bisphosphonates are utilized (American Dental Association, 2019). The use of IV bisphosphonates or denosumab therapy for osteoporosis patients are usually given in much lower doses and a reduced duration of administration compared to those uswed for oncology patients (Chan,et.al., 2018). However, in a systematic literature review of MRONJ in osteoporotic patients treated with oral bisphosphonates, the most common characteristics of those who developed ONJ were being female, being aged 60 years or older, and having had previous invasive dental treatment (Jeong et al., 2017; American Dental Association, 2019). Although Jeong and colleagues caution that in their study the gender disparity may actually be the result of more women than men taking bisphosphonates, women, especially older women, seem more prone to this condition even if only because they are more likely to require the medication. evidence supports a link between pregnancy outcomes and periodontal disease; however, treating periodontal disease has not been conclusively demonstrated to improve birth outcomes. During the middle years, female patients can experience a number of dental concerns, including temporomandibular joint dysfunction, trigeminal neuralgia, and other atypical facial pain. Oral findings in postmenopausal women may include decreased saliva, increased dental caries, burning mouth syndrome, alterations in taste, atrophic gingivitis, periodontitis, and osteoporosis of the mandible and maxilla. Because women represent the majority of the population, make the majority of healthcare decisions, and most often live longer than men, it is essential that the dental team continually gain knowledge about women’s oral health issues and appropriate interventions. Childers, N. K., Momeni, S. S., Whiddon, J., Cheon, K., Cutter, G. R., Wiener, H. W., … Moser, S. A. (2017). Association of colonization with Streptococcus mutans genotypes from mothers and early childhood caries. Pediatric Dentistry, 39 (2), 130-135. Cleveland Clinic. (2018). Hormones and oral health . https://my.clevelandclinic.org>health>articles>1119... Cleveland Clinic. (2019). Burning mouth . https://my.clevelandclinic.org>health>diseases>144... Cobb, C. M., Kelly, P. J., Williams, K. B., Babbar, S., Angolkar, M., & Derman, R. (2017). The oral microbiome and adverse pregnancy outcomes. International Journal of Women’s Health, 9 , 551-559. College of Dental Hygienists of Ontario (CDHO). (2019). Eating disorders . https://www.cdho.org/Advisories/ CDH)_Factsheet_Eating_Disorders.pdf Consolini, D. M. (2019). Breastfeeding. Merck Manual. https://merckmanuals.com>...>standalonemedia Corbella, S., Taschieri, S., Del Fabbro, M., Weinstein, R., & Ferrazzi, E. Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association. Quintessence International, 47 (3), 193-204. https://doi.org/10.3290/j.qi.a34780 County Health Rankings & Roadmaps. (2016). Grady Memorial Hospital interpregnancy care program . http:// www.countyhealthrankings.org/policies/grady-memorial-hospital-interpregnancy-care-program CVS Pharmacy. (n.d.). Sodium fluoride: Dental gel . https://www.cvs.com/drug/sodium-fluoride/dental-gel Daalderop, L.A., Wielnad, B.V., Tomsin, K., et al. (2018). Periodontal disease and pregnancy outcomes: Overview of systemic reviews. JDR Clinical and Translational Ressearch, 3 (1), 10-27. Damle, S. G., Yadav, R., Garg, S., Dhindsa, A., Beniwal, V., Loomba, A., & Chatterjee, S. (2016). Transmission of mutans streptococci in mother-child pairs. Indian Journal of Medical Research, 144 (2), 264-270. DentaGama. (2019). What can bulimia nervosa do to your teeth? https://dentagama.com/news/what-can- bulimia-nervosa-do-to-your-teeth Drugs.com. (2021). Xylitol. https://www.drugs.com>...>Xylitol Pg. 14 Figueiredo, C., de Araujo, S., Rosalem, C., Goncalves, C., Cantanhede, A.L, et al. (2017). Systemic alterations and their oral manifestations in pregnant women. Journal of Obstetric Gynecological Research, 43 (1), 16-22. Forney, K. J., Buchman-Schmitt, J. M., Keel, P. K., & Frank, G. K. W. (2016). The medical complications associated with purging. The International Journal of Eating Disorders, 49 (3), 249-259. Gividen, S. L. (2020). Eating disorders: A brief overview of the dentist’s role in diagnosis and management. Dentistry IQ. https://www.dentistryiq.com/dentistry/oral González-Jaranay, M., Téllez, L., Roa-López, A., Gómez-Moreno, G., & Moreu, G. (2017). Periodontal status during pregnancy and postpartum . PLOS ONE, 12 (5), e0178234. https://doi.org/10.1371/journal. pone.0178234 Grocholewicz, K., Janisszewska-Olszowska, J., Aniko-Wlodarczyk, M., Preuss, O., Trybek, G., Sobolewska, E., & Lipski, M. (2018). Panoramic radiographs and quantitative ultrasound of the radius and phalanx III to