Dental Caries Status in Postmenopausal Women: Systematic Review and Meta-Analysis

Background. Dental caries is one of the most common oral infections observed worldwide. It is defined as a multifactorial dynamic disease-causing mineral loss of dental hard tissue, which is identified by the caries lesion. Treatment of caries lesion involves filling the cavity or removing the damaged tooth. Then, decayed, missing, and filled teeth (DMFT) index is the simplest and most commonly used index to assess the dental caries status. Salivary glands are estrogen dependent and, after menopause, the changes in salivary flow and saliva consistency produce xerostomia, hyposiale or dryness, common findings among postmenopausal women. Since saliva plays a fundamental role in caries prevention, the postmenopausal decline in salivary secretion may contribute to increased caries incidence. The aim of this systematic review and meta-analysis was to answer the following PICO question: In adult women (P), does the presence of menopause (I), compared to its absence (C), influence dental caries status, assessed as DMFT index (O)? Methods. The study adhered to PRISMA guidelines. A systematic search was conducted in PubMed/MEDLINE, Web of Science, Scopus, and EMBASE databases. For each study, characteristics and mean difference (MD) with 95% CI were extracted. Meta-analyses were performed using the Revman software (version 5.4) to calculate pooled MD and 95% CI. Random-effects model meta-analysis was performed. Risk of bias was evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional studies. To estimate variance and heterogeneity between trials, the Higgins I2 test was used. The certainty level of the evidence was determined through the GRADE approach. Results. Seven studies fulfilled the inclusion criteria, including 4,396 postmenopausal women and 5,131 control women. Meta-analysis showed an overall MD = 3.13 (95% CI = 2.12 – 4.15; p < 0.00001), which suggest that postmenopausal women had a DMFT index 3 units higher than the control group. Conclusions. Menopause significantly associated to worse dental caries status, probably due to declining estrogen levels affecting salivary function. Further research is needed to confirm mechanisms and evaluate preventive strategies like hormone replacement therapy.