Gum Health During Pregnancy

Overview

Importance of gum health during pregnancy

Pregnancy can make you more susceptible to periodontal (gum) disease, with 60-75% of pregnant individuals having gingivitis. Gingivitis is an early stage of periodontal disease where your gums can become swollen and red, and this is triggered by hormone changes during pregnancy. The high prevalence of gingivitis in those who are pregnant highlights the importance of gum health during pregnancy.

In addition, periodontal disease of the pregnant person has also been associated with the baby having a low birth weight, and preterm delivery, where your baby is born before the 37^th week. Sadly babies which are born preterm and/or have a low birth weight are more vulnerable to an array of health conditions, including issues with their cognitive development. This highlights the importance of your gum health during pregnancy not just for you but for your unborn baby as well. 

Which factors affect gum health during pregnancy?

The following factors which can affect your gum health during pregnancy are listed below:

• Hormonal changes: this can make your gums more vulnerable to plaque and can result in the development of periodontal (gum) disease 
• Immune system changes: Hormonal changes during pregnancy can in turn affect how your immune system responds to plaque build-up on your gums. This can cause exacerbate the inflammation of your gums if you develop gingivitis¹
• Increased blood flow to gums: when you’re pregnant you produce more of the hormone progesterone, which in turn causes more blood to flow to your gums making them more sensitive to plaque-causing bacteria. This can cause the development of gingivitis 
• Oral hygiene: your oral hygiene is important to keep your gums healthy during pregnancy 
• Smoking: Smoking can exacerbate periodontal disease so this should be stopped if you are pregnant 

Changes in gum health during pregnancy

Hormonal changes and their impact on your gums: Can pregnancy hormonal changes cause gum disease?

During your pregnancy, your placenta produces higher levels of the hormones oestrogen and progesterone. During this time, changes can occur in the tissues of your body including your gums. This makes your gums more sensitive and irritations occur in the gums during pregnancy. Pregnancy tumours can develop, which are enlargements of the gum or gum inflammation.

In addition, pregnancy gingivitis can also occur due to the rise in oestrogen and progesterone levels in your body. Pregnancy gingivitis is a mild form of gum disease which causes inflammation and irritation of your gums due to an increase in hormone levels making your gums more susceptible to plaque. So yes, pregnancy hormones can give rise to a mild form of gum disease.² 

Pregnancy gingivitis usually begins at the second month of gestation and reaches the highest level when you are eight months pregnant.²

What are the common gum problems experienced during pregnancy?

The common gum problems experienced during pregnancy are listed below:

• Bleeding gums (due to a build of plaque in your teeth)
• Inflammation of the gums
• Pregnancy tumours or pregnancy gingivitis²

What are the symptoms of gum disease?

With gum disease being a highly prevalent condition in those who are pregnant, with 60-75% of pregnant individuals having pregnancy gingivitis (mild gum disease) it is important to know which symptoms to look out for. The symptoms of pregnancy gingivitis are listed below:

• Swollen gums
• Red and tender gums
• Bleeding gums when you brush your teeth or floss

Please note that despite the high prevalence of pregnancy gingivitis, after giving birth this condition spontaneously heals.²

Importance of maintaining gum health during pregnancy

Effects of poor gum health on pregnancy outcomes

There has sadly been an association that pregnant individuals with periodontal (gum) disease have a higher risk of giving birth both preterm and to babies who have a low birth weight (which is lower than what the baby should weigh for their gestational age).²

Links between gum disease and pregnancy complications

In addition, periodontal diseases are sadly linked to gestational complications.² These gestational complications can include conditions such as preeclampsia. Importance of preventive measures for overall maternal and foetal health

Taking preventative measures can ensure that gum disease is not exacerbated and that complications for your baby have a lower risk of occurring. Periodontal disease can also result in tooth loss for you, and gum disease may result in complications for your baby such as low birth weight and preterm delivery of your baby.^2,3

So which preventative measures can be taken? The preventative measures for gum disease are listed below:

• Stopping smoking
• Avoid using mouthwashes that contain alcohol
• Brush your teeth twice daily for 2 minutes using a fluoride-based toothpaste
• Avoid communing drinks with a high sugar content
• Brush and floss daily to remove bacteria that can cause gum disease

