Women & Gum Disease: Your Unique Oral Health Needs
As a woman you know that your health needs are unique. You know that brushing and flossing daily, diet, exercise and regular visits to your physician and dentist are all important to help you stay in shape. You also know that at specific times in your life you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause and times when you have special health needs, such as menstruation or pregnancy. Did you know that your oral health needs change at these times too?
During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease.
What is Gum Disease?
Gum disease, or periodontal disease, is caused by the bacteria and toxins in dental plaque, a sticky colorless film that constantly forms on the teeth. Gum disease affects the gums and supporting structures of the teeth. The earliest stage of gum disease, gingivitis, usually causes the gum tissue to swell, turn red and bleed easily. There is usually little to no pain at this time. Sometimes swelling and bleeding can be seen only by the dentist.
If left untreated, gum disease can progress to a more serious stage where the bone and tissue surrounding the teeth are damaged or destroyed. If still not treated, teeth eventually become loose and may be lost.
Without diligent home oral care, including brushing and flossing and regular trips to the dentist, you put yourself at risk for gum disease. In addition, as mentioned before, hormonal changes at certain stages in life can be a contributing factor in your chances of getting some kinds of gum disease or can make an existing gum problem worse.
The following will give you an idea of some of the symptoms you might experience with your oral health during puberty, menstruation, pregnancy and menopause and help to answer some of the questions you might have.
During puberty, an increased level of sex hormones such as progesterone and possibly estrogen, in a young woman’s maturing system causes increased blood circulation to the gums. This in turn, may cause an increase in the gums’ sensitivity which leads to a greater susceptibility or reaction to any irritation including food particles, plaque bacteria and calculus (or tartar).
The gums react to local irritants and swell. Since the cause of this swelling is due to local irritants, these must be removed by a dental professional. Afterwards, careful oral home care (including brushing and flossing) is necessary, or the swelling will return. If not treated, the bone and tissue surrounding the teeth can be damaged.
As a young woman progresses through puberty, the tendency for her gums to swell so much in response to a small amount of irritants will lessen. However, it is important that she remember to brush and floss daily and seek regular professional dental care.
Gingivitis (red, swollen, tender or bleeding gums) can be much more prevalent during menstruation. Again, this is due to an increased amount of progesterone in your system before your period begins, accompanied by plaque accumulation.
Occasionally, some women experience sores to bleeding in the mouth three or four days before their period begins. Another rare occurrence for some women is gingivitis during menstruation, which is marked by reappearing gingival (gum) bleeding, a bright red swelling of the gums between the teeth and sores on the tongue and the inside of the cheek.
Menstruation gingivitis usually occurs right before a woman’s period and clears up once her period has started. As always, good home oral hygiene, including brushing and flossing, is important to maintain oral health, especially during these hormonal fluctuations.
There used to be an old wives tale that said “A tooth lost for every child.” While it may seem far fetched, it actually was based loosely in fact. Your teeth and gums are affected by your pregnancy, just as other tissues in your body.
Most commonly, women experience increased gingivitis beginning in the second or third month that increases in severity through the eighth month and begins to decrease in the ninth month. This condition, called pregnancy gingivitis, is marked by an increased amount of swelling, bleeding and redness in the gum tissue in response to a very small amount of plaque or calculus. This again is caused by an increased level of progesterone in the system.
If your gums are in good health before you get pregnant, you are less likely to have any problems. Pregnancy gingivitis usually affects areas of previous inflammation, not healthy gum tissue. If you experienced some swelling and bleeding of your gums before pregnancy, you might be at an increased risk for pregnancy gingivitis.
Just like any other type of gingivitis, if left untreated, pregnancy gingivitis can have damaging effects on the gums and bone surrounding your teeth, resulting in tissue (bone and gum) loss.
As there will be a great increase of estrogen and progesterone in your system throughout your pregnancy, you may experience more gingival problems at this time. Because your oral tissues are more sensitive due to increased progesterone, they will react strongly to any local irritant present.
