Dr Daniell raises an important issue for postmenopausal women, namely, the role of estrogen deficiency as a risk for periodontal disease and subsequent tooth loss and the use of H/ERT to prevent gum deterioration after menopause. As outlined by Dr Daniell, the evidence linking estrogen deficiency to risk of soft tissue disease is based on observational studies or findings in small-sized cohorts. We agree that to unambiguously establish the extent to which H/ERT is effective in preventing soft tissue deterioration, a placebo-controlled, randomized trial is needed. Such a study would not, however, be easy to design and implement because it would require leaving subjects with active periodontal disease untreated—an unethical proposition. Our study was deliberately designed to exclude patients with moderate or advanced periodontal disease to specifically address the complementary issue (ie, the extent to which H/ERT would improve alveolar bone independent of local disease).1 Our results demonstrate that the effect of estrogen is clinically significant, and it seems likely that the same benefits would occur in subjects with active disease.
Civitelli R, Hildebolt C. Periodontitis in Estrogen-Deficient Women—Reply. Arch Intern Med. 2002;162(22):2635. doi: