Evaluation of the consequences of menopause on women with respect to salivary flow rate, gustatory function, and pH

Anshu Agrawal; Minal S Chaudhary; Alka Harish Hande

doi:10.4103/jdmimsu.jdmimsu_13_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 17 | Issue : 3 | Page : 595-599

Evaluation of the consequences of menopause on women with respect to salivary flow rate, gustatory function, and pH

Anshu Agrawal, Minal S Chaudhary, Alka Harish Hande
Department of Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission	12-Jan-2022
Date of Decision	08-Aug-2022
Date of Acceptance	09-Sep-2022
Date of Web Publication	2-Nov-2022

Correspondence Address:
Dr. Alka Harish Hande
Department of Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha - 442 001, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdmimsu.jdmimsu_13_22

Abstract

Context: Saliva is considered a predictive gateway to the body. Alterations in salivary secretion can be assessed quantitatively and/or qualitatively. Thus, estimation of salivary components may give insight to the general health of an individual and be considered the mirror of the body's health. The health needs of women vary mainly due to hormonal fluctuations occurring throughout the woman's life. Hence, the “menstruation cycle and menopause” may affect the metabolism of periodontal tissue including swollen salivary glands, bright red swollen gums, or bleeding gums or might cause alterations in the flow rate of saliva, its pH, as well as taste function. Due to menopause, there are unique hormonal changes in women and they are more receptive to salivary alterations, such as sensitivity to hot and cold food, altered taste, burning sensation, and reduced flow rate of saliva that lead to xerostomia and atrophic gingivitis also. Aim: This research project is designed for the evaluation of “salivary flow rate,” gustatory perception, and “pH” of resting saliva in premenopausal, menopausal, and postmenopausal women. Subjects and Methods: The evaluation of salivary flow rate, gustatory perception, and salivary pH was carried out in a total of 105 women, each 35 from, the premenopausal, menopausal, and postmenopausal categories. Results: The present study observed significant alterations of reduced salivary flow rate, reduced sweet intensity, and pH in postmenopausal women than the menstruating women. Conclusion: Menopause is followed by a variety of alterations, few of which occur in the mouth. The use of salivary flow rate, gustatory perception, and pH is helpful to identify the risks linked with menopause.

Keywords: Gustatory perception, menopause, pH, salivary flow rate

How to cite this article:
Agrawal A, Chaudhary MS, Hande AH. Evaluation of the consequences of menopause on women with respect to salivary flow rate, gustatory function, and pH. J Datta Meghe Inst Med Sci Univ 2022;17:595-9

How to cite this URL:
Agrawal A, Chaudhary MS, Hande AH. Evaluation of the consequences of menopause on women with respect to salivary flow rate, gustatory function, and pH. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 8];17:595-9. Available from: http://www.journaldmims.com/text.asp?2022/17/3/595/360177

Introduction

”Climacteric” is termed to be a natural stage of life that begins with ovarian activity reduction and ends with ovarian function termination.^[1] Due to menopause, there are unique hormonal changes in women and they are more receptive to salivary alterations including more sensitivity to hot and cold food, altered taste, burning sensation in mouth, and reduced flow rate of saliva that leads to xerostomia/dry mouth. Following menopause, function of taste buds and related neural network changes due to decrease in the production of saliva which results in “dysesthesia.”^[2] There is a greater risk for bone density loss especially in the jaws which can lead to tooth loss because of diminishing estrogen which occurs with menopause. Hence, there can be a direct connection between oral health among females and changing hormonal status.^[3],[4],[5]

Fluid in the oral cavity that is, saliva is the utmost accessible “biofluid” of human metabolism that persistently flushes the oral cavity and tries to manage the ecosystem of the oral cavity. Saliva is considered a predictive gateway to the body in the context to “health and disease.” A number of inorganic and organic compounds are present in the saliva and its evaluation help to monitor various physiologic and pathologic processes.^[6] Alterations in salivary secretion can be assessed quantitatively and/or qualitatively. Thus, estimation of salivary components may give insight to the general health of an individual and be considered the mirror of the body's health. Thus, the use of saliva is a captivating reason to use it as a diagnostic fluid in disease.^[7] Although saliva has been inspected with regard to several “physiologic and pathologic” conditions, the association of various properties of saliva with reference to different phases of women's menstrual cycle remains uninspected.

In a life span of a woman, there are various milestones in context to the hormonal variation during various phases of the reproductive cycle. During these times, women are more prone to oral health issues. These phases may include puberty, monthly menses cycle, stage of birth control pills usage, time of pregnancy, and menopause.^[8] With this premise in mind, this research project is designed for the evaluation of “salivary flow rate,” gustatory perception, and “pH” of resting saliva in premenopausal, menopausal, and postmenopausal women.

