This is a long post. If you want the TL;DR (too long, didn’t read), the people at the “M Factor” documentary could not provide me with a study to support their claim that “Nearly 30% of women in menopause will lose a tooth within the first five years of menopause.” In fact, they suggested I was simply interpreting the literature in a different way. While this response was disappointing, given the fact that the documentary contained a lot of misinformation, and so was clearly not fact checked, I wasn’t surprised.
Read on if you want to follow me down a dental rabbit hole, which is way more fun than it sounds! If not, while your teeth are not likely to start falling out when you buy your last menstrual products, many women have dental health issues, so if you haven’t seen a dentist in the past year, here’s a reminder, regardless of your age!
I reviewed “The M Factor: Shredding the Silence on Menopause” back in October 2024. It was advertised as the “first-ever broadcast film accredited by the Federation of State Medical Boards (FSMB) to provide Continuing Medical Education (CME) credits,” which to me implied that this was more than just a documentary, but something that had genuinely been vetted medically and could be backed up by guidelines and the latest research.1
Unfortunately, I was wrong.
While parts of the documentary were excellent, there were several doctors who, had they been speaking at a medical event, would have been challenged by their peers, myself included, to defend heir claims. You can read my review here.2 This was a shame because the misinformation on key topics marred the good parts.
One question that came up on social media and that I have been asked about repeatedly since writing my review, is the statement from Dr. Teri Barichello, DMD, VP and Chief Dental Officer for Delta Dental of Oregon/Alaska, that “Nearly 30% of women in menopause will lose a tooth within the first five years of menopause.” Many women reached out to me and were frightened that their teeth were going to start falling out the day of their last period! Here is one of those comments, and I think it seems up the sentiment expressed by many women:
I watched this documentary with a group of middle-age friends. We lost our collective shit over the tooth soundbite, had to pause it and replay because we were all freaking out about this bomb-drop of a statement. We also felt skepticism about the stat, so I'm glad you're looking into it!
Thank you for doing the digging and research to contextualize this documentary!
Reproductive hormones can have wide-reaching effects, so discussing a connection between menopause and oral health is valid and important. For example, the oral microbiome can change in menopause and bone health can impact dental health.3 However, with dental health, as with many things in menopause, age, access to good preventative care, and other medical conditions (to name but a few factors) can also have an impact. This means teasing out what is menopause and what is age, or access to dental care, or social factors, or general health, is essential. This is why studies like SWAN (Study of Women’s Health Across the Nation), that follow women over time, are critical.
When writing my review, I couldn't find a study that addressed tooth loss in the first five years of menopause. I did find the paper, Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study, which looked at data from the Women’s Health Initiative Observational Study (WHIOS), and reported that 28.7% of women who were menopausal lost at least one tooth over an average over “5.1 years of follow-up.”4,5 This study did not enroll women before their last menstrual period, which would be needed to evaluate the impact of the first five years of menopause. Also, the average age at the first visit in this study was 65.88 years, much later than the average age when menopause begins, and the article does not mention the first five years of menopause as a risk factor for tooth loss.4,5 In fact, this study doesn’t mention the first five years of menopause at all.
I spent a lot of time scouring the literature trying to find the source for the quote, but came up empty handed. I found an observational study looking at women in early menopause with two years of follow up, but an increase in tooth loss was not reported.6 For many women this claim about tooth loss in the first five years of menopause was a frightening bombshell, so I wanted the reference to put it in context. I also wanted to know about the quality of the study, because too often in medicine, and I suspect dentistry as well, bold claims are made, when in reality, the study says, “maybe.” Finally, after reading so many articles on dental health and menopause (which is now going to become part of a larger project) I was curious to read the research and understand what had or hadn’t been done.
I obtained Dr. Barichello’s email from her reply to a direct message I sent via LinkedIn, and subsequently emailed her twice but received no response. Next, I contacted one of the producers, Tamsen Fadal, on Instagram, who sent my request to the director, Coby Atlas.
Ms. Atlas promptly forwarded a response from Dr. Barichello with three references. Here is the relevant part from her email:
I found the stat first through this UK oral health foundation:
Unfortunately, none of these references support the claim that “Nearly 30% of women in menopause will lose a tooth within the first five years of menopause.” So, I sent a follow up request. Here is my email:
Hi Coby,
Those references that you forwarded do not support the claim of tooth loss in the first five years of menopause. The quote from the Uk Oral Health Foundation is "Gum disease is the leading cause of tooth loss while previous studies have also suggested more than one in four (28%) post-menopausal women are likely to suffer from tooth loss within five years." That does not say within 5 years of menopause.
