Podcast Summary: The Neuro Experience

Episode: How Your Mouth Reveals the First Warning Sign of Menopause
Host: Louisa Nicola & Pursuit Network
Guest: Dr. Leedia Riman (Biological and Integrative Dentist)
Date: November 25, 2025

Brief Overview

In this episode, host Louisa Nicola explores the unexpected connections between oral health, hormonal changes, and systemic disease with Dr. Leedia Riman. Focusing on midlife women, they dive into how declining estrogen impacts saliva production and the oral microbiome, which can serve as early warning signs of menopause and even be linked to brain health, fertility, and chronic diseases. Dr. Riman shares actionable strategies for optimizing oral health during hormonal transitions, advocating for a holistic and individualized dental approach.

Key Discussion Points & Insights

1. The Mouth as a Hormonal Mirror

• Saliva and Estrogen:
  Salivary glands contain estrogen receptors; their decline during menopause reduces salivary flow and quality, leading to xerostomia (dry mouth). (00:00, 03:49)
• Dry Mouth Prevalence:
  "85% of menopausal women have xerostomia, dry mouth. And it's because of that salivary drop." – Dr. Riman (00:00, 05:43)

2. Oral Microbiome and Systemic Health

• Dysbiosis & Disease Risk:
  Shift in the oral microbiome post-menopause sees rise of pathogenic bacteria (e.g., F. nucleatum, P. gingivalis), increasing risk of gum disease, cavities, and systemic diseases like pancreatic and colon cancer, and even Alzheimer’s. (06:03, 09:35, 13:43)
• Bidirectional Connections:
  Oral health is closely linked to overall health and brain aging via neural and bloodstream pathways.
  "Women are twice as likely to have Alzheimer's if they have a poor oral microbiome." – Dr. Riman (10:21)

3. Biological Dentistry: Beyond Teeth

• Comprehensive Exams:
  Dr. Riman looks at nutrition, life history, hormonal status, pregnancies, and medications, integrating oral and systemic health. (02:11, 03:29)
• Bio-individualized Care:
  "We gotta integrate. We can't just look at teeth." – Dr. Riman (02:11)

4. Women’s Unique Vulnerabilities

• Hormonal Cycles Across Life:
  Each phase (puberty, pregnancy, menopause) leaves distinct oral signatures; oral health can deteriorate rapidly during hormonal transitions if not proactively managed. (03:49, 08:35)
• Fertility Link:
  Oral dysbiosis can delay conception; periodontal disease can lower sperm quality in men and affect birth outcomes. (17:24)
• Mother-to-Child Microbiome Transmission:
  "We pass on our microbiome to our children." – Dr. Riman (17:53)

5. Early Oral Warning Signs of Menopause

• Symptoms:
  Burning mouth/tongue, gum sensitivity, rapid decay or gum recession sometimes precede classic menopause symptoms. (24:27, 24:38)
• Clinical Practice:
  "Oral health can be an early warning sign of menopause, even before hot flashes and brain fog." – Louisa & Dr. Riman (24:10-24:27)

6. Oral-Systemic Disease Connections

• Mechanisms:
  Hormonal decline leads to loss of collagen, weaker periodontal ligaments, and more porous gum "pockets," allowing pathogens into bloodstream and beyond. (08:35, 26:25)
• Vitamin D and K2:
  Deficiency impacts bone and immune health; essential for healing and calcium utilization in the mouth and body. (52:32, 53:07)

7. Hormone Replacement Therapy (HRT) and Oral Health

• Mixed Evidence:
  Some studies suggest HRT may help restore salivary flow and oral health, but clinical evidence is limited and mostly correlative. (28:57-29:13)
• Clinical Experience:
  Dr. Riman notes improvements in salivary quality and patient comfort with HRT, especially alongside infection control. (38:00, 39:02)

