Pregnancy gingivitis

Gingivitis is an inflammation of the gums that is caused when plaque that contains bacteria slowly backs up on your teeth and gums accumulates in the spaces between the gums and the teeth. The accumulation of bacteria release toxins that can lead to the loss of bone around the teeth and can eventually lead to tooth decay and tooth loss. During pregnancy, about half of all women (60 to 70 percent) experience a condition called pregnancy gingivitis or swollen gums during pregnancy. Prolonging gingivitis can lead to much more serious conditions like periodontitis—a much more dangerous form of gum disease. Periodontal disease can cause an infection that destroys the bone supporting your teeth which may lead to tooth loss, bleeding gums and bad breath.

Pregnant women are at increased risk for periodontal disease because the increased levels of progesterone hormone that come with pregnancy cause an increased response to plaque bacteria in the mouth.

Your dentist will be able to help with your swollen and bleeding gums during pregnancy. If you’re pregnant, your dental professional needs to know about the first signs of gingivitis symptoms. Gingivitis is most common during months two to eight of pregnancy. Tell your dental professional when you are pregnant—he or she may recommend more frequent dental cleanings during the second trimester or early in the third trimester to help combat the effects of increased progesterone and help you avoid gingivitis. This extra plaque may cause swelling, bleeding, redness and/or tenderness in the gums. As a result, pregnant women are more likely to develop gingivitis even if they follow a consistent oral health care routine.

When you want to treat gum disease, especially gingivitis, try these simple but effective methods:

• Brush twice a day, every day
• Floss twice a day, every day
• Rinse thoroughly with an anti-gingivitis mouthwash. Avoid mouthwashes that contain alcohol.
• Mouthwashes cannot remove existing plaque. Only regular toothbrushing and flossing can do this.
• A daily salt rinse (1 teaspoon of salt added to a cup of warm water) can help reduce gum inflammation. Swirl the wash around your mouth a few times before spitting it out (do not swallow).
• Visit your dentist regularly

Pregnancy gingivitis causes

Pregnant women are at increased risk for periodontal disease because the increased levels of progesterone hormone that come with pregnancy cause an increased response to plaque bacteria in the mouth.

Plaque

Your mouth is full of bacteria that combine with saliva to form a sticky film known as plaque, which builds up on your teeth. When you consume food and drink high in carbohydrates (sugary or starchy foods), bacteria in plaque turn carbohydrates into the energy they need, producing acid at the same time. Over time, acid in plaque begins to break down your tooth’s surface and causes tooth decay.

Other bacteria in plaque can also irritate your gums, making them inflamed and sore.

Plaque is usually easy to remove by brushing and flossing your teeth, but it can harden and form a substance called tartar if it’s not removed.

Tartar sticks much more firmly to teeth than plaque and can usually only be removed by a dentist or dental hygienist.

Conditions related to gum disease

As well as poor oral hygiene, a number of things can increase your risk of developing problems with your gums. Conditions like diabetes and heart disease can also be impacted by gum disease. In fact, 95% of people who suffer from diabetes will experience some form of gum disease. Gum disease also impacts heart health, and could even lead to cardiovascular disease if not treated.

• Diabetes: Several types of health conditions contribute to poor healing of oral tissues. But people with diabetes should always be aware that they are at risk for poor healing from any type of dental problem. Diabetes is one of the most common endocrine disorders. People with diabetes are at greater risk for infections and often suffer from dry mouth, which can promote tooth decay and gingivitis. And because people with diabetes are also prone to poor healing of oral tissues, gingivitis can be more difficult to treat if it does occur. This is why a regular oral care routine is especially important. If you have sensitive teeth or gums, choose a toothbrush with soft bristles and a soft floss to minimize discomfort. If you have diabetes, be sure to tell your dental professional. He or she may want results from a blood test to show how well you control your condition.
• Vitamin C deficiency: Gum tissue conditions can have many causes, but don’t forget to consider poor nutrition. Inadequate vitamin C can promote bleeding gums that can develop into gingivitis if left untreated. Vitamin C also helps the body perform maintenance and repair on bones, teeth, and cartilage, and it also helps wounds heal.
• Malnutrition: A condition that occurs when a person’s diet does not contain the right amount of nutrients.
• Smoking
• Stress
• Weakened immune system – for example, because of conditions like HIV and AIDS or certain treatments, such as chemotherapy.

You may also be more likely to have gum disease if you’re taking medicines that cause a dry mouth. These medicines include antidepressants and antihistamines.

Pregnancy gingivitis prevention

It’s very important to keep your teeth and gums clean and healthy while you’re pregnant. The best way to prevent or deal with gum problems is to practise good oral hygiene.

To control the amount of plaque in your mouth and to prevent pregnancy gingivitis, follow these steps to reduce the bacteria that can lead to pregnancy gingivitis.