The Buffalo Osteo Perio Study, which is the second reference linked above, is a prospective study with the average age of enrollment of about 66 years and I cannot find that it reports tooth loss in regards to the first five years of menopause. It states, "After an average 5.1 years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7%." So almost 30% of women lose a tooth during a five year span while they were in menopause. Unless I am missing something, this article does not support the quote, "Nearly 30% of women in menopause will lose a tooth within the first five years of menopause."
Have I missed something in the article or is there perhaps another reference?
Thanks
Jen
After a several days without a reply, I sent a follow-up email and I also asked for the references to support Dr. Haver’s claim that “We know” menopause hormone therapy is “protective against neuro dementia.” I figured I might as well ask, considering Haver’s claim goes against the recommendation of the Menopause Society.
I received a disappointing reply:
Good Morning,
With your expertise in the field of menopause medicine, it’s understandable that you want to do a deep dive into what other experts have said. Dr. Teri Barichello summarized how she interpreted the two studies, with the goal of making sure women know that oral health is affected by menopause. So many factors go into tooth loss in menopause — calling attention to that was her intension.
What’s been clear over the last few years — perhaps dating from COVID — as public health issues and medical directives become part of the conversation — scientists, doctors and others in these fields can look at the same data and come to different conclusions. It can be very confusing to the public as the debates are often conducted by established experts like yourself. Our goal with the film was to create awareness of menopause in all its complexity.
As you know better than most, more research is sorely needed and advocating for that is paramount. We don’t know how the recent edicts regarding the NIH and other research organizations will affect that research. I know that you and your colleagues in this field will continue to insist that research into menopause proceeds at a much more robust level than it is currently.
With your own work, I know your goal is to provide your best assessments of the information offered so that women have a better understanding of menopause, its symptoms and treatments. I assume Dr. Haver can address your concern directly.
Regards,
Coby
Heavy sigh.
This isn’t about questioning inclusion criteria in a study or the conclusions drawn by the authors, it’s about quoting a pretty specific number in a documentary that has been heavily promoted to the public as being so factual that it is worthy of educating doctors. And the claim scared women. This is a “show me the number” situation, because I can’t find it. So, let’s look at the points from the email, so we can see if they support the claim or not. Also, there are not two studies to look at, there is a study and a review article.
“I found this stat from the UK oral health foundation:
This is not a scientific article, but a post written for the public on the UK Oral Health Foundation. Here is the screenshot I took from the quote attached to the hyperlink:
This not within the first five years of menopause. It’s clunky writing, to be sure, and I can see how it could be misinterpreted, but it does not support the claim. Neither does the supporting reference, which is the Buffalo Osteo Perio Study discussed above.4
The hyperlink goes to the Buffalo Osteo Perio Study.4 As previously mentioned, this study does not support a claim about tooth loss in the first five years of menopause. It states there is an “observed cumulative rate of person-level tooth loss of nearly 30% within a 5 year period” and the authors state this “is compatible with other published findings, underscoring the fact that tooth loss occurs frequently and affects a large number of people, including postmenopausal women.” The researchers identified various factors associated with tooth loss, including “history of diabetes, prior gum disease/surgery, cigarette smoking, number of missing teeth at baseline examination, BMI, and plaque.”4,5 They do not mention the first five years of menopause.
I really felt like I was going in circles.
I didn't speak about this one but it is also important as it further underscores the impact of hormone replacement therapy (HT). "...the overall risk of tooth loss was 24% lower in current HT users than in non-users." (https://pmc.ncbi.nlm.nih.gov/articles/PMC3793432/
This is not a study but a review article titled, Oral Health and Menopause: A Comprehensive Review on Current Knowledge and Associated Dental Management.7 It does not mention tooth loss in the first five years of menopause. Here is the relevant excerpt:
In addition, women without hormone treatment had less teeth than other women in this study. This finding is in accordance with results from the Women's Health Study from the United States were among the 42,171 post-menopausal women the overall risk of tooth loss was 24% lower in current HT users than in non-users.[30]
I will push back on the claim about “tooth loss was 24% lower in current users than in non-users,” which the paper claims is from the “Women’s Health Study,” which is a study of low dose aspirin and vitamin E to prevent heart disease and cancer. I suspect they mean the WHI, although technically it’s the Women’s Health Initiative Observational Study (WHIOS). The problem is the reference used to support this claim is: Grodstein F, Stampfer M. The epidemiology of coronary heart disease and estrogen replacement in postmenopausal women. Prog Cardiovasc Dis. 1995;38:199–210, a review article on heart disease and menopause hormone therapy and doesn’t mention the words tooth, teeth, or 24%.8 My guess, although I can’t know for sure, is the 24% comes from the Buffalo Osteo Perio Study (previously discussed) which does show that 25% of women on MHT lost at least one tooth over five years versus 32% of those not taking MHT. However, in the Osteo Perio study, current or previous hormone therapy was only statistically significant in reducing tooth loss for women who had all of their teeth at baseline. Keep in mind, this is an observational study, so we shouldn’t draw conclusions about cause and effect, especially as another paper referenced in this review article found that women who used menopause hormone therapy were more likely to have had dental care, which of course raises the question, are women who take menopause hormone therapy more likely to engage in preventative dental care, which is a major confounding factor?9 One must be careful about making claims about hormone therapy and outcomes based on observational studies.