Subjects and Methods

The study was conducted in the department of gynecology and obstetrics. The inclusion and exclusion criteria utilized for the study were

Inclusion criteria

Women with “good oral hygiene” and without any complaint of “xerostomia/dry mouth” and any diseases involving salivary glands were included in the study
Women without any systemic or local disorders which affect salivary secretions were included in the study.

Exclusion criteria

Women which were on any medication, which can affect gustatory function
Women with the habit of alcohol drinking and smoking
Women who were not willing to participate in the project.

This study was a prospective analysis for which the required protocol was approved by the “Institutional Ethical Committee.” The informed consent was obtained from the women reporting to the department of gynecology and obstetrics. A total of 105 women were enrolled for the project who visited to the hospital for some or other gynecological complaints. The participants of the project were further divided into three groups of 35 each.

Group A: Premenopausal women (control group)
Group B: Menopausal women (study group)
Group C: Postmenopausal women (study group).

The information regarding demographic data was tabulated. The details pertaining to the presence of any manifestations of systemic disease, administration of any medication, various oral symptoms and habits, and dietary regimens along with symptoms of xerostomia were sought through a questionnaire for each individual.

The evaluation parameters

Estimation of salivary flow rate

The saliva samples were collected at noon hours at least 1 h after the patient had finished their meal eating. The study participant was instructed to swallow the residual saliva and clean the mouth. Later, the participant was asked to chew the “paraffin wax” for 8–10 min to “stimulate the salivary flow.” The stimulated saliva was thus collected in a calibrated saliva container provided as per the manufacturer's specification. The grading of 0.1 ml increments was there on the saliva collector and extended up to 10 ml. Determination of “salivary flow rate” was done as ml/min. In few cases, the saliva collection time was reduced or extended by 5–15 min.

Estimation of gustatory perception

The test of entire mouth threshold taste was performed for the evaluation of gustatory perception. There are four main taste perceptions, namely, “sweet, salty, sour, and bitter.” The concentrated levels of fructose, potassium chloride, and ascorbic “acid and quinine hydrochloride” solutions were used for identifying the type of taste. This type of investigation was utilized for the identification, detection, and evaluation of the potency of varied concentrations of taste solutions.^[9] In this investigation, five concentration sequences of “potassium chloride (0.02–1.0 mM), ascorbic acid (0.33–0.033 mol/L), “quinine hydrochloride” (0.01–1 mM), and fructose (0.01–1 mM) were made ready with distilled water in a 5-mL sample for the individuals to drink and rinse for 10 s before spitting. Later, the study participants were instructed to identify “the taste (sweet, sour, salty, bitter, or tasteless)” and its potency was recorded. In case of failure to identify the taste perception, the participant was tested with a new sample with a higher concentration of the taste solution. A similar procedure was performed for the remaining taste followed by distilled water rinse in an individual.

The taste perception intensity threshold was scored for every solution. It was marked 5 for the lowest concentration and 1 for the highest concentration.^[9] As per the participant's interpretation, coding of the quality interpretations for each solution was done as accurate, inaccurate, or tasteless.^[9]

Estimation of salivary pH

pH test strip method was utilized for the estimation of salivary pH. In this technique, the pH test paper was directly immersed immediately after the collection of stimulated saliva into the sample. Estimation of hemoglobin: digital hemoglobinometer was used for the estimation of hemoglobin.

Results

The evaluation of salivary flow rate, gustatory perception, and salivary pH was carried out in a total of 105 women. Further, the participants were divided into three groups, which include 35 premenopausal women as controls and 70 cases (35 menopausal and 35 postmenopausal). A comparison of results was done between the groups.

Estimation of salivary flow rate

On observation of the flow rate of saliva, there was no statistically significant difference found between the study and control groups. However, it was less in Group C (0.82 ± 0.42) as compared to Group A (1.18 ± 0.50). This results in oral discomfort [Graph 1].

Estimation of gustatory perception

All the study groups and control groups observed “sour, salt, and bitter taste” almost accurately. The potency of gustatory perception for sweet was significantly less in postmenopausal women (P < 0.01) compared to the intensity of gustatory perception for other tastes. As far as the judgments of mean total taste intensity were concerned, there was a significant difference for fructose perception among postmenopausal women and the control group (P < 0.01). The mean total intensity ratings for “potassium chloride, ascorbic acid, and quinine hydrochloride” showed no significant difference between the groups (P > 0.01) [Graph 2] Complete amenorrhea time differed from 3 to 10 years. Duration of amenorrhea showed no significant relation in gustatory perception. Some of postmenopausal women failed to taste all fundamental taste chemicals as thoroughly as they did before menopause.