In order to reduce the amount of gingival problems, it is important to seek a professional cleaning to remove irritants and keep up a diligent daily home oral care routine, including brushing and flossing. Now more than ever, regular examinations by your dentist are very important. If your dental checkup is due, don’t skip it. In fact, you might benefit from more frequent professional cleanings during your second trimester or early third trimester. Remember, if tenderness, bleeding or gum swelling occurs at any time during your pregnancy, notify your dentist as soon as possible.
Occasionally, the inflamed gum tissue will form a large lump. These growths, called pregnancy tumors, usually appear by the third month of pregnancy, but may occur at any time during the course of pregnancy.
A pregnancy tumor is a large swelling of gum tissue and is not cancerous in any way. It is an extreme inflammatory response to any local irritation (including food particles, plaque or calculus) that may be present.
A pregnancy tumor usually looks like a large lump on the gum tissue with many deep red pin-point markings on it. The tumor is usually painless; however, it can become painful if it interferes with your bite or if debris collects beneath it.
If a pregnancy tumor forms, it may be treated by professional removal of all local irritants and diligent home oral care. Any further treatment or removal would need to be discussed with your dentist and your obstetrician.
Pregnancy gingivitis and pregnancy tumors usually diminish following pregnancy, but they do not go away completely. If you experience any gum problems during your pregnancy, it is important, upon completion of your pregnancy, to have your entire mouth examined and your periodontal health evaluated. Any treatment you might need can be determined at this time.
How can Periodontitis affect my baby?
As in other infections, when you have periodontitis, your body tries to fight it to stay healthy. Scientists believe that this fight produces byproducts and chemicals that can travel through your blood stream into other parts of your body. If these chemicals reach your uterus (womb), they may cause you to go into labor before your baby has fully developed.
According to some estimates, periodontitis may contribute to as many as 45,500 preterm, low birth-weight babies every year in the United States alone. That is more than those attributed to smoking and alcohol use.
Facts about Preterm, Low Birth-Weight Babies
Babies who are born before the 36th week of pregnancy (a normal pregnancy lasts 40 weeks), and weighing less than 5 pounds 8 ounces, are called preterm, low birth-weight babies. Some of these babies may develop slowly and experience serious health problems, including cerebral palsy, epilepsy, chronic lung disease, learning disabilities and attention deficit disorder.
What You Can Do
Visit your dental professional several times while you are pregnant to have a dental examination and your teeth cleaned. Also, make sure to brush your teeth twice a day and floss at least once a day.
What Your Dental Professional Needs to Know
Your dental professional needs to know certain facts about your health to make sure you receive the best treatment during your pregnancy. This includes the following:
If you are taking any oral contraceptives (birth control pills), you may be susceptible to those same oral health conditions that affect pregnant women. As the hormones in oral contraceptives will increase the levels of progesterone in your system, any local irritants (food, plaque, etc.) may cause your gums to turn red, bleed and swell.
There are many medications (for example, antibiotics) that can lessen the effect of an oral contraceptive, so it is important for you to tell your dentist or physician you are taking oral contraceptives before he or she prescribes anything for you.
For the most part, any oral problem you have while you are in menopause probably is not directly related to the changes going on in your body. If you are taking estrogen supplements during this time, these should have little to no effect on your oral health. However, progesterone supplements may increase your gums’ response to local irritants, causing the gums to bleed, turn red and swell.
On rare occasions, a woman may experience a condition called menopausal gingivostomatitis. This condition is marked by gums that are dry and shiny, bleed easily and that range in color from abnormally pale to deep red.
Other symptoms include a dry, burning sensation in the mouth, abnormal taste sensations (especially salty; peppery or sour), extreme sensitivity to hot or cold foods or drinks, and finally difficulty removing any partial bridges or dentures.
If you are diagnosed with menopausal gingivostomatitis, your periodontist can help you manage your condition with special medications.
If you have any questions about your oral health, talk with your periodontist. They will be happy to address any concerns you may have.
Each phase of a woman’s life brings with it many changes. As always, your oral health at these times continues to be of importance to your overall health and well-being. Nothing helps greet each day and each new change in your life like a bright, healthy smile.
© 1993 The American Academy of Periodontology