assess bone mineral status in postmenopausal women. BMC Oral Health, 18 (127). https://bmcoralhealth. biomedcentral.com/articles/10.1186/s12903-018-0593-4 Hamasni, F. M., El Hajj, F., & Abdallah, R. (2018). Single sitting surgical treatment of generalized aggressive periodontitis using GTR technique and immediate implant placement with 10-year follow-up. Case Reports in Dentistry, 6194042. https://doi.org/10.1155/2018/6194042 Hariri, R., & Alzoubi, E. E. (2017). Oral manifestations of menopause. Journal of Dental Health, Oral Disorders and Therapy, 7 (4), 306-309. https://medcraveonline.com/JDHODT/oral-manifestations-of-menopause.html Hartnett, E., Haber, J., Krainovich-Miller, B., Bella, A., Vasilyeva, A., & Kessler, J. L. (2016). Oral health in pregnancy . Journal of Obstetric, Gynecological and Neonatal Nursing, 45 , 565-573. http://dx.doi. org/10.1016/j.jogn.2016.04.005 HealthyPeople.gov. (n.d.). Arthritis, osteoporosis, and chronic back conditions . https://www.healthypeople. gov/2020/topics-objectives/topic/Arthritis-Osteoporosis-and-Chronic-Back-Conditions Hennessy, B. J. (2020). Burning mouth syndrome. Merck Manual Professional Version. https://www. merckmanuals/com>dental-disorders>bu... Huggins, K. H., & Wright, E. (2019). The detection and management of temporomandibular disorders in primary dental care. Dentalcare.com. https://www.dentalcare.com/en-us/professional-education/ce-courses/ce395 Jeong, H.-G., Hwang, J. J., Lee, J.-H., Kim, Y. H., Na, J. Y., & Han, S.-S. (2017). Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates. Imaging Science in Dentistry, 47 (1), 45-50. Jones, W. R., Schellhase, M., & Morgan, J. F. (2018). Eating disorders: Clinical features and the role of the general psychiatrist. Cambridge University Press. https://www.cambridge.org/core/journals/advances... Kashetty, M., Kumbhar, S., Patil, S., & Patil, P. (2018). Oral hygiene status, gingival status, periodontal status, and treatment needs among pregnant and nonpregnant women: A comparative study. Journal of Indian Society of Periodontology, 22(2), 164-170. Kawar, N. I., Partovi, E., Hildebolt, C., McLeod, D., & Miley, D. D. (2016). Periodontal disease and preterm birth, is there any relationship? JBR Journal of Interdisciplinary Medicine and Dental Sciences, 4 (4). https://doi. org/10.4172/2376-032X.1000202 Khairnar, M., Pawar, B., Marawar, P. P., & Raut, D. (2013). Correlation between periodontitis with pre-term birth and low birth weight and effect of non-surgical supportive periodontal therapy on pregnancy outcome in a
at the spine and hip in a dose-dependent manner and reduce the risk of fracture at some sites. Bisphosphonate therapy is also reported to have beneficial effects on the periodontium (Muniz, et. al., 2021). Although bisphosphonates are effective as a prophylaxis and intervention for osteoporosis, exposure to them has led to reports of medication-related osteonecrosis of the jaw (MRONJ) (Aldhalaan, et al., 2020). This condition is defined as the “presence of necrotic bone anywhere in the oral cavity in a patient who is taking bisphosphonates, who has not received radiation to the head and neck and in whom the necrotic area does not heal within 8 weeks after diagnosis after receiving proper care” (American College of Prosthodontists, 2018). Approximately 0.001%-0.01% of patients who take oral bisphosphonate medications will develop MRONJ compared to between 1% and 10% of patients for whom Intravenous (IV) Conclusion The oral health of men and women differs for a variety of reasons ranging from biological differences to different roles and perceptions. Oral health issues of female patients also change throughout their life cycle. Most pubertal females with healthy gingiva will not develop gingival inflammation, but some individuals will have gingival inflammation with even minor accumulation of dental plaque. Many oral changes may occur with the start of menses and over the menstrual cycle, including swollen gingival tissues, activation of herpes labialis, aphthous ulcers, prolonged bleeding following oral surgery, and swollen salivary glands. Most evidence does not support a putative association between oral contraceptives and gingivitis or periodontitis, but further research is needed. During pregnancy, a woman is exposed to significant hormonal changes that, in turn, affect the oral tissues. Importantly, most References Academy for Eating Disorders. (n.d.). Information on eating disorders . https://web4health.info/en/med/docs/ acadeatdis.html Aldhalaan, N. A., BaQaia A., & Al-Omar, . (2020). Medication-related osteonecrosis of the jaw: A review. Cureus. 