Oral Health for Women

Throughout their life, a woman’s body is constantly undergoing changes. As you progress through puberty, menstruation, pregnancy and menopause, the horonal changes experienced by your body can influence your oral health and ultimately, how you need to care for your mouth. Some of the more common and noticeable changes are bleeding or puffy gums and sensitive teeth. The risk for gum disease is also increased at certain intervals in a woman’s life. When these changes occur, your strategy for caring for your gums and teeth may also need to change to keep them healthy.

What is Gum Disease?

Gum disease, also known as periodontal disease, is an infection of the gums and bone. Bacteria produce a sticky film called plaque that adheres to teeth. Plaque forms consistently on teeth and will build up and calcify if it is not physically removed through daily cleaning. The bacteria in plaque produce toxins, or poisons, that irritate your gums.

In the earliest stage of gum disease, called gingivitis, gums swell, turn red and bleed easily. If the bacterial biofilm is not removed, these toxins will cause the gums to separate from the tooth and form deepened spaces called pockets. In later stages of gum disease, called periodontists, the bone and soft tissues that support the teeth are destroyed and recede, which ultimately causes the teeth to loosen, fall out, abscess or require removal by a dentist. For this reason, gum disease should really be called bone disease.

Periodontal disease can occur at any age, but it is most common among adults. In fact, three out of four adults are affected by gum disease at some point in their lives. Women are especially susceptible to periodontal disease at certain stages in life. Hormonal changes can affect the blood supply to the gums, and the response to irritants from plaque may be exaggerated. If you already have periodontal disease, or are genetically predisposed to periodontal disease, you may find the problem worsening at these times.

The Teenage Years

As females reach puberty, the production of the sex hormones progesterone and estrogen increases. The hormonal increase, accompanied by an increase in blood flow to the gums, can exaggerate the way gum tissues react to the toxins inside plaque on the teeth. Gums may become red, tender, swollen and will bleed easily when brushing or flossing the teeth. After the early teen years, women may notice less inflammation and bleeding. Orthodontic treatment during the early years of puberty may further complicate these changes since braces will make cleaning the teeth even more difficult. Brushing and flossing along with regular professional dental care are vital at this stage in your young womanhood.

Your Monthly Cycle

Before your period, or menses, begins you have a surge of progesterone. This surge leads to several changes in your mouth, including swollen gums, lesions, canker sores and swollen salivary glands.

Some women don’t notice any changes at all. For others, particularly those whom plaque or deep pockets are a problem, the gums may bleed in the days before the period begins. You may also get canker sores (apthous ulcers). These symptoms may go away when your period begins. Although these symptoms usually go away once your period starts, these symptoms should not be ignored. Dr. Duke may prescribe special cleanings, laser cleanings, more frequent regular cleanings, gum treatment or topical anesthetics to ease any discomfort. Canker sores are quickly and painlessly treated using one of our lasers, giving you instant pain relief and faster healing.

Pregnancy and Your Oral Health

If your gums are healthy before your pregnancy, you are less likely to have oral problems during pregnancy.

During pregnancy, your body’s hormone levels rise considerably. Pregnancy gingivitis, especially common during the second to eighth months of pregnancy, may cause puffy, red or tender gums to bleed when you brush or floss. This sensitivity is a magnified response to plaque and is caused by an increased level of progesterone in your system. If left untreated, pregnancy gingivitis can damage the gums supporting your teeth. The damage leads to loss of gum tissue and bone. Dr. Duke usually recommends a cleaning during your second trimester to help you avoid problems. This benefits you by reducing bacterial plaque and gingivitis. Women who have cleanings during pregnancy have fewer dental problems than those who do not seek treatment during pregnancy, partly because new mothers are frequently unable to find time during the first few months of their baby’s life to visit the dentist, resulting in one to two years between dental visits.

Occasionally, overgrowths of gum tissue, called “pregnancy tumors,” appear on the gums during the second trimester. These painless growths or swellings are usually found between the teeth. They are believed to be due to inflammation related to excess plaque. They bleed very easily and are characterized by a red, raw-looking, mulberry-like surface. They are often surgically removed after the baby is born. if you are experiencing pregnancy tumors, see Dr. Duke for an evaluation of your options.

It’s especially important to practice great oral hygiene habits at home and seek professional dental care while pregnant. Current research has shown there is a strong link between periodontal disease in pregnant women and preeclampsia, low birth weight babies, premature birth, and an increased risk of stillborn births. It is not yet clear how periodontal is associated with these events (possibly by increasing prostaglandin production, C reactive protein increases, or increases in bacterial spread from the mouth throughout the entire body) but it is clear that good oral health during pregnancy does more than protect your gums, teeth and bone – it protects your baby.

The most common myth we hear from pregnant women is no dental work should be done during pregnancy. Current research and most physicians do not support this position. It is however true that there are times during pregnancy that are better to have dental work performed, such as the second trimester. Cleanings should be performed during pregnancy for mothers who are battling gum disease, are diabetic, or are having significant changes in their mouth due to pregnancy. Many times women will forgo simple procedures for fear of harming the baby, only to have a serious problem arise late in pregnancy or after birth. Frequently pregnant women will tolerate significant dental pain because they believe nothing can be done until the baby is born. While it is wise to avoid unnecessary dental work (such as cosmetic dentistry or implants), routine work such as fillings can be safely performed. In emergency situations, teeth can be extracted or a root canal performed, but it is best to avoid this situation by keeping the health of your mouth in good condition if you are considering getting pregnant. In our office, we are able to use lasers to treat a variety of dental problems safely, with no risk to the baby because we use no anesthetic. For example, no shot fillings, treatment of canker sores, laser reduction of bacteria in the gums and laser tooth sensitivity treatments are just a few of the things we can safely perform. In many cases, getting no work done can have more risk to the baby than the risks of getting work done (such as cleanings and no shot laser fillings). It should be noted that there is inherent risk with any dental work while pregnant, but these risks can be minimized by taking proper steps. Of course, these are general guidelines and we recommend consulting Dr. Duke and your physician before treatment.

Menopause

You will notice a number of physical changes in your body when you reach menopause. Some changes will take place in your mouth as well. These may include more sensitive teeth (to hot or cold), altered taste, a burning sensation (sometimes on the tongue), and a more dry mouth. Of course, you will need to address your calcium balance to prevent osteoporosis.

It can be difficult to determine which symptoms are related to menopause and which are related to aging. In some cases, an increased number of medications can further enhance the negative changes of menopause. Saliva flow, for example, decreases in men and women as we age, but also decreases with menopause and many medications, especially heart and blood pressure medications. Please provide Dr. Duke with a current list of all medications, over-the-counter drugs, vitamins and herbal supplements as they may have dental-related side effects. For many patients, saliva stimulating products or substitutes are effective for dry mouth. Vitamin C and B complexes can be helpful for taste alterations and burning sensations. Fluoride varnishes and other toothpastes can decease tooth senstivity. Women undergoing hormone repacement therapy often see their oral problems improve. Never underestimate the importance of a healthy, well-balanced diet.

How You Can Prevent Periodontal Disease

The number one reason for periodontal disease is plaque. Fluctuating hormone levels play a role in creating more dramatic symptoms but hormones are not the cause for gum disease. Periodontal disease can be prevented by:

• Brushing your teeth twice a day and cleaning between the teeth daily using floss or brushes. We highly recommend the use of a mechanical toothbush, such as a Sonicare.
• Visit us often for your scheduled cleanings. Missing a cleaning can have more dramatic effects than you may think, even if you’re only “a few months late.” A few months allows an already high level of bacteria to reach critical levels. Any areas with missed plaque will quickly harden forming calculus (tartar) which is very damaging to gums and bone around the teeth.
• Opt for laser gum treatments in addition to the traditional hand instrument and ultrasonic cleaning techniques. Lasers allow the most effective bacterial control and gum therapy possible.
• Eat a healthy diet. Avoid sugary snacks and frequent snacking.