Dental Health in Perimenopause: Why Your Teeth and Gums Change and What to Do

Your Gums Are Bleeding. Your Dentist Says You Need to Floss More. But Something Else Is Going On.

You are brushing and flossing the same way you always have. Maybe more carefully than before. And yet your gums are sensitive, they bleed when you floss, and your last dental cleaning was more uncomfortable than any you can remember.

Your dentist may have focused on technique. But what they may not have mentioned is that estrogen receptors exist throughout the gum tissue, and when estrogen levels drop during perimenopause, those tissues become more inflamed, more reactive, and more vulnerable to gum disease.

Dental changes during perimenopause are real, clinically documented, and also genuinely preventable if you know what you are managing. This guide covers what is happening, what to tell your dentist, and what to do at home and with your healthcare team.

Estrogen Receptors in the Mouth: Why Hormones Affect Gum Health

Gingival tissue (your gums) contains estrogen receptors. Estrogen plays a role in maintaining the health, thickness, and immune response of gum tissue. When estrogen levels fluctuate and decline during perimenopause, gum tissue becomes more prone to inflammation, which is the underlying condition of gingivitis and, if untreated, periodontitis.

Research has consistently shown that women going through menopause and perimenopause have higher rates of gum disease progression than premenopausal women of similar age. This is not because their hygiene worsens. It is because the tissue itself has changed its inflammatory baseline.

The consequence of untreated gum disease extends beyond your teeth. Periodontal disease is associated with increased cardiovascular risk, and cardiovascular risk already rises during perimenopause as estrogen declines. Managing your gum health is not just a dental issue. It connects to broader health outcomes that matter significantly during this transition.

Bone Loss in the Jaw: The Connection to Tooth Stability

Osteoporosis risk increases significantly after menopause, when estrogen is no longer moderating bone resorption. Less discussed is that this bone loss affects the jaw, the alveolar bone that supports your teeth.

As the alveolar bone thins, the foundation supporting teeth becomes less robust. This does not mean teeth simply fall out, but it does mean that gum disease progresses faster, that teeth are more vulnerable to movement, and that dental procedures, if needed, become more complex.

The connection is bidirectional. Active gum disease accelerates bone loss in the jaw. And systemic bone loss makes gum disease harder to contain. This is why periodontal maintenance during perimenopause is not just cosmetic. It is bone health management.

If you are taking calcium and vitamin D for bone density, which is appropriate during perimenopause, the same supplementation supports jawbone health. Making sure your vitamin D level is adequate is directly relevant to your dentist's concerns as well as your physician's.

Dry Mouth (Xerostomia): Hormonal Causes and Practical Solutions

Dry mouth, or xerostomia, is more common during perimenopause than most women expect. Salivary glands have estrogen receptors, and declining estrogen can reduce saliva production. Saliva is not just a comfort issue. It actively protects teeth from decay by buffering acids, clearing food debris, and containing antimicrobial proteins.

When saliva decreases, cavity risk increases. Food and bacteria that saliva would normally clear sit on tooth surfaces longer. The protective buffering effect that keeps oral pH stable weakens.

Some medications commonly used during perimenopause also cause dry mouth as a side effect. Antidepressants, antihistamines, and certain blood pressure medications are frequent contributors. If you have recently started a medication and noticed increased dry mouth, this is worth flagging with the prescribing provider.

Practical management of dry mouth includes staying well hydrated throughout the day, using a saliva substitute or mouth spray if needed, chewing sugar-free gum with xylitol (which stimulates saliva and is also antibacterial), and using a fluoride toothpaste to protect against the increased cavity risk. Breathing through your mouth, particularly at night, worsens dry mouth, so addressing any nasal congestion or sleep-disordered breathing helps.

Burning Mouth Syndrome: The Symptom That Baffles Dentists

Burning mouth syndrome is a persistent burning sensation in the mouth, often affecting the tongue, lips, and inner cheeks, in the absence of any visible oral cause. It is significantly more common in perimenopausal and postmenopausal women than in any other group.

The mechanism involves changes in the trigeminal nerve, which supplies sensation to the mouth, and altered pain processing that appears to be connected to hormonal shifts. Some researchers also point to nutritional deficiencies, particularly vitamin B12, iron, and zinc, as contributing factors.