Tips for maintaining gum health during pregnancy

Regular dental check-ups and cleanings

Your oral health largely influences the oral health of your unborn child. When you are pregnant, changing hormone levels can influence your oral health. Therefore regular dental check-ups should continue when you are pregnant as they allow your dentist to assess the health of your teeth, mouth and gums. When you discover you are pregnant you should book your first dental check-up and you should book a second prenatal dental check-up six months later. Dentists can spot early signs of dental problems and conditions, such as gum disease which can aid in the prevention of tooth loss. A dentist can also offer oral health care advice and tips to maintain the health of your teeth and gums whilst you are pregnant. It is important to note that both X-rays and local anaesthesia are safe during your pregnancy so this is no reason to avoid prenatal dental care as this can be beneficial to both you and your unborn child. 

In addition to dental check-ups dental cleanings are also very beneficial when you are pregnant as dental cleanings prevent bacteria build up in your mouth which can in turn prevent the development of periodontal disease during your pregnancy. 

Effective oral hygiene practices

Effective oral hygiene practices for good oral health are as follows:

• Brush each tooth in small circular motions using a fluoride-based toothpaste
• Clean between your teeth and floss to remove plaque and food debris in between your teeth. This can prevent periodontal disease and gingivitis
• Brush your teeth twice a day for two minutes
• Avoid smoking as this can increase your risk of developing periodontal disease
• Eat a balanced diet, and reduce your consumption of foods and drinks high in sugar

Nutritional considerations for gum health

Poor nutrition is a risk factor for periodontal (gum) disease. A diet that is high in sugar, saturated fats and low fibre can increase your risk of gum disease. However, a healthier diet that is rich in micronutrients such as zinc, calcium and A, B and C vitamins has been shown to prevent the development of gum disease. This highlights the importance of a good nutritional diet for your gum health.⁴

During pregnancy nutritional requirements are even more important. If you are pregnant you should meet your daily calcium requirements by ensuring that your diet is rich in dairy and leafy green vegetables. A nutritional diet helps to ensure that there will be no dental problems during your pregnancy and ensures that your baby's teeth develop in a healthy manner too.²

Lifestyle habits that promote gum health

The following lifestyle habits can promote healthy gums:

• Limiting alcohol consumption
• Avoiding foods and drinks that are high in sugar content
• Eating a nutritional diet
• Avoiding smoking

Addressing common concerns

Safety of dental treatments during pregnancy

It is safe to receive dental treatment during your pregnancy, while you may have concerns about unsafe drugs due to pregnancy the majority of drugs used in dental treatments have a safe alternative. The best time to conduct dental treatment is in your second trimester of pregnancy, although you should always seek advice from your dentist if you have concerns about any treatments.⁵

Dealing with morning sickness and its effects on oral health

Approximately 66% of those assigned female at birth experience nausea and sickness during pregnancy. Morning sickness is thought to be induced by an increase in the hormone human chorionic gonadotropin (hCG). If you are experiencing morning sickness regularly this can cause erosion of the palatal surfaces of your teeth, due to your teeth being frequently exposed to acid attacks from vomiting. You are therefore advised to rinse your mouth with a fluoridated mouthwash or water after vomiting, to protect your teeth from the acid in your mouth from vomiting. 

Summary

• Gum problems can be a common occurrence during pregnancy with 65-70% of those who are pregnant experiencing a mild form of periodontal (gum) disease known as pregnancy gingivitis
• Gum problems can also include bleeding of the gums, redness and tenderness, as well as the development of gingival (gum) tumours that are inflammations of the gum
• Conditions affecting your gum such as pregnancy gingivitis spontaneously heal after giving birth to your baby
• Periodontal disease has been linked to preterm birth and low birth weight in babies
• Preventative measures can be taken to reduce your risk of developing gum conditions during your pregnancy such as flossing, quitting smoking, eating a high nutritional diet, limiting alcohol consumption, and brushing twice a day for two minutes with a fluoride-based toothpaste· Dental checkups and cleanings are both recommended and beneficial to you during your pregnancy as cleanings can prevent bacteria build up in your mouth, reducing your risk of developing periodontal disease