women's oral health an overview

Women’s Oral Health An overview

Dr Paula Vassallo President

Council of European Chief Dental Officers

Defini@on

•  Women’s Health has been defined as diseases or condi@ons that are unique to, more prevalent in, or more serious in women;

•  They have dis@nct causes or manifest themselves directly in women; or have different outcomes or require different interven@ons than men. This defini@on encompasses Oral diseases and condi@ons.

Sex and Gender

•  The World Health Organisa@on dis@nguishes between a person’s ‘sex’ and “gender”.

•  Sex refers to the biological and physiological characteris@cs that define men and women

•  Gender refers to the socially constructed roles, behaviours and aPributes that society considers appropriate for men and women

Women’s oral health topics found un the systema@c review databse

•  Oral health during pregnancy •  Periodontal disease and adverse pregnancy outcomes

•  Prenatal cleQ lip and palate detec@on •  Osteonoecrosis of the jaw •  Osteoporosis •  Sex differences in Periodontal disease •  Oral Human Papilloma virus •  Menopause and Oral Health

•  Gender mainstreaming is oQen the method used to assess the implica@ons for women, men and transgender people of any planned ac@on on health, including legisla@on, policies and programmes.

•  (Irish Times August 20th 2013)

Does Sex and Gender MaPer ?

Does Sex and Gender MaPer ?

Sex and gender remain important determinants of health

There are numerous condi@ons and diseases that affect women in dispropor@onate degrees and across their life span: TMJ disorders Bone and Joint Disorders Rheumatoid Arthri@s HIV/AIDs

Top 10 causes of mortality in men and women age 65+

WOMEN MEN

Major Cardiovascular disease Heart Disease

Major Cardiovascular disease Heart Disease

Malignant Neoplasms Malignant Neoplasms

Ischemic Heart Disease Stroke Chronic Lower Respiratory Diseases

Ischemic Heart Disease Trachea, Bronchus and Lung Cancer Chronic Lower Respiratory Diseases

Trachea, Bronchus and lung Cancer Myocardial Infarc@on

Heart APack Alzheimer Disease

Stroke Prostate Cancer

Heart Failure Alzheimer’s Disease

CDC: Mortality by underlying cause, ages 18+ US, state,2001-‐2009

•  Women have special oral health requirements during the unique phases of their lives

•  Changes in female hormone levels during puberty, menstrua@on , pregnancy and menopause exacerbate the way the gingiva react to the presence of plaque.

Puberty

•  Increased levels of oestrogen and progesterone

•  Increased blood flow to the gingival @ssue

•  Microbial changes in oral flora

Pregnancy

•  Gingivi@s is the most common condi@on experienced during pregnancy affec@ng 60-‐75% of all pregnant women

•  Rela@onship between caries and pregnancy not well defined. Prenatal fluoride administra@on showed no difference in caries rates – not recommended

(LevereP 1991)

•  Current research shows that women tend to receive less dental care than usual when they are pregnant.

Pregnancy

Rou@ne preven@ve , diagnos@c and restora@ve dental treatment-‐ including periodontal therapy-‐ during pregnancy does not increase adverse pregnancy outcomes (Michalowicz et al 2008)

Temperomandibular Disorders

•  Gender is the biggest risk factor in the development of temperomandibular disorders and orofacial pain.

leResche 2011; Dao 2001; Greespan et al 2007

•  Community studies show that there is a 2:1 to 3:1 predilec@on in favour of women and women seek care at an 8:! Ra@o over men (Halpern et al 2013)

•  Gender specific differences are also apparent in the ageing jaw, with the accelera@on of jaw bone atrophy upon loss of teeth, especially in women

The impact of sex and gender on caries prevalence

•  There is evidence indica@ng that many caries risk factors provide a gender bias placing women at a higher caries risk than man (Lukacs 2011). These factors may include –  Different salivary composi@on –  Hormonal fluctua@ons –  Dietary habits –  Gene@c varia@ons –  Social roles among the family

•  Dental caries has been reported to dispropor@onally affect women in many popula@ons around the world

The impact of sex and gender on caries prevalence

•  Recent studies suggest that a sex linked gene may explain, to some extent, why rates of dental caries may be higher in women (Ferraro et al 2010; Veira et al 2008)

•  These genes Amelogenin X ( found on the Xchromosome) and Amelogenin Y , code for proteins that cons@tute 90% of the enamel matrix (Deeley et al 2008; Pa@r et al 2008)

Dietary Behaviours and Oral Systema@c Health in Women

•  The impact of dietary behaviours and food consump@on and their rela@on to oral health are significant public health issues.