Estimation of salivary pH

It was observed that pH values were significantly lower in postmenopausal women than that of the control group (P < 0.01) [Graph 3].

Discussion

Saliva is an essential element in maintaining oral health. Meal times are tough, painful, and embarrassing without saliva.^[10] The health needs of women vary mainly due to hormonal fluctuations occurring throughout the woman's life. Hence, the “menstruation cycle and menopause” may affect the metabolism of periodontal tissue including swollen salivary glands, bright red swollen gums, or bleeding gums or might cause alterations in the flow rate of saliva, its pH, as well as taste function.^[11] Salivary function is influenced by the rate and composition of saliva. In our investigation, we prefer to measure “stimulated saliva” since it is a modulator of salivary pH and is also useful for determining the role of “whole saliva” in oral mucosal defense and for the assessment of functional reserve. Furthermore, because of interferences of environmental stimuli, it is difficult to collect true unstimulated saliva.

We observed that the salivary flow rate gradually decreases from the beginning of menopause till the attainment of complete menopause. However, the difference was not found statistically significant [Graph 1] Our study results are in accordance with Shetty,^[7] Rockenbach et al.,^[11] and Laine et al.^[12] Although Fenoll-Palomares et al.^[13] and Harirah et al.^[14] have shown no change in the flow rate of saliva after menopause. It is also found that geriatric aging can give rise to a decline in the “salivary flow rate” as a result of atrophy of parenchymal tissue.^[15] Patients with low salivary flow rate report higher incidences of “dental caries, dysphagia, oral mucositis, and altered taste” and should be encouraged to participate actively in management by replacing moisture and lubricating the mouth with artificial saliva or a salivary substitute.

Because saliva and diet have a mutual relationship, food not only influences saliva flow but saliva can also affect “sensory perception.” Taste is one of the most significant human senses and influences an “individual's food preferences,” which in turn influence “dietary behavior” and human “nutritional status.”^[16] Hence, along with alterations in the flow rate of saliva, its pH, “menstruation and menopause” might also alter potentiality for gustatory perception.^[17] Nutritional status is crucial in menopause because it can affect chemosensory function, and chemosensory dysfunction leading to dietary changes.^[2]

We observed that postmenopausal women have decreased sweet intensity and decreased mean total intensity of fructose. Conversely, the mean total potency of potassium chloride, ascorbic “acid, and quinine hydrochloride” between the three groups have not shown a significant difference; thus decrease in sensitivity in postmenopausal women cannot be concluded [Graph 2]. Our study results are in accordance with Saluja et al.^[8] and Delilbasi et al.^[2] Changes in various sense organs including taste organs can be brought by aging. As there is no direct correlation between menstruation, menopause, and taste alteration, there can be an increased incidence of oral discomfort among women due to hormonal fluctuations including complaints of candida infections, burning sensation in the oral cavity, swollen salivary glands, and mood alteration.^[9] Wardrop et al. observed a higher frequency of “oral discomfort” in menopausal and postmenopausal women.^[18] Periodic gingival alterations found during menstruation were blamed by Prabhu SR et al. for hormonal imbalances and ovarian dysfunction.^[19]

With respect to pH, we observed that the “postmenopausal” group has significantly lower salivary pH than the control group which can lead to a higher “Decayed, Missing, and Filled teeth and Oral Hygiene Index-Simplified” score in both groups.^[20] [Graph 3] Furthermore, higher incidences of dental caries and oral infections can be noted in individuals with lower pH. Our study result is in accordance with Dural S et al.^[20] and Mahesh et al.^[1] At critical pH 5.5, there is demineralization of enamel prisms, and in our study, values acquired for the postmenopausal group were close to the critical pH value which recommend that in this group more demineralization may occur.^[21] In women, salivary pH is significantly linked to plasma adiponectin levels which are an indicator of “pro-inflammatory cardiometabolic” risk profile related to Type 2 diabetes and obesity. Salivary pH is determined by various components of cardiometabolic risk such as oxidation, inflammation, and many health modulators consisting status of menopause. Thus, “salivary pH could be a potential marker for cardiometabolic risk profile assessment.”^[22]

