Women & Periodontal Disease
Why do women have unique oral health needs?
Women have special dental needs at different stages of life. Women are especially susceptible to periodontal disease at various times of their lives. Hormonal changes such as puberty, menstruation, pregnancy and menopause can cause an exaggerated response to irritants from bacterial plaque. During these times, your body experiences hormonal changes that can make your gums sensitive and increase your risks for gum disease. The condition worsens if patients are already prone to periodontal disease. You need to take extra care of yourself at times when your body is going through these hormonal changes. Diet, exercise and regular visits to your physician are important to maintain good health. Daily brushing and flossing and regular visits to your dentist are important, too.
The Teen-Age Years
As you reach puberty, you increase your production of the female sex hormones progesterone and estrogen. As a consequence, the blood circulation to the gums is increased, possibly accompanied by increased gum sensitivity. This hormonal increase can exaggerate the way your gum tissues react to the irritants in plaque. Your gums may become red, tender, swollen and likely to bleed easily when you chew or brush your teeth. The condition can be difficult to manage when undergoing orthodontic treatment due to limitations in access for complete oral hygiene. A dental professional must remove these irritants to protect the bone and tissue surrounding the teeth from damage. Afterward, you will need to be diligent in your home regimen of oral care to prevent further swelling. As puberty progresses, your gums will have less tendency to swell. Brushing and flossing along with regular professional dental care are vital at this stage in your young womanhood.
Your Monthly Cycle
During menstruation, you may notice several changes in your mouth, including swollen gums, lesions, canker sores and swollen salivary glands because of a surge of progesterone before your period, or menses, begins. Some women don’t notice any changes at all. For others, particularly those for whom plaque or pockets are a problem, there may be bleeding gums and sores for three or four days before the start of your period/menses. During hormonal fluctuations, it is especially necessary to maintain oral health.
Pregnant women are particularly prone to periodontal (gum) disease due to hormonal changes associated with pregnancy. Research has found that women with periodontal disease are at higher risk for delivering pre-term, low birth weight (PLBW) infants, that is, an infant born before the 37th week of pregnancy. In fact, research indicates that pregnant women who have periodontal disease may be seven times more likely to have a pre-term, low birth weight infant. If you are pregnant and are noticing any signs of gum disease (swollen, tender, or irritated gums; bleeding when brushing or flossing) make an appointment with your dentist immediately to have your teeth cleaned. For a complete list of the warning signs of periodontal disease, please click here. We can do a thorough evaluation of your condition and safely reduce the bacteria associated with problems related to pregnancy.
The old wives’ tale, “A tooth lost for every child,” seems far-fetched, but it actually has a loose basis in fact. If you are pregnant, changes in your hormone levels affect your teeth and gums just as they do other tissues in your body. Most commonly, gingivitis increases beginning in the second or third month, becomes more severe through the eighth month, then begins to diminish in the ninth month. In this condition, called “pregnancy gingivitis,” increased progesterone secretion causes gum tissue to increasingly swell, bleed and redden in response to a very small amount of plaque. If your gums are healthy before pregnancy, you are less likely to have problems. Pregnancy gingivitis usually does not affect healthy gum tissue, but just previously inflamed regions. If left untreated, pregnancy gingivitis can damage the gums and bone supporting your teeth. This damage then leads to loss of gum tissue and bone.
To reduce gingival problems during pregnancy, you need to have a professional cleaning to remove irritants. You also need to be diligent in your daily, home regimen of oral care. During pregnancy, more than ever, you need to have regular dental examinations. Don’t skip a scheduled dental checkup. During your second trimester or early third trimester, more frequent professional cleanings may be beneficial. Remember, if you have tender, bleeding or swollen gums during your pregnancy, notify your dentist as soon as possible.
Occasionally, a large swelling of gum tissue will form, marked with many deep-red pinpoints. This “pregnancy tumor” is an extreme inflammatory response to local irritants such as food particles, plaque or tartar. This growth may occur any time during pregnancy, but it most often appears during the third month of pregnancy. Although it is usually painless, the tumor can become painful if it interferes with your bite or if food debris collects beneath it. A pregnancy tumor is definitely not a cancer. It may be treated by professional removal of all local irritants, followed by a diligent home regimen of oral care. Be sure to discuss further treatment or removal with your dentist and your obstetrician.
If you have any gum problems during your pregnancy, you must have your entire mouth examined and your periodontal health evaluated after your delivery. During your pregnancy we will not only be in close communication with your physician and your general dentist but we also may recommend a more frequent professional cleanings to help you avoid problems.
If you are taking oral contraceptives
A common problem for women who take oral contraceptives, or birth control pills, is gum inflammation. The hormone in oral contraceptives increases the level of progesterone. Periodontal pathogens (disease causing bacteria) utilize this hormone as a growth factor. So good oral hygiene is especially important when taking birth control pills. Also, many medications, such as antibiotics, can lessen the effectiveness of oral contraceptives. Therefore, it is important that you inform your dentist or physician that you are taking birth control pills before either one prescribes any medication for you.
If you are menopausal, any oral problem that you have probably is not related to the hormonal changes you are undergoing. If you take estrogen supplements, they should have little effect, if any, on your oral health. If you have the rare condition called “menopausal gingivostomatitis”, your gums will be dry and shiny, bleed easily and appear abnormally pale to deep red.
You may notice a number of physical changes when you reach menopause, including some that occur in the mouth. These may include burning sensation, altered taste sensations (salty, peppery or sour), a decrease in saliva flow that can result in dry mouth, and greater sensitivity to hot and cold foods or drinks. Also, you may find it difficult to remove any partial bridges or dentures. If any of these symptoms occur, we may be able to help you manage these conditions.
Some dermatologic (skin) and ophthalmic (eye) lesions manifest themselves in the mouth as well. These lesions appear to occur at a higher incidence in menopausal and post menopausal women, and oftentimes manifest themselves in the mouth before they are present on the skin or eyes. Dr. Primm may diagnose oral problems related to menopause.
Later in Life
As time marches on, our bodies experience ongoing wear and tear associated simply with living. Knees, hips and teeth are replaced quite often these days when they fail after many years of daily use. Missing teeth that are not replaced contribute to accelerated facial aging, difficulty chewing and earlier onset of disease and loss of other teeth in your mouth. When teeth are lost, the jawbone that supported the teeth begins to melt away and disappear. Especially when a number of teeth are missing, this can have an impact on your facial appearance. As the jawbone disappears, your face loses the foundation on which your skin relies to define your appearance. This causes you to look older as facial wrinkle lines become more exaggerated. Missing teeth will also greatly alter your ability to chew your food properly resulting in diminished nutrition.
Dental implants are the standard of care in tooth replacement and with today’s technology can be placed without incisions or stitches. Replacing a missing tooth is an important part of delaying the aging process and helping to keep you the way you were.
As you make the transition through these various phases of your life cycle, always remember the importance of oral health to your overall health and well-being. Then, greet each new day and each new change with a bright, healthy smile.