Each phase of a woman’s life cycle brings about many changes to our body. Oral health of a woman can also often be affected during such times as puberty, menstruation, use of contraceptives, pregnancy and menopause. 

The scientific and clinical advances in medicine and dentistry have successfully brought women’s health issues to the forefront. There are specific oral manifestations found primarily in women which require specific treatment. I therefore believe that it is important that women are made aware of the specifics of women’s oral health as it specifically pertains to them.

Women’s life cycle changes present unique challenges to the oral health care professional.

Most women know that at times their hormones are to blame for their moods, lack of energy, sex drives and complexions. What they may not know is that the various hormonal influences associated with the reproductive process have been widely recognized to also affect their oral health and increase their susceptibility to periodontal (gum) disease.

What is periodontal (gum) disease?

Periodontal disease is a bacterial gum infection that destroys the gums and supporting bone that hold the teeth. 

It is the leading cause of tooth loss in adults. It is caused by the accumulation of plaque and bacteria around the gum line often as a result of inadequate brushing and flossing and/or irregular dental care. The bacteria that cause gum disease are different than the bacteria that cause cavities.

Most people realize that it is important to maintain a good oral health care regime to protect their teeth. What they may not realize is that periodontal disease is an infection, it can enter the blood stream and cause health problems in other parts of the body. For example, low-weight pre-term births have been linked with periodontal disease. Pregnant women who have untreated periodontal disease may be 7 times more likely to have a low-weight preterm baby, according to research.

Periodontal disease is widespread. According to the American Dental Association 80% of Americans over 65 and 25% of women between age 30-54 show some degree of periodontal disease.

Warning signs of periodontal disease may include: persistent bad breath; red, swollen and tender gums; gums that 

Bleed upon brushing; gums that have pulled away from the teeth; loose or separating teeth; pus between the gums and teeth and a change in the way teeth fit together upon biting.

Most important is that periodontal disease can be a silent disease, so the majority of people with it do not even realize they have it! The absence of signs and symptoms do not always indicate periodontal health as the signs may be very subtle.

In those who are pregnant, as many as 75% of women exhibit pregnancy gingivitis. Characterized by red, inflamed, swollen gums most often in the front of the mouth. Quite often the periodontal status of the patient prior to pregnancy influences the progression or severity of the gum condition with it getting worse during the 2^nd and 3^rd 

trimesters.

The pregnancy tumor, which may also occur is most common during the 2^nd and 3^rd trimesters of pregnancy.

It can be found 70 % of the time on the gum. They grow rapidly, bleed easily. They often occur in an area of gingivitis associated with poor hygiene. Both of these clinical manifestations as others not mentioned are treatable and often resolve soon after delivery once hormone levels, etc are re-established.

In addition to pregnancy affecting the inside of the mouth there is increasing evidence which supports the concept that gum infection may indeed play a role in pregnancy complications. This could include possibly inducing miscarriage, premature birth as well as inhibiting the growth and development of the unborn child.

Clearly, there are many causes for problems that can arise during pregnancy and now through research it appears that oral infection can be added to the list of possible risk factors.

Inflammation has been found to be a factor in low-weight pre-term birth, and the bacterial infections that cause moderate to severe periodontal disease in pregnant women is suspected to be one of the sources of that inflammation.

What do we do?

In the future a vaccine may be developed to combat the bacterial organisms which cause periodontal disease.

The good news is that we know how to prevent and manage periodontal disease – and treatment if necessary can be provided safely during pregnancy to improve a mother’s oral health ensuring she is comfortable and reducing infection and inflammation that may harm her or her unborn child.

It all begins with a thorough periodontal examination and conversation.

As someone who believes in prevention I believe it is pertinent to have open dialogue among women as to the importance of maintaining healthy periodontal and dental health. 

To educate them as to the changes they may experience during various stages of their life cycle especially to those who are planning to become pregnant or who are at the early stage of their pregnancy.

It is imperative to address any risk factors which may have a negative effect on our general health. Inflammation, the new risk factor arising from periodontal disease should be addressed in the same conversation as smoking, obesity, lack of exercise etc. The mouth-body connection.

The conversation will continue as we look at how puberty, menstruation, use of contraceptive, menopause etc. can present clinically in our mouths and have an specific health ramifications.