If you’re a woman over 50, there’s a decent chance you put more effort into how you look than into your oral health—but also that you’ll regret it. These are just some of the findings from a survey of more than 1,000 women aged 50 and older released this month by Delta Dental.

In Delta Dental’s 2023 Senior Oral Health and Menopause Report: Breaking the Stigma, 35% of women surveyed said their skincare, hair, or makeup routine is more extensive than their oral health routine.

This prioritization may reflect another key finding from the survey: utter lack of awareness that menopause can affect oral health.

Despite growing public focus on menopause, many women don’t realize the full extent of menopause symptoms—which can range from hot flashes and weight gain to incontinence, thinning hair, dry skin, and disrupted sleep. Many women don’t seek treatment for their symptoms—if they even recognize them as symptoms of menopause in the first place.

The vast majority (84%) of women surveyed did not know that menopause can affect oral health. Nearly 90% were unaware of specific oral health risks related to menopause, including increased tooth decay, increased risk of gum disease, impact on jaw density, and tooth loss. More than three-quarters didn’t know that menopause can cause dry mouth and receding gumlines.

“Menopause may be having a moment, but until very recently, it has long been an ignored topic not openly talked about among women, or frankly anyone.” said Sarah Chavarria, President of Delta Dental of California. “We still have a long way to go to overcome the stigma,”

According to Chavarria, lack of awareness about the oral health-menopause connection is compounded by a general lack of awareness about oral health.

“Our mouth can be the gateway to our overall health, but it is often thought of and treated as a separate entity,” she said.

Women may not be especially well informed about oral health risks related to menopause, but many are likely experiencing them. Most (79%) women over 50 said that they’ve noticed changes in the appearance of their teeth and gums as they age. And 70% said they’ve had at least one oral health symptom during menopause, such as burning tongue, altered taste, bleeding gums, tooth sensitivity or pain, tooth decay, receding gumlines, or dry mouth, with the last two being the most common.

Many women want more information, with 49% saying they are moderately or extremely curious to learn more about how menopause affects oral health. Google tied with primary care providers as the top source of information about oral health concerns related to menopause for 26% of survey respondents. But more than one-quarter (27%) said they can’t find information about the link between menopause and oral health at all.

Most (84%) said they feel there should be more information available.

Just who should be responsible for providing that information? Two in five (39%) women in the survey said that they think healthcare providers need to do more to encourage women to ask questions about menopause.

Chavarria said it must be a shared effort.

“We’re only just starting to overcome some of the stigma of talking openly about menopause, so there is a lot of room for opportunity to improve education across the board,” she said. “It’s no single person’s responsibility because as a society, women’s health continues to be a major gap in healthcare.”

In fact, those conversations are not always happening. Fewer than half (38%) of women surveyed said they have discussed menopause with their primary care provider and most of the rest (45%) have never discussed menopause with any healthcare provider.

Almost no one had discussed their concerns with a dentist (2%) or hygienist (1%)—a missed opportunity, according to Chavarria.

“We tend to see our dentists more regularly than other primary care physicians,” she said. “That means your dentist is often the first person to see some of the impacts of menopause.”

It’s not too late

Seventy percent of women surveyed said they regret not taking better care of their teeth or gums when they were younger. And after learning about the potential impact of menopause on oral health, many respondents were more motivated to make up for lost time. More than half (54%) of premenopausal, perimenopausal, and menopausal women said they will spend much more time on their oral health routine.

Chavarria said there’s plenty that women at any stage can do to protect their oral health, starting with what she calls “the rule of 2-1-2”: brush teeth twice a day, floss once a day, and get a dental checkup twice a year. Day to day, she also said that drinking water with fluoride, eating a well-balanced diet, and exercising regularly can help protect your teeth.

According to Dr. Jessica Buehler, senior director of dental affairs at Delta Dental, the common menopause-related oral health issues—dry mouth, tooth decay, receding gum lines—are caused by reduced saliva production. She recommends that perimenopausal and menopausal women who notice oral health symptoms drink a lot of plain bottled or tap water to stay hydrated. She advised that women share information about their prescriptions with their dentists, as many medications can cause dry mouth. She also noted that dental offices can perform saliva flow tests to determine the level of dryness.

“We definitely encourage women to use their dental visit as a way to get more information on the changes that are happening in their bodies as they approach menopause,” Buehler said.

If you feel uncomfortable talking about menopause, Buehler suggests focusing on your symptoms and even emailing your dentist ahead of the visit so they can be prepared to help.

Chavarria said she feels hopeful that increased communication about menopause and oral health will continue to break down stigma.

“To my fellow menopausal people, this is our time. It’s not just you,” Chavarria said. “I’m encouraged that we’re having this conversation, and I’d encourage more people to be open about their experiences so they can get the integrated care they need.”