Steps to prevent pregnancy gingivitis and look after your teeth and gums:

• Remember to floss twice daily to remove small bits of food from between your teeth, which will help to prevent the build-up of plaque and avoid the build-up of bacteria.
• Brush thoroughly at least twice a day for 2 minutes with a fluoride toothpaste, preferably in the morning and at night. Ask your dentist to show you a good brushing method to remove plaque.
• Take your time; you should spend at least two minutes brushing your teeth
• Be sure to use anti-plaque toothpaste to help protect your teeth from decay and gingivitis
• Rinse thoroughly after brushing to get rid of bacteria in hard-to-reach places. Avoid mouthwashes that contain alcohol.
• A daily salt rinse (1 teaspoon of salt added to a cup of warm water) can help reduce gum inflammation. Swirl the wash around your mouth a few times before spitting it out (do not swallow).
• Eat a healthy, balanced diet; be sure that you are getting enough calcium, vitamins D, C and A, phosphorous and protein.
• Avoid sugary snacks, drinks (such as fizzy drinks or sweet tea) and sugary foods too often – try to keep them to meal times.
• If you’re hungry between meals, snack on foods such as vegetables, fresh fruit or plain yogurt, and avoid sugary or acidic foods.
• Stop smoking, as it can make gum disease worse.
• Continue to visit your dentist regularly.

If you have morning sickness (nausea and vomiting), rinse your mouth with plain water after each time you are sick. This will help prevent the acid in your vomit from damaging your teeth.

Do not brush your teeth straight away as they will be softened by the acid from your stomach. Wait about an hour before brushing.

Pregnancy gingivitis signs and symptoms

Healthy gums should be pink, firm and keep your teeth securely in place. Your gums should not bleed when you touch or brush them.

Gum disease is not always painful and you may be unaware you have it. Pregnancy gingivitis and its later form, periodontitis—are formed by plaque buildup along the gum line. Though you may not notice anything in mild cases of gum disease, sensitive teeth, bleeding or swollen gums are the most common warning signs that something needs to be addressed.

Bleeding after brushing your teeth is due to early stages of pregnancy gingivitis. Now, if you just started to floss again, you will likely see some blood due to the irritation it causes in the gums initially. However, this should only last a short amount of time and even so, your gums should not bleed just from brushing.

Other symptoms include swollen gums, the persistence of bad breath (or having a bad taste in your mouth), shifting teeth and the formation of pockets between your teeth and your gums. On top of this, it is possible you actually have gum disease but just can’t see the conditions, depending on the area of the gums suffering from periodontitis. Seeing your dental professional every six months allows you to stay on top of this potential condition.

If gingivitis goes without treatment, it develops into periodontitis or gum disease. Eventually, the inner layers of the gum begin to pull away from the teeth. This forms pockets on either side of the teeth. The spaces collect debris brushing your teeth will not always remove, causing infection in the gums and the gum line to shrink. As the gum line shrinks, the pockets enlarge, and you run the risk of teeth falling out and suffering from other serious oral conditions.

Early symptoms of gum disease

This stage of gum disease is called gingivitis. Gum disease is not always painful and you may be unaware you have it.

The initial symptoms of gum disease can include:

• red and swollen gums
• bleeding gums after brushing or flossing your teeth

Advanced symptoms

If gingivitis is untreated, the tissues and bone that support the teeth can also become affected. This is known as periodontitis, or periodontal disease.

Symptoms of periodontitis can include:

• bad breath (halitosis)
• an unpleasant taste in your mouth
• loose teeth that can make eating difficult
• collections of pus that develop under your gums or teeth (gum abscesses)

Acute necrotizing ulcerative gingivitis

In rare cases, a condition called acute necrotizing ulcerative gingivitis (ANUG) can develop suddenly.

The symptoms of acute necrotising ulcerative gingivitis are usually more severe than those of gum disease and can include:

• bleeding, painful gums
• painful ulcers
• receding gums in between your teeth
• bad breath
• a metallic taste in your mouth
• excess saliva in your mouth
• difficulty swallowing or talking
• a high temperature (fever).

Pregnancy gingivitis complications

If you develop pregnancy gingivitis and do not have the plaque or tartar (hardened plaque) removed from your teeth, the condition may get worse and lead to periodontitis.

You may develop further complications if you do not treat periodontitis, where the tissue that supports teeth is affected.

These include:

• recurrent gum abscesses (painful collections of pus)
• increasing damage to the periodontal ligament (the tissue that connects the tooth to the socket)
• increasing damage to and loss of the alveolar bone (the bone in the jaw that contains the sockets of the teeth)
• receding gums
• loose teeth
• loss of teeth

Acute necrotizing ulcerative gingivitis

If you have acute necrotizing ulcerative gingivitis (ANUG) and it’s not treated, it can cause more severe complications. The infection can spread to all areas of your gums and the alveolar bone surrounding your teeth.

This can lead to:

• the gums between your teeth being completely destroyed
• large ulcers (open sores) leaving permanent holes in your gums
• loose and unstable teeth

If acute necrotizing ulcerative gingivitis is not properly treated the first time you have it, you’re more likely to have recurring cases in the future. This can cause persistent bad breath (halitosis) and bleeding gums, as well as gradually receding gums.

