Health
December 12, 2019
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Important: women and periodontal health

By: George Malkemus
June 28, 2019

Periodontal disease, commonly known as gum disease, is predominately caused by bacterial plaque accumulation from poor brushing and flossing habits.  Other co-factors can increase the severity of the disease, including genetic predisposition, many medications, other systemic diseases and hormone changes.  Hormonal fluctuations can contribute to certain kinds of periodontal diseases by speeding up the progression of the disease.

Puberty

When a young woman enters puberty the production of the hormones progesterone and estrogen increase.  This can lead to a greater reaction to any irritation of the gums, including food particles and plaque.  The hormone change makes a better environment for bacterial growth in the gums.  During this time, gingivitis can occur, the gums becoming inflamed with swelling, turning red, bleeding and feeling tender.  The best defense to these symptoms is good oral hygiene:  brushing and flossing and having regular professional cleanings.

Menstruation

Some women may experience menstruation gingivitis during ovulation with gingival bleeding, redness, swelling or soreness.  These problems typically occur right before the cycle and clear once the cycle has started.  Again increased hormonal changes make a better environment for bacterial growth.   The degree of reaction is related to the degree of periodontal disease, so keeping the mouth clean is the key.  With no disease, there are usually little or no symptoms.

Pregnancy

Women can experience pregnancy gingivitis beginning in the second or third month of pregnancy, increasing in severity through the eighth month.  Symptoms include swelling, redness, bleeding and tenderness of the gingival tissues.  In some cases, the gums can swell into a mass, called a pyogenic granuloma and commonly called a pregnancy tumor.  The existing degree of gum disease relates to the severity of gingival reaction in pregnancy gingivitis.

Periodontal disease is also linked to pre-term low birth weight babies.  [This is also found with smoking and alcohol use.]  Periodontal infections during pregnancy cause a faster increase in prostaglandin and tumor necrosis factor.  These molecules can induce labor, thus causing premature delivery before the fetus can grow to normal birth weight. 

The best way to avoid periodontal conditions with pregnancy is to begin with healthy gums.  Have a professional evaluation and thorough cleaning before and during pregnancy.

Oral contraceptives

Oral contraceptives, “the pill,” can make women susceptible to oral health conditions that affect pregnant women.  Synthetic hormones in oral contraceptives are designed to mimic pregnancy and may lead to gum inflammation, similar to pregnancy gingivitis.  Again it is important to have a clean mouth to prevent bacterial growth in a more inviting hormonal environment.  

Be aware that antibiotic medication can lessen the effect of an oral contraceptive medication.  Studies have shown that the effectiveness of “the pill” [the chance of preventing pregnancy] lessens from the mid-90s percent level to the high-80s percent level.

Menopause

Menopause may lead to discomfort in the mouth.  Burning sensations in the gingival tissues, roof of the mouth and/or tongue are common.  Mouth sores, called apthous ulcers can also occur.  Altered tastes to foods and drinks are a common symptom as well.  On rare occasions, a woman may experience menopausal gingivostomatits.  Symptoms include dry or shiny gingival tissues that bleed easily and range from abnormally pale to deep red in color.   In most cases, women find that hormone replacement therapy improves these symptoms, though the hormone replacement therapy can lead to pregnancy gingivitis-like symptoms without proper oral hygiene.

Menopause can also reduce saliva flow leading to an increase in periodontal disease and tooth decay.  Saliva helps clean the mouth of bacteria plaque.  When saliva flow is reduced, rampant gum disease and decay can occur without good oral hygiene.  Tooth decay is particularly a problem on the root surface when there has been gum recession.  The root surface is more prone to decay because of a softer surface and an increased difficult to clean. Many medications also cause reduced saliva flow, which can compound the dry mouth created by menopause. Along with good oral hygiene, sipping water throughout the day and chewing sugarless gum can lessen the effects of these symptoms. 

Women have better oral health than men

Though women have increased hormonal concerns, statistical studies show they have better periodontal health than men.  This fact is because women brush, floss and seek professional dental treatment more than men. 

Surveys done by the American Dental Hygienists Association [ADHA] show that more women than men brush their teeth before going out, at work, in a restaurant restroom and three times a day.  More women than men could correctly identify the way to brush teeth: use a circular motion close to the gum line with a soft brush and hold the brush at a 45-degree angle to the teeth. 

Flossing ranks even lower with men.  Surveys show that 20 percent of men never floss; only 10 percent of women fall into that category.  The major reason for not brushing or flossing regularly typically fell into either the “I don’t have time” or “I forgot/didn’t think about it” categories.  Interestingly, the number two reason stated by men was because they were “lazy!” 

So the moral of the story is if you want to keep your teeth, then brush, floss and seek regular professional dental visits - no matter what stage of life or what sex you are! 

ENJOY LIFE AND KEEP SMILING!

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com.  Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com