Perimenopause and Dental Health: Gum Disease, Bone Loss, and Oral Care
Perimenopause increases gum disease risk and affects jawbone density. Learn what to tell your dentist, how HRT helps, and the best daily oral hygiene habits.
How Estrogen Affects Gum and Oral Tissue
Estrogen receptors are present in gingival (gum) tissue, periodontal ligaments, and the bones that support the teeth. Estrogen promotes collagen production in gum tissue, maintains tissue thickness and resilience, and modulates the inflammatory response in the oral environment. When estrogen declines in perimenopause, gingival tissue becomes more vulnerable to inflammation and less capable of resisting bacterial challenge. The same inflammatory pathway that is upregulated in joint pain and cardiovascular risk during perimenopause also affects the oral environment. The result is that many women notice their gums bleeding more readily when brushing, becoming more sensitive, or appearing redder during perimenopause even if their oral hygiene routine has not changed. This is not imagined: it reflects a real change in tissue biology driven by declining hormones.
The Rise in Periodontitis Risk
Periodontitis is a serious form of gum disease in which infection extends below the gumline, damaging the periodontal ligaments and alveolar bone that anchor the teeth. It is distinct from superficial gingivitis (gum inflammation), though gingivitis that goes untreated can progress to periodontitis. The risk of periodontitis increases with age, and the hormonal changes of perimenopause accelerate this risk for women. Research has found that postmenopausal women with lower estrogen levels have higher rates of tooth loss and reduced alveolar bone density compared with premenopausal women. Periodontitis is also linked to systemic inflammation and has associations with cardiovascular disease, diabetes, and rheumatoid arthritis, conditions whose own risk rises during perimenopause. Preventing or controlling periodontitis is therefore relevant not just to dental health but to systemic health.
Bone Density in the Jaw
The same mechanisms that drive osteoporosis in perimenopause affect the jawbone. Alveolar bone (the bone that supports the tooth sockets) is resorbed more rapidly when estrogen levels fall. This contributes to deeper periodontal pockets, increased tooth mobility in women with pre-existing gum disease, and greater risk of tooth loss. Women who already have some level of periodontitis are particularly vulnerable to accelerated progression during perimenopause. Bone loss in the jaw is not detectable by how the teeth look from the outside. Dental X-rays, which your dentist takes periodically, are the primary tool for monitoring alveolar bone levels. If you have not had a full dental assessment including X-rays and periodontal probing in the last two years, this is worth prioritising during perimenopause.
What to Tell Your Dentist
Many dentists are not routinely informed about a patient's menopausal status, yet it is clinically relevant information that should influence how closely they monitor gum health. Tell your dentist and dental hygienist that you are in perimenopause. This prompts them to assess gum health more thoroughly, check for periodontal pocket depth changes, and schedule hygiene appointments more frequently if early signs of gum disease are present. If you are taking or considering HRT, let your dental team know. Some medications used in perimenopause (including antidepressants prescribed for vasomotor symptoms) cause dry mouth (xerostomia), which significantly raises the risk of dental decay and gum disease by reducing the protective and cleansing effect of saliva. Dry mouth should be reported to both your dentist and your prescriber so it can be managed.
Calcium, Vitamin D, and Jawbone Health
The nutritional foundations of bone health apply equally to the jawbone as they do to the spine and hip. Calcium (1,000 mg per day for women in perimenopause, increasing to 1,200 mg after 50) and vitamin D (at least 800 to 1,000 IU per day, though many adults require more to maintain optimal blood levels) are essential for maintaining bone density across the whole skeleton, including alveolar bone. Dietary calcium from dairy, fortified plant milks, calcium-set tofu, white bread (in the UK it is fortified), and leafy greens is better absorbed and distributed than supplements taken in large single doses. Vitamin D is produced in the skin on sun exposure but synthesis is limited in northern latitudes between October and March. A daily supplement of 1,000 IU is a sensible baseline for most women in these latitudes during winter months. Magnesium, vitamin K2, and boron also support bone mineralisation and are worth ensuring through a varied diet or targeted supplementation under guidance.
HRT and Dental Health
Estrogen replacement therapy has a measurable protective effect on alveolar bone density and gum health. Studies have found that postmenopausal women using HRT have better preserved jawbone density, lower rates of tooth loss, and lower periodontal attachment loss compared with non-users. This protective effect mirrors HRT's effect on skeletal bone density at the hip and spine. For women already using HRT for vasomotor symptoms or osteoporosis prevention, the dental benefits are an additional advantage worth knowing about. HRT is not prescribed specifically for dental health, but understanding its broad tissue-protective effects may be useful context when weighing its risks and benefits. If you use HRT and notice your dentist commenting on improved gum stability, that is likely part of the same mechanism.
Practical Daily Oral Hygiene in Perimenopause
The basics of good oral hygiene become more important, not less, during perimenopause precisely because the biological environment is less forgiving. Brushing for two full minutes twice a day with a fluoride toothpaste, using interdental brushes or floss daily to clean between teeth where the brush cannot reach, and using a fluoride mouthwash in the evening (at a separate time from brushing, not immediately after, to avoid diluting fluoride) are the proven cornerstones. Electric toothbrushes with pressure sensors are more effective than manual brushing for most people and avoid the over-brushing that can cause gum recession. Attending a dental hygienist for professional cleaning every three to six months (more frequent than the usual annual check if gum disease is active) removes hardened calculus that home cleaning cannot address. Staying well hydrated also supports saliva production, which is the mouth's natural defence system. PeriPlan lets you log symptoms and track patterns, and if you notice recurring oral symptoms such as bleeding gums, sensitivity, or dry mouth alongside other perimenopause symptoms, recording them helps build a complete picture to discuss with both your dentist and GP.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.