Oral discomfort in menopausal women : questionnaire validation, cross-sectional study and microbiome analysis

Abstract

Background: Menopause-related oral discomfort refers to oral dryness, oral burning sensation and altered taste perception. Previous studies focused on oral dryness. However, the association between menopause and oral dryness has been controversial. There is no standardized measurement to evaluate the oral discomfort in menopausal women. Limited information is known about the oral health condition in Chinese menopausal women. Also, the effect of menopause on the oral microbiome has little evidence. Therefore, five scientific studies were performed to bridge the research gaps. Method and Result: Chapter Two performed a systematic review and meta-analysis to evaluate the association between menopause and oral dryness. The overall odds ratio for the association between menopause and xerostomia was 1.94, and the mean difference in the unstimulated/stimulated whole salivary flow rate between premenopausal and postmenopausal women was 0.18 and 0.48. Chapter Three developed a specific questionnaire to evaluate the oral discomfort in menopausal women. The items were generated through participant interviews and literature review. The items were selected based on the frequency of endorsement, content validity and face validity. Chapter Four validated the questionnaire through construct validity, criterion validity, internal consistency and test-retest reliability testing. The validated menopause-related oral discomfort questionnaire (MODQ) consisted of 29 items and four domains: "oral dryness", "oral discomfort sensation", "decreased taste and smell" and "increased taste and smell". The questionnaire demonstrated good validity and excellent reliability. The Spearman correlation coefficient of criterion validity was (0.38<r<0.56). The overall Cronbach's alpha of internal consistency was 0.91. The intraclass correlation coefficient of test-retest reliability was 0.81. Chapter Five conducted a cross-sectional study to investigate the oral discomfort, as well as dental, periodontal and salivary conditions in Chinese menopausal women (n=300) and age-matched men (n=108). Postmenopausal women showed higher MODQ total scores, missing teeth number and clinical oral dryness score than premenopausal women. Besides, menopausal women had higher MODQ total score than age-matched men. Chapter Six investigated the salivary microbiome in menopausal women (n=36) and age-matched men (n=5). The vaginal microbiome was investigated among menopausal women to find out the similarity and dissimilarity of oral and vaginal microbiome variation during menopause. No significant difference was found in the salivary microbiome diversity among premenopausal, perimenopausal and postmenopausal women. However, the relative abundance of Streptococcus in premenopausal women and Actinomyces in perimenopausal women was significantly higher than postmenopausal women. The salivary microbiome diversity was significantly associated with gender, unstimulated whole salivary flow rate and total salivary protein. The vaginal microbiome diversity was significantly associated with menopausal status and marginally associated with clinical oral dryness score and the salivary estrogen levels. Conclusion: A 29-item specific questionnaire has been developed and validated to evaluate oral discomfort in menopause women. Chinese postmenopausal women showed a worse condition of oral discomfort compared to premenopausal women. Females around menopause transition age had more oral discomfort than age-matched men. However, the salivary microbiome diversity was not associated with menopause status.