The review paper referenced by Dr. Barichello also states, “Nevertheless, further studies with longer follow-up time are needed to evaluate the effect of HT on oral health parameters. The role of HT in ameliorating oral symptoms is still controversial.”7 And, “so far there are no randomized controlled studies to answer these questions.”7 This review article also does not mention the first five years of menopause.
I wondered about the spelling error, the incorrect study name, and the incorrect reference in the quote above. (I did say this was a rabbit hole). The paper, Oral Health and Menopause: a Comprehensive Review on Current Knowledge and Associated Dental Management is published in the Annals of Medical & Health Sciences Research, which is owned by OMICS, which is widely considered to be a predatory publisher.9 It’s unclear when this journal was bought by OMICS, and it may have been in 2017, after the article was written, but this is just another caveat to consider.
Why Go To These Lengths for a Fact Check?
Reason 1: The bigger your megaphone, the greater your responsibility to get it right. This documentary has been heavily promoted by many people with massive followings on social media and there have been many screenings and discussion groups. In addition, part of that promotion involved advertising about continuing medical education credit (CME), and a lay audience would reasonably assume this means that everything had been fact checked, which doesn’t seem to be the case.
Reason 2: I was really curious about the statistic. And I love learning things.
Reason 3: Women were scared and deserve the facts. You cannot be empowered about your health with misinformation and disinformation.
Reason 4: Have you been reading my work for the past decade? I can’t help but fact check, because you have to start from a place of accuracy.
All jokes aside, the producers and director earned the fact check. Their documentary was misleading and had incorrect information about breast cancer, hormone levels, dementia, and testosterone therapy, as well as a bizarre general promotion of supplements. Quite frankly, I found this all pretty galling given its promotion as the “first-ever broadcast film accredited by the Federation of State Medical Boards (FSMB) to provide Continuing Medical Education (CME) credits.” Which also, on fact check, isn’t quite correct. The film itself is not accredited; the CME accreditation comes from watching the film AND viewing a webinar discussion with two of the medical experts from the film, who, during the webinar, did not deviate from the recommendations of the professional medical societies. These two experts were also completely factual in the documentary. There is a big difference between the film itself being certified and the film plus a webinar with more content and the disclosures about conflicts of interest being CME certified.
I wanted to give every benefit of the doubt. I am sympathetic that it's easy to misspeak on camera when there is a lot of pressure to be compelling. Recently, I shot a Master Class on menopause. When I was shown the rough cut, I realized I was slightly off with one of my statistics, so I emailed the director to make sure that clip did not make it into the final version or, if it did, that there would be a graphic below correcting my error. When I reviewed all the episodes of my show Jensplaining for CBC Gem, I caught a couple of questionable statements and made sure we fixed them in post, so trust me, I get that these kinds of mix-ups easily happen. That is why a condition of me being on camera this way is final approval of my segment. If I’d been told the claim was a simply a misquote of the Buffalo Oseto Perio study, I would have totally understood, and I would have written a paragraph explaining the fact, people would have breathed a sigh of relief, and that would have been that. And if this “nearly 30%” was from Dr. Barichello’s personal experience as a dentist, that could have also been an answer. This would be low quality supporting evidence, but it would have been an answer.
But from the reply that I received, the M Factor people are acting as if their original claim is correct and that this is a question of differing interpretations. Yet, they still can’t show me a line from their reference that supports the quote, “Nearly 30% of women in menopause will lose a tooth within the first five years of menopause.” If I misread the Boston Osteo Perio study, it would have been easy to show me the specific line I missed. Then again, the Boston Osteo Perio study is not a study of women in the first five years of menopause, so I just don’t see how that is possible.