12 (2), e6944. https://www.ncbi.nlm.nih.gov>articles>PMC7067354 Ali, I., Patthi, B., Singla, A., Gupta, R., Dhama, K., Niraj, L. K., … Prasad, M. (2016). Oral health and oral contraceptive – Is it a shadow behind broad day light? Journal of Clinical & Diagnostic Research, 10 (11), ZE01- ZE06. https://doi.org/10.7860/JCDR/2016/19439.8790. Almeida, L. E., Pierce, S., Klar, K., & Sherman, K. (2016). Effects of oral contraceptives on the prevalence of alveolar osteitis after mandibular third molar surgery: A retrospective study. [Abstract]. International Journal of Oral and Maxillofacial Surgery, 45 (10), 1299-1302. American Academy of Orthopaedic Surgeons. (2016). Osteoporosis and spinal fractures . https://orthoinfo. aaos.org/en/diseases--conditions/osteoporosis-and-spinal-fractures American Academy of Pediatric Dentistry. (2016). Perinatal and infant oral health care. https://www.aapd. org/.../perinatal-and-infant-oral-health-care American Academy of Periodontology. (n.d.). Gum disease and women . https://www.perio.org/consumer/gum- disease-and-women American College of Prosthodontists. (2018). Medication-related osteonecrosis of the jaw. https://www. prosthodontics.org>about-acp>position-s... American Dental Association. (n.d.). Hormones and dental health: What every woman should know . https:// www.mouthhealthy.org/en/az-topics/h/hormones American Dental Association. (2017). Oral health topics: Pregnancy . https://www.ada.org/en/member-center/ oral-health-topics/pregnancy American Dental Association. (2019). Oral health topics: Osteoporosis medications and medication-related osteonecrosis of the jaw. https://www.org/en/member-center/oral-health-topics/osteoporosis-medications American Dental Association. (2021). Oral health topics: pregnancy . https://www.ada.org/en/member-center/ oral-health-topics/pregnancy American Family Physician. (2019). Potential drug interactions in patients taking oral contraceptive pills . 4100(10), 599-600. https://www.aafp.org>afp Babay N., Alshehri, F., & Al, R. R. (2019). Majors highlights of the new 2017 classification of periodontal and peri-implant diseases and conditions. Saudi Dental Journal, 31 (3), 303-305. https://doi.org/10.1016/j. dentj.2019.04.006 Barrett, J. R. (2017). Low prenatal exposures to fluoride: Are there neurotoxic risks for children? Environmental Health Perspectives, 125 (10). https://doi.org/10.1289/EHP2289 Berard, A., Iessa, N., Chaabane, S., Muanda, F. T., Boukhris, T., & Shao, Jin-Ping. (2016). The risk of cardiac malformations associated with paroxetine use during the first trimester of pregnancy: A systematic review and meta-analysis. British Journal of Clinical Pharmacology, 81(4) , 589-604. https://pubmed.ncbi.nlm.nih. gov/26613360 Biological Psychiatry. (2018). Prevalence of eating disorders from largest sample in the United States. www. elsevier.com/about/press-releases/reserach-and-journals/prevalence-of-e Bobetsis ,Y. A., Graziani, F., Gursoy, M., & Madianos, P. N. (2020). Periodontal disease and adverse pregnancy outcomes. Periodontol 2000, 83 (1), 154-174. https://pubmed.ncbi.nlm.nih.gov/32385871 Bone, H. G., Wagman, R. B., Brandi, M. L., Brown, J. P., Chapurlat, R., Cummings, S. R., … Papapoulos, S. (2017). 10 years of denosumab treatment in postmenopausal women with osteoporosis: Results from the phase 3 randomised FREEDOM trial and open-label extension. [Abstract]. Lancet: Diabetes & Endocrinology, 5 (7), 513-523. California Dental Association Foundation. (2010). Oral health during pregnancy and early childhood: Evidence- based guidelines for health prof essionals. California Dental Association. https://www.cda.org/.../pregnancy- and-oral-health [Keeping this reference] Camacho, P. M., Petak, S. M., Binkley, N., Clarke, B. L., Harris, S. T., Hurley, D. L., … Watts, N. B. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis – 2016 . https://www.aace.com/ files/postmenopausal-guidelines.pdf Carmo, J. Z. B., & de Medeiros, S. F. (2017). Mandibular inferior cortex erosiono n dental panoramic radiograph as a sign of low bone mineral density in postmenopaual women. Rev Bras Ginecol Obstet, 39 , 663-669. https://www.thieme-connect.com>ejournals>pdf Centers for Disease Control and Prevention. (2018). Smoking, gum disease, and tooth loss . https://www.cdc.gov/tobacco/campaign/tips/diseases/periodontal-gum- disease.html Centers for Disease Control and Prevention. (2020). Preconception health . https://www.cdc.gov/preconception Centers for Disease Control and Prevention. (2020). Prescription medication use: Breastfeeding. https://www. cdc.gov/breastfeeding/breastfeeding Chan, B. H., Yee, R., Puvanendran, R., & Ang, S. B. (2018). Medication-related osteonecrosis of the jaw in osteoporotic patients: Prevention and management. Singapore Medical Journal, 59 (2),70-79. https://www. smj.org.sg>default>files>SMJ-59-70
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