In rare cases, acute necrotizing ulcerative gingivitis can lead to gangrene affecting the lips and cheeks. This occurs when tissue starts to die and waste away. If you develop gangrene, you may need to have the dead tissue removed.

Other complications

Gum disease has also been associated with an increased risk for a number of other health conditions, including:

• cardiovascular disease
• lung infections
• premature labor and having a baby with a low birth weight if you’re affected during pregnancy

But while people with gum disease may have an increased risk of these problems, there’s not currently any clear evidence that gum disease directly causes them.

Pregnancy gingivitis treatment

Go to the dentist so they can give your teeth a thorough clean and show you how to keep your teeth clean at home. There are ways in which you can treat or severely limit gum disease. First and foremost, follow your dentist’s instructions for regular oral care at home in order to get the most benefit out of your treatment. That means twice-daily tooth brushing and flossing, plus regular visits to the dentist for follow-ups and professional cleanings. If you experience any new problems following a regular oral care routine, ask your dental hygienist or dentist to recommend products that can make your routine easier.

Oral hygiene

Good oral hygiene involves:

• Brushing your teeth for about 2 minutes last thing at night before you go to bed and on 1 other occasion every day – it does not matter if you use an electric or manual toothbrush, but some people find it easier to clean their teeth thoroughly with an electric toothbrush
• Using toothpaste that contains the right amount of fluoride, a natural mineral that helps protect against tooth decay
• Flossing your teeth or using interdental brushes regularly – preferably daily, before brushing your teeth
• Not smoking
• Regularly visiting your dentist – at least once every 1 to 2 years, but more frequently if necessary

Mouthwash

Antiseptic mouthwashes containing chlorhexidine or hexetidine are available over the counter from pharmacies. But there’s some debate about whether using mouthwash is necessary for people with healthy gums.

Mouthwashes cannot remove existing plaque. Only regular toothbrushing and flossing can do this.

Your dentist may recommend using mouthwash if it helps control the build-up of plaque, the sticky substance that forms when bacteria collects on the surface of your teeth.

Your dentist will be able to advise you about which type of mouthwash is most suitable and how to use it.

Chlorhexidine mouthwash can stain your teeth brown if you use it regularly.

Rinse your mouth thoroughly between brushing your teeth and using a chlorhexidine mouthwash as some ingredients in toothpaste can prevent the mouthwash working.

You should not use a chlorhexidine mouthwash for longer than 4 weeks.

Dental treatments

Some of the dental treatments described here may also be recommended if you have gum disease.

Scale and polish

To remove plaque and tartar (hardened plaque) that can build up on your teeth, your dentist may suggest that you have your teeth scaled and polished. This is a “professional clean” usually carried out at your dental surgery by a dental hygienist. The dental hygienist will scrape away plaque and tartar from your teeth using special instruments, then polish your teeth to remove marks or stains.

If a lot of plaque or tartar has built up, you may need to have more than 1 scale and polish.

Root planing

In some cases of gum disease, root planing (debridement) may be required. This is a deep clean under the gums that gets rid of bacteria from the roots of your teeth.

Before having the treatment, you may need to have a local anesthetic (painkilling medication) to numb the area. You may experience some pain and discomfort for up to 48 hours after having root planing.

Further treatment

If you have severe gum disease, you may need further treatment, such as periodontal surgery.

In some cases, it’s necessary to remove the affected tooth.

Your dentist will be able to tell you about the procedure needed and how it’s carried out. If necessary, they can refer you to a specialist.

If you’re having surgery or root planing, you may be given antibiotics (medication to treat infections). Your dentist will tell you whether this is necessary.

Stopping smoking

Smoking is one of the most significant risk factors for gum disease.

Acute necrotizing ulcerative gingivitis

Acute necrotizing ulcerative gingivitis should always be treated by a dentist. But if you see your doctor before visiting a dentist, they may provide you with some treatment while you wait to see your dentist.

As well as the oral hygiene advice and dental treatments mentioned above, treatments for acute necrotizing ulcerative gingivitis may also include antibiotics, painkillers and different types of mouthwash.

Antibiotics

Treatment with antibiotics, such as metronidazole or amoxicillin, may be recommended if you have acute necrotizing ulcerative gingivitis. You’ll usually have to take these for 3 days.

Amoxicillin is not suitable for people allergic to penicillin.

Metronidazole can react with alcohol, causing you to feel very unwell. You should not drink alcohol while you’re taking metronidazole and for 48 hours after you finish the course of treatment.

Other side effects of metronidazole and amoxicillin can include feeling sick, vomiting and diarrhea.

Painkillers

Acetaminophen (paracetamol) and ibuprofen are the most commonly prescribed painkillers.

They’re also available over the counter from pharmacies. They may help reduce pain and discomfort.

But paracetamol and ibuprofen are not suitable for