (p<0.05), dry mouth (p<0.05), facial pain (p=0.03),
and ulcerative lesion (p=0.04). These findings suggest
that hormonal changes during menopause may affect
oral health, salivary pH and quality of life in women.
4|DISCUSSION
Saliva plays a vital role in maintaining the oral tissue
health and offering a non-invasive method.11 However,
when the quantity or quality of saliva is compromised, it
can lead to various issues. The hormonal changes before
menopause have an impact on the immune system and
the oral health of women.12 Therefore, it is important to
have a comprehensive understanding of the oral health
condition of patients who are undergoing or approaching
menopause. Recently, researchers and health policymak-
ers have started to focus on and increase their interest
in menopause as a global condition affecting millions of
women. Further, to advocate on measures to have longer
and better quality of life in those women as the hormonal
changes can also result in oral changes which can further
reduce the quality of life.
It was noticed that hormonal change have effect on
saliva composition that directly linked to its pH. Usually
saliva is neutral tightly maintained by buffering system
and maintaining salivary pH is crucial to oral health.13
However, certain condition10,14-17 including the hor-
monal imbalance such as menopause can altered the sali-
vary pH. In present study, there is a significant differ-
ence in the salivary pH between premenopausal and post-
menopausal women. The average salivary pH was higher
in postmenopausal women compared to premenopausal
women. This was in contrast to Foglio-Bonda et al, where
they observed lower salivary pH values. 18 Lower (acidic)
salivary pH increases the incidence of dental caries by cre-
ating the environment conducive to bacterial growth.19
Further, it can induces the periodontitis and bone destruc-
tion. These contradicting findings indicates the influence
of different factors in maintenance of salivary pH. In addi-
tion to the difference in salivary pH, the study also found
that postmenopausal women had a higher prevalence of
oral symptoms than premenopausal women. Specifically,
there were statistically significant differences between
the two groups in terms of dry mouth, facial pain, and ul-
cerative lesions. Similar, oral changes have been reported
in studies on menopause women.20
One of the main oral health problems of these pa-
tients is dry mouth, which is characterized by dryness,
thick and stringy saliva, difficulty in chewing, speak-
ing, and swallowing, sore throat and hoarseness, dry or
cracked tongue, and altered taste sensation. These pa-
tients may also suffer from dental or facial pain, ulcerative
lesions, and dry mouth. According Jacob et al. it is more
prevalent in menopause women.21 This could be due to
reduction in salivary flow. Studies have found significant
association between menopause and salivary flow rate.
Similar, observations were noted in present study. In
30 Prasad et al.
present study, majority postmenopausal women had dry
mouth.10 However, Minicucci et al. suggested that re-
duction in saliva flow might not always associated with
clinical symptoms of xerostomia.22 In that case, it may
be possible to be associated with stress in menopause
women. It is evident from correlation of salivary cortisol
and xerostomia.23 Similarly, association is also evident be-
tween salivary progesterone and dryness.24 However, ex-
act mechanism is not clear.
Dryness or xerostomia make the oral mucosa suscep-
tible to ulceration, and infection. As result, person feels
facial pains due to constant friction during oral function.
Facial pain can be of varying degree depending upon the
involvement of oral tissue. Dryness often lead to small
mucosal ulceration which often developed and have su-
peradded infection. In present study, facial pain and ul-
ceration were more evident in postmenopausal women
compared to premenopausal. Besides oral mucosal pain,
postmenopausal women are reported to be prone for
trigeminal neuralgia and have high prevalence among
postmenopausal women.25 Mechanism behind these are
yet to be clear and may warrant further studies.
Overall, the results of this study suggest that
menopause may be associated with changes in oral
health, including changes in salivary pH and an increased
prevalence of oral symptoms. These findings suggest that
hormonal changes during menopause may have an impact
on oral health and quality of life in women. Further re-
search may be needed to better understand the mecha-
nisms underlying these changes and to develop interven-
tions to improve oral health in postmenopausal women.
5|CONCLUSION
Menopause affects the oral health and salivary pH of
women. Postmenopausal women are more prone to oral
diseases and have lower salivary pH than premenopausal
women. Salivary pH may be used as a biomarker for oral
health status in postmenopausal women.
Acknowledgements
Nil
Co nfl ict of interest
The authors have no conflicts of interest to declare.
Supporting Information
Additional supporting information may be found at
the journal’s website.
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32 Prasad et al.
How to cite this article: Prasad S, Pancharethi-
nam D, Gokulraj S, Kumar A. Oral Health and Sali-
vary pH Changes in Menopausal Women: A Cross-
sectional Study. Int J Orofac Res. 2023;7(1):27-
32. https://doi.org/10.56501/intjorofacres.v7i1.
845
TA B L E 2 Comparison of mean salivary pH between pre- and post-menopausal women using student‘t’ test
Groups N Mean ±SD 95% CI P-value
Premenopausal 30 6.32 ±0.50 5.88 - 6.82 0.001
Postmenopausal 30 6.93 ±0.58 6.35 - 7.51