8. Holistic Oral Health Action Plan

• Cleaning ‘Essentials’:
  Eliminate infections, remove toxic dental materials (like mercury amalgams), and use ozone/airflow technologies to gently clean biofilms. (33:51-36:19)
• Lifestyle & Routine:
  • Tongue scraping: Removes toxins, supports detox (46:23)
  • Oil pulling with coconut oil: Reduces oral pathogens, especially useful for dry mouth (47:06-48:04)
  • Baking soda rinses: Alkalizes mouth to counteract acidic shift from estrogen drop (49:09)
  • Brush before breakfast, floss at night
  • Chew crunchy veggies and hydrate with electrolytes, not just water (44:33-45:03)
• Mouth Taping & Oral Probiotics:
  Used to encourage nasal breathing and promote a balanced oral microbiome at night, but only for those who can breathe comfortably through their nose. (49:39-51:43)
• Vitamin D & K2 Monitoring:
  Essential before dental surgery or for persistent oral health problems. Prep at least 3 months before planned procedures. (52:22-54:17)
• Stress, Cortisol, and Exercise:
  Impact salivary flow and oral resilience; stress management and strength training are recommended for overall health. (45:03)

9. Reframing Gum Disease

• Not Just Hygiene:
  "We've been treating gum disease as a hygiene problem, when in actual fact, I believe it's an endocrine problem." – Louisa Nicola (45:42)

Notable Quotes & Memorable Moments

• Saliva as Shield:
  "Your saliva is the golden elixir in your mouth." – Dr. Riman (00:00)
• On Systemic Impacts of Oral Health:
  "What's in your mouth travels to the rest of your body." – Dr. Riman (00:52)
• Rethinking Causality:
  "Nearly one in two women will experience gum disease after menopause... What if the real cause isn't your toothbrush? It's in your hormones?" – Louisa Nicola (00:14)
• Burning Mouth as Menopause Warning:
  "Burning tongue as a symptom of perimenopause or a warning sign? Yes, yes, yes." – Dr. Riman (25:05)
• Call for Better Standards:
  "I believe it needs to be the standard of care where we test the microbiome for every single woman, any woman going through a fertility journey to post menopause." – Dr. Riman (00:25, 10:51)
• Women Not Informed:
  "85% of women over 50 don't know about the menopause-oral connection." – Dr. Riman (33:10)

Timestamps for Important Segments

| Segment/Topic | Timestamp | |----------------------------------------------------------|--------------| | Saliva, Estrogen, and Dry Mouth | 00:00–05:43 | | Oral Microbiome’s Role in Disease | 06:03–10:21 | | Biological Dentistry Explained | 02:11–03:29 | | Impact of Hormonal Drops on Gum, Bone, & Cavities | 08:35–09:35 | | Oral–Brain Axis/Alzheimer’s Connection | 09:35–10:21 | | Fertility and Microbiome | 17:24–18:18 | | Oral Symptoms as Menopause Warnings | 24:10–25:05 | | The Role of Estrogen Receptors in Oral Tissues | 03:49–05:04 | | HRT and Oral Microbiome Health | 28:57–39:02 | | Bone Loss, Estrogen, and the Alveolar Bone | 42:10–43:23 | | Daily Oral Health Routine for Menopausal Women | 46:14–51:43 | | The Central Role of Vitamin D and K2 | 52:22–53:36 | | Addressing Persistent Bleeding Gums and Brain Fog | 54:51–55:44 |

Actionable Oral Health Routine for Midlife & Menopausal Women

• Routine:

  • Tongue scrape upon waking (46:23–46:29)
  • Brush before breakfast
  • Optional coconut oil pulling (10–20 mins, spit in trash) (47:06–48:00)
  • Brush & floss thoroughly at night (48:00)
  • Use baking soda rinse for acidity (49:08–49:20)
  • Add oral probiotic at night before mouth taping (51:00–51:43)
  • Hydrate with minerals/electrolytes; eat fibrous veggies
  • Monitor vitamin D & K2 status, especially pre-surgery (52:22)

• Lifestyle Adjustments:

  • Prioritize stress reduction, exercise, and manage cortisol
  • Address infections/toxic materials before pursuing HRT for oral symptoms

Final Thoughts

Dr. Riman champions a holistic, bio-individual approach to oral care, highlighting oral health’s role as both a diagnostic and preventative tool during hormonal transitions. Menopausal and perimenopausal women should advocate for microbiome testing and collaboration between their dentists and other healthcare providers. Oral symptoms like dry mouth or burning sensations are not just dental nuisances—they can signify deeper hormonal and systemic shifts.