Conclusion

Menopause is followed by a variety of alterations, few of which occur in the mouth. Using salivary flow rate, gustatory perception, and pH to identify risks linked with menopause and the monthly reproductive cycle could be a good strategy as it does not necessitate a large number of “professional or material resources” and it may be carried out in any therapeutic setting at a low cost. The present study results showed significant alterations of reduced salivary flow rate, reduced sweet intensity, and pH in postmenopausal women than the menstruating women.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Mahesh DR, Komali G, Jyanathi K, Dinesh D, Saikavitha TV, Dinesh P. Evaluation of Salivary Flow Rate, pH and Buffer in Pre, Post and Post Menopausal Women on HRT. J Clin Diagn Res 2014;8:233-6.
2.	Delilbasi C, Cehiz T, Akal UK, Yilmaz T. Evaluation of gustatory function in postmenopausal women. Br Dent J 2003;194:447-9.
3.	Balan U, Gonsalves N, Jose M, Girish KL. Symptomatic changes of oral mucosa during normal hormonal turnover in healthy young menstruating women. J Contemp Dent Pract 2012;13:178-81.
4.	Ferris GM. Alteration in female sex hormones: Their effect on oral tissues and dental treatment. Compendium 1993;14:1558-64.
5.	Güncü GN, Tözüm TF, Cağlayan F. Effects of endogenous sex hormones on the periodontium – Review of literature. Aust Dent J 2005;50:138-45.
6.	Greabu M, Battino M, Mohora M, Totan A, Didilescu A, Spinu T, et al. Saliva – A diagnostic window to the body, both in health and in disease. J Med Life 2009;2:124-32.
7.	Shetty S. Quantitative evaluation of salivary calcium, phosporous, protein and pH in health and diseased periodontium. Ann Essences Dent 2010;2:21.
8.	Saluja P, Shetty V, Dave A, Arora M, Hans V, Madan A. Comparative evaluation of the effect of menstruation, pregnancy and menopause on salivary flow rate, pH and gustatory function. J Clin Diagn Res 2014;8:C81-5.
9.	Dangore-Khasbage SB, Degwekar SS, Bhowate RR, Motwani MB, Indurkar AD, Lohe VK, et al. Comparative evaluation of gustatory function between postmenopausal women and age-matched men. Oral Dis 2010;16:469-75.
10.	Mandel ID. The functions of saliva. J Dent Res 1987;66:623.
11.	Rockenbach MI, Marinho SA, Veeck EB, Lindemann L, Shinkai RS. Salivary flow rate, pH, and concentrations of calcium, phosphate, and sIgA in Brazilian pregnant and non-pregnant women. Head Face Med 2006;2:44.
12.	Laine M, Tenovuo J, Lehtonen OP, Ojanotko-Harri A, Vilja P, Tuohimaa P. Pregnancy-related changes in human whole saliva. Arch Oral Biol 1988;33:913-7.
13.	Fenoll-Palomares C, Muñoz Montagud JV, Sanchiz V, Herreros B, Hernández V, Mínguez M, et al. Unstimulated salivary flow rate, pH and buffer capacity of saliva in healthy volunteers. Rev Esp Enferm Dig 2004;96:773-83.
14.	Harirah HM, Donia SE, Nasrallah FK, Saade GR, Belfort MA. Effect of gestational age and position on peak expiratory flow rate: A longitudinal study. Obstet Gynecol 2005;105:372-6.
15.	Yeh CK, Johnson DA, Dodds MW. Impact of aging on human salivary gland function: A community-based study. Aging (Milano) 1998;10:421-8.
16.	Bais A, Mishra SA, Darda PP, Phansopkar P. Impact of 6 Weeks Pilates Training on Menopause Specific Symptoms and Quality of Life in Menopausal Women: A Case Report. J Pharm Res Int 2021;33:83-9. doi: 10.9734/jpri/2021/v33i37B32024.
17.	Brown JE, Toma RB. Taste changes during pregnancy. Am J Clin Nutr 1986;43:414-8.
18.	Wardrop RW, Hailes J, Burger H, Reade PC. Oral discomfort at menopause. Oral Surg Oral Med Oral Pathol 1989;67:535-40.
19.	Prabhu SR. Oral Diseases in the Tropics. Oxford, New York: Oxford University Press; 1992. p. 794.
20.	Dural S, Gungor M, Berna L. Evaluation of the Effect of Menopause on Saliva and Dental Health. Journal of Hacettepe Faculty of Dentistry. 2006;30:15-18.
21.	Preethi BP, Reshma D, Anand P. Evaluation of flow rate, pH, buffering capacity, calcium, total proteins and total antioxidant capacity levels of saliva in caries free and caries active children: An in vivo study. Indian J Clin Biochem 2010;25:425-8.
22.	Tremblay M, Loucif Y, Methot J, Brisson D, Gaudet D. Salivary pH as a marker of plasma adiponectin concentrations in Women. Diabetol Metab Syndr 2012;4:4.