Burning mouth syndrome is often undertreated because it can be hard to diagnose. Providers may look in the mouth, find nothing visible, and have no straightforward next step. If you are experiencing this, asking for a referral to an oral medicine specialist (a subspecialty of dentistry) rather than continuing to see a general dentist for this specific symptom is a better path.

Blood tests for B12, iron, and zinc are worth requesting if burning mouth is present. Deficiency in any of these is treatable and can significantly improve the sensation when the underlying deficit is addressed.

What to Tell Your Dentist

Most dentists are not trained to ask about menopause status, and most women do not think to mention it at a dental appointment. But your dentist can only make informed recommendations if they have the full clinical picture.

Telling your dentist that you are in perimenopause changes the context for several things: the gum sensitivity they observe, the dry mouth you report, the bone density changes that may show on dental X-rays, and the decision about how frequently you should be seen.

Many dental professionals recommend more frequent cleanings during perimenopause, moving from twice-yearly to three or four times yearly, to stay ahead of the increased gum disease risk. This is a reasonable conversation to have based on your individual gum health.

If you are taking bisphosphonates for osteoporosis, this is essential information for your dentist before any tooth extraction or oral surgery. These medications affect jaw bone healing in ways that matter for procedural planning.

Sharing your full medication list, including any hormone therapy, supplements, and medications from other providers, at each dental appointment is genuinely relevant. Drug interactions that affect saliva, bone health, and healing matter in a dental context.

Nutrition for Dental and Bone Health During the Transition

What you eat during perimenopause has direct consequences for both your teeth and the jawbone that supports them. These consequences are more significant during perimenopause than at any previous life stage because the hormonal shifts are actively accelerating bone resorption.

Calcium and vitamin D are the most discussed nutrients for bone health, and their relevance to dental health is direct. The jawbone is bone. It responds to the same nutrient supply and hormonal signals as the rest of your skeleton. Adequate calcium intake, typically 1,000 to 1,200 mg per day for women in this age range from food and supplements combined, and sufficient vitamin D to absorb that calcium, are foundational.

Dairy foods are the most calcium-dense dietary sources for most people. Yogurt, hard cheeses, and milk provide meaningful calcium per serving. Non-dairy sources include fortified plant milks, canned salmon and sardines eaten with bones, tofu made with calcium sulfate, and leafy greens like kale and bok choy. Getting your calcium from food is preferable to high-dose supplements, as some evidence suggests high supplemental calcium doses may have cardiovascular effects that food-sourced calcium does not.

Vitamin K2 is less discussed but directly relevant to dental bone health. It helps direct calcium into bone rather than soft tissues. Some research suggests adequate K2 intake is associated with better bone quality. Fermented foods like natto and some cheeses contain K2, and supplementation is available for those who do not get it from diet. As always, discuss supplementation with your provider before starting.

Reducing sugar and refined carbohydrates reduces the acid production in the mouth that erodes enamel and promotes cavities. During perimenopause, when saliva is reduced and enamel is more vulnerable, keeping sugar exposure low and rinsing with water after eating sweet foods offers meaningful protection.

Building a Dental Routine That Matches Your Current Biology

The dental hygiene habits that served you in your 30s need recalibration during perimenopause. The underlying biology has shifted enough that the same effort produces different results, and a few targeted additions make a real difference.

An electric toothbrush is consistently better than a manual brush at removing plaque at the gumline, which is where the perimenopause-related inflammation is most active. If you are still using a manual brush, this is the highest-impact upgrade you can make.

Add a water flosser if standard flossing is uncomfortable or if your gum sensitivity makes it hard to floss consistently. Water flossers are not a complete replacement for interdental cleaning, but they are effective at flushing debris from under the gumline and around existing dental work.

A prescription-strength fluoride toothpaste, if recommended by your dentist, offers significantly better protection against the decay risk that comes with reduced saliva. This requires a prescription but is available from most dentists who understand the increased cavity risk in perimenopause.

PeriPlan helps you track overall patterns in how you feel, which is useful context for your dental team too. Logging days when dry mouth is worse or when gum sensitivity spikes can reveal connections to hormonal patterns that help your dentist understand what they are managing.

Your teeth and gums are not collateral damage of perimenopause. With targeted care, most dental changes during this transition are manageable and many are preventable.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.