By studying only women without significant periodontal disease, the study by Civitelli et al1 skirts the important and largely ignored issue of a potential primary and destructive influence of the lack of estrogen on periodontal tissues. Much evidence suggests that such an influence may contribute to the development of periodontitis in postmenopausal women, independent of the influence of the lack of estrogen on alveolar bone.
Daniell HW. Periodontitis in Estrogen-Deficient Women. Arch Intern Med. 2002;162(22):2634. doi: