Menopause Can Take a Bite Out of Your Oral Health

Athletics and hormone decline can set the stage for dental disease. Here’s how to save your teeth.

By Selene Yeager 

Endurance sports are good for your heart and mind, but man they can wreak havoc on your teeth, and menopause can make the situation for your pearly whites even more precarious.

After decades of triathlon, mountain bike stage racing, and gravel racing I have more fillings than teeth. I’ve lost count of how many root canals I’ve had, so I’ll say seven. I’ve had more crowns than the royal family, and sadly I’ve lost almost as many at mountain bike stage races around the world, including one after undergoing a crown lengthening procedure – a rather unpleasant affair where the dental surgeon removes some gum around a tooth to securely attach a crown following a root canal. But it wasn’t secure enough to withstand an energy chew I’d stuffed in my face midway through stage two of Hot Israel Epic just a few weeks later. That one ended up stuffed in my jersey pocket, and later lost.

I blame growing up without fluoride and a lifetime of endurance sports, which research shows can be damaging to our dental health because we’re constantly chomping sugary bits, washing them down with sugary fluids, all on top of a dry mouth that’s leaving our teeth vulnerable to decay. As if that weren’t enough, I can now add menopause, which poses risks of its own, including dry mouth, to the list. 

The Menopausal Athlete’s Mouth

Research shows a pretty clear link between sports and compromised oral health. Hit Play Not Pause guest Dr. Julie Gallagher, an honorary research fellow at University College London and avid triathlete, shared her research on the topic in episode 72 Save Your Teeth. 

Her study on 350 athletes published in the British Dental Journal found that despite 94 percent of athletes brushing their teeth at least twice a day and 44 percent flossing regularly, nearly half (49 percent) had untreated tooth decay; most of them had early signs of gum inflammation, and a third (32 percent) said that oral health had a negative impact on their training and performance.

Adding to the oral health challenge, research indicates that the hormonal changes that come with menopause can give rise to oral health conditions such as periodontitis (a gum infection that damages the soft tissue and, left unchecked, can destroy the bone that supports your teeth) and burning mouth syndrome. The core issue is lowered saliva production which can lead to a dry mouth. 

That dry mouth part can be a double-whammy for a menopausal endurance athlete, says Gallagher. 

“Saliva protects your mouth against all of the oral health diseases,” she says. “It can help rinse away food particles and it’s got immunoglobulins that will protect gum health. If you regularly brush with fluoride toothpaste, your saliva will also have a reservoir of fluoride ions that are available to help repair microscopic damage.” 

When you’re out running, riding, training, and/or competing for hours, you’re getting dehydrated and drying out your mouth, so your teeth are more vulnerable to all the sugar. If your mouth is already dry to begin with, the situation can be worse.

Because sports and sport nutrition can be so hard on your dental health, it’s important that you practice high-performance dental hygiene in your general life. Your goal is to protect your teeth and avoid gingivitis (gum inflammation) which can pave the way for periodontitis and bone loss. Here’s what Gallagher recommends. 

Rinse your teeth often

Gallagher’s research also found that 87 percent of the athletes regularly drank sports drinks; 70 percent used energy gels, and 59 percent consumed energy bars. Bathing your teeth in sugary, and sometimes acidic drinks, along with chewing on sticky bars, chews, and other energy foods takes a toll on your teeth. When possible chase any sugary sports nutrition–drinks, chews, gels, etc.–with a swish of plain water to clean the sticky, decay-causing stuff from your teeth. Cyclists can do this fairly easily by having one bottle of plain water on their bike. 

Try a high-fluoride toothpaste

“Fluoride in toothpaste is really, really important for mitigating against dental decay,” Gallagher says. She recommends athletes who challenge their teeth with lots of sugar use a very high-fluoride toothpaste. For reference, normal toothpaste has about 1000 to 1450 parts per million of fluoride. High fluoride toothpaste will contain 2800 up to 5000 parts per million. It’s prescription only, so you have to ask your dentist for it. (Keep it out of reach of young children if you have kids at home.)

Brush right: do NOT rinse

The important thing about fluoride is it needs to be in contact with the teeth for it to work, Gallagher says. “So, absolutely, absolutely, do not rinse it away after brushing!” Put your toothpaste on a dry brush. Brush for two full minutes. Then spit the toothpaste into the sink, and rinse your toothbrush and sink with water. But do not rinse your mouth. Brush twice a day: Once in the morning and again before bed.

Be mindful of mouthwash

Your mouth contains an important microbiome. When that oral microbiome is out of healthy balance, decay and inflammation can follow. And endurance athletes take note: there are also bacteria in your mouth that convert nitrates into nitrites, which are then converted to nitric oxide, which widens your blood vessels to increase blood flow for exercise and helps lower blood pressure generally. If you use antiseptic/antibacterial mouthwash, you kill those bacteria, lose those exercise benefits, and may be more susceptible to elevated blood pressure. You also erase the ergogenic benefit of nitrate-rich supplements like beetroot juice. 

If you’re susceptible to dental erosion (i.e. have lots of cavities), you may want to consider supplementing your brushing and flossing with a fluoride (but not antibacterial) mouthwash. 

Rehydrate with milk

If you drink milk, rehydrating with it post-exercise is also a good way to help your dental health. The calcium, phosphate, and casein in milk help your teeth and gums. Research shows milk’s natural sugar and protein are also good for hydration (which in turn is good for your dental health). “Milk is a very, very good post-exercise recovery drink,” Gallagher says.

Chew sugar-free gum

Chewing gum stimulates saliva, which can help relieve dry mouth and protect your teeth. Just be sure it’s sugar-free. 

Talk to your doctor about MHT

The bone loss that can happen during and after the menopause transition also leaves you vulnerable to tooth loss. If you’re at a higher risk for osteoporosis, you may want to talk to your doctor about menopausal hormone therapy. Research shows postmenopausal MHT can protect against tooth loss.