•  Women and men exhibit different dietary behaviours. •  In children , boys have been reported to prefer sugary foods (Cooke et al 2005)

•  In adults, women have been reported to prefer carbohydrates and sugary foods (Drewnowski et al 1992), although no gender difference has been reported in the frequency of consump@on of sugary snacks (Grogan et al 1997;Maciel et al 2001)

Salivary Composi@on

•  There is an indica@on that fluctua@ng hormone levels in women and the associated physiologic changes during events, alter the biochemical composi@on of saliva and overall saliva flow rate. (Dodds 2005)

•  These cganges would make the oral environment significantly more cariogenic for women then for men

•  Women have been shown to be more preven@ve oriented or proac@ve then men

•  Kent et al 2012

•  Women seek dental care more then men and are more likely to seek preven@ve care

•  Delta Dental Insurance 2013

•  Women smokers have a more difficult @me quiung permanently then men; smoking cessa@on rates are low in women

Amos et al 2012

Gender Differences and Tooth Loss

•  Factors related to tooth loss are associated with societal gender roles – Smoking – Diet – Oral Hygiene

•  In general a higher prevalence of both tooth loss and dental caries has been documented among women then among men in many parts of the world

Lukacs 2011

Sex and Gender and Tooth loss

•  The higher incidence in tooth loss…

•  …. Could it be aPributable to – Sex dispari@es in rates of diseases thought to be caused by infected teeth were higher in women then in men ….OR

– More frequent use of both general and dental services by women

Oro Pharyngeal Cancer (OPC)

•  480,000 new cases diagnosed globally every year

•  Women comprise 147,000 of the new cases globally

•  Rates among women are lower when compared with men

•  Recent trends show an increase in incidence among women

•  79,000 women die every year globally hPp://seer.cancer.gov/staxacts/html/oralcav.htm


•  In 1950 M:F ra@o was 6:1 •  In 2002 gap has closed to a ra@o of 2:1

•  The incidence rates for oral cancer and cervical cancer appear to be closing on each other

•  Among non hispanic white women , incidence of OPC higher than cervical cancer


•  Excessive smoking and alcohol consump@on con@nue to be important risk factors for oral cancer.

•  However in the past few years evidence form epidemiological studies suggest that more than 25% of head and neck cancers are caused by HPV

•  Joseph A et al 2012


Women widely recognise the risk of cervical cancer and the need for regular screenings, but the same is not true for oral and pharyngeal cancer

Violence and Abuse

•  Violence and abuse is recognised as a significant public health problem, especially in females.

•  In America it is “as common as birth because it occurs almost 4 million @mes each year”, and more than 2.5 million women are abused annually

•  An es@mated 75% of physical abuse case results in injuries to the head, neck and/or mouth areas that are clearly visible to the dental team

Violence and Abuse

•  Most female pa@ents do not report inter partner violence (IPV)

•  RELUCTANCE TO ADMIT THE TRUE CAUSE OF IN INJURY DUE TO

•  SHAME,

•  DENIAL , •  FEAR, •  POOR COMMUNICATION WITH PROFESSIONAL •  OR DESIRE TO PROTECT THE ASSAILANT

Conclusions

•  Women compromise most of the aging popula@on

•  There will be con@nued challenges to maintain good health throughout their life @me

•  Key milestones, par@cularly in the last decade , provide a road map towards the necessary inclusion of gender into dental prac@ce.

Conclusion

•  Oral diseases are part of the bigger systema@c health picture

•  Building beyond women’s Health as reproduc@ve Health Topics into healthy sexuality as a component of op@mal health care will need to include competency at the individual learner, educa@onal ins@tu@on, and health system levels

THANK YOU

women's oral health an overview

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