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YOUR ORAL HEALTH : ORAL HEALTH TOPICS

Women and Gum Disease

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 doctor and dentist are all important to help you stay in good 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 colourless 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 or 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 careful home oral care, including brushing and flossing and regular visits to the dentist, you put yourself at risk of 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.

Click here for more information on Gum Disease.

Puberty

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).

There is also some evidence that the increased level of sex hormones increases the growth of some bacteria just beneath the gums around the teeth. The gums react to local irritants and swell. Since the cause of the 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 tissues 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 remembers to brush and floss daily and seek regular professional dental care.

Menstruation

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 sore or 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 inside of the cheek.

Menstruation gingivitis 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.

Pregnancy

There used to be an old wives tale that said 'A tooth lost for every child'. While it may be 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 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 check-up is due, don't skip it. In fact, you might benefit from more frequent professional cleaning 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 gum growths, called pregnancy tumours (or granuloma), usually appear in the third month of pregnancy, but may occur at any time during the course of pregnancy. A pregnancy tumour is a large swelling of gum tissue and is not cancerous in any way. It is an extreme inflammatory response to any local irritant (including food particles, plaque or calculus) that may be present.

A pregnancy tumour usually looks like a large lump on the gum tissue with many deep red pin-point markings on it. The tumour is usually painless, however, it can become painful if it interferes with your bite or if debris collects beneath it. If a pregnancy tumour 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 doctor.

Pregnancy gingivitis and pregnancy tumours usually diminish following pregnancy but they do not go away completely. If you experience any gum problems during your pregnancy, it is important on completion of your pregnancy to have your entire mouth examined and your periodontal health checked. Any treatment you might need can be determined at this time.

Oral contraceptives

If you are taking any oral contraceptives (birth control pills), you may be susceptible to the 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 doctor you are taking oral contraceptives before he or she prescribes anything for you

Menopause

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 supplement during this time, these should have little or 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 which are red and shiny, bleed easily and that range in colour from the normally 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 and cold foods or drinks, and finally, difficulty removing any partial dentures. If you are diagnosed with menopause gingivostomatitis, your dentist or periodontist can help you manage your condition with special medications.

If you have any questions about your oral health, talk with your dentist or 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.