No one is saying dental health isn't important or that women in menopause or even women in general don’t have unique dental issues or that dental health for women in menopause is grossly understudied. I agree its vital to discuss dental health. And, during my reading, I was startled at how poor dental health is in general for the majority of women over the age of 50, and this definitely needs more attention in research, in clinical care, and in the media. How much is age? Economics? Misogyny? Previous pregnancies? Menopause? However, starting with inaccurate information that makes women dread menopause is, in my opinion, not the route to better medical or dental care or research.
Here’s My Final Take
The more I reflect on the documentary, the more disappointed I am. This was a documentary about menopause developed by women for women and promoted as good enough for continuing medical education but a lot of it did not pass my fact checking. Why do this? There is already so much good quality information out there that women and their providers desperately need and that could have been used to educate and raise awareness while still being accurate. They could have stuck to the guidelines, which have already been vetted. There was no need to stray from the science. But choices were made. While following the guidelines serves women, it probably doesn’t garner much attention.
My simple request is this: if you are going to claim that you are filling an educational gap, do better.
My simple request is this: if you are going to claim that you are filling an educational gap, do better.
Banack HR, Genco RJ, LaMonte MJ, Millen AE, Buck MJ, Sun Y, Andrews CA, Hovey KM, Tsompana M, McSkimming DI, Zhao J, Wactawski-Wende J; OsteoPerio Study Group. Cohort profile: the Buffalo OsteoPerio microbiome prospective cohort study. BMJ Open. 2018 Dec 4;8(12):e024263. doi: 10.1136/bmjopen-2018-024263. PMID: 30518590; PMCID: PMC6286477.
Bole C, Wactawski-Wende J, Hovey KM, Genco RJ, Hausmann E. Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study. Community Dent Oral Epidemiol. 2010 Dec;38(6):487-97. doi: 10.1111/j.1600-0528.2010.00555.x. PMID: 20636416; PMCID: PMC2975786.
Wactawski-Wende J, LaMonte MJ, Hovey K, Banack H. The Buffalo OsteoPerio Studies: Summary of our findings and the unique contributions of Robert J. Genco, DDS, PhD. Curr Oral Health Rep. 2020 Mar;7(1):29-36. doi: 10.1007/s40496-020-00257-3. Epub 2020 Jan 27. PMID: 35591981; PMCID: PMC9116690.
L. Tarkkila, J. Furuholm, A. Tiitinen, J. H. Meurman. Oral health in perimenopausal and early postmenopausal women from baseline to 2 years of follow-up with reference to hormone replacement therapy. Clin Oral Invest 2008;12:271–277 DOI 10.1007/s00784-008-0190-z
Dutt P, Chaudhary S, Kumar P. Oral health and menopause: a comprehensive review on current knowledge and associated dental management. Ann Med Health Sci Res. 2013 Jul;3(3):320-3. doi: 10.4103/2141-9248.117926. PMID: 24116306; PMCID: PMC3793432.
Grodstein F, Stampfer M. The epidemiology of coronary heart disease and estrogen replacement in postmenopausal women. Prog Cardiovasc Dis. 1995;38:199–210. doi: 10.1016/s0033-0620(95)80012-3
Meisel, Peter PhD1; Reifenberger, Jenni PhD1,2; Haase, Romy MD3; Nauck, Matthias MD4; Bandt, Christoph PhD2; Kocher, Thomas MD3. Women are periodontally healthier than men, but why don't they have more teeth than men?. Menopause 15(2):p 270-275, March 2008. | DOI: 10.1097/gme.0b013e31811ece0a
Kyle Siler, Philippe Vincent-Lamarre, Cassidy R. Sugimoto & Vincent Larivière. Predatory publishers’ latest scam: bootlegged and rebranded papers, Nature. https://www.nature.com/articles/d41586-021-02906-8
Thank you for taking the time to research and fact check this documentary. Women in menopause deserve and need quality information about what is happening to them.
This was literally the only statistic from the documentary that was interesting or new to me as a provider and I am so so grateful to you for taking the fear mongering out of the clear and present (or in this case not so present) science. Team Gunter always!
Thank you for taking the time to research and fact check this documentary. Women in menopause deserve and need quality information about what is happening to them.
This was literally the only statistic from the documentary that was interesting or new to me as a provider and I am so so grateful to you for taking the fear mongering out of the clear and present (or in this case not so present) science. Team Gunter always!