How Women Can Protect Oral Health For Life

As a woman, you know that your health needs are unique. 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 also change at these times?

While women tend to take better care of their oral health than men do, women's oral health is not markedly better than men's. This is because hormonal fluctuations throughout a woman's life can affect many tissues, including gum tissue.

A study published in the January 1999 issue of the Journal of Periodontology reports that at least 23 percent of women ages 30 to 54 have periodontitis (an advanced state of periodontal disease in which there is active destruction of the periodontal supporting tissues). Forty-four percent of women ages 55 to 90 who still have their teeth have periodontitis.

Because periodontal disease is often a "silent" disease, many women do not realize they have it until it reaches an advanced state. However, at each stage of your life, you can take steps to protect your oral health.

Why do women have unique oral health needs?

Women have special dental needs at different stages of life and 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 risk 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 periodontist  and 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 begins. Some women do not 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. During hormonal fluctuations, it is especially necessary to maintain good oral hygiene.

Pregnancy and your oral health

The old wives' tale "A tooth lost for every child" seems far-fetched, but it is actually loosely based on 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 periodontist or 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 cancerous. 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 periodontist, 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. Your periodontist can determine necessary treatment at that visit. During your pregnancy we will not only be in close communication with your physician and general dentist, but we may also recommend 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 in the body. 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 periodontist, dentist or physician that you are taking birth control pills before either one prescribes any medication for you.

Reaching Menopause

If you are menopausal, any oral problem that you experience is most likely 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.
However, if you develop 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 a burning sensation, altered taste sensations (salty, peppery or sour), and 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. Your periodontist may diagnose oral problems related to menopause. We may communicate these signs and symptoms to your physician, who would then recommend an appropriate treatment course.

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.

Steps to Protect Oral Health

Careful periodontal monitoring and excellent oral hygiene are especially important for women who may be noticing changes in their mouths during times of hormonal fluctuation. To help ensure good oral (and overall) health, be sure to:

• See a dental professional for cleanings at least twice a year.
• See a periodontist in your area if you or your dentist notices problems with your gum tissue. Problems may include:
  • Bleeding gums during brushing
  • Red, swollen or tender gums
  • Gums that have pulled away from the teeth (recession)
  • Persistent bad breath
  • Pus between the teeth and gums
  • Loose or separating teeth
  • A change in the way your teeth fit together when you bite
  • A change in the fit of your dentures
• Keep your dental professionals informed about any medications you are taking and any changes in your health history.
• Brush and floss properly every day.

The above information has been provided by the American Academy of Periodontology (AAP).  The AAP is the professional organization for periodontists - specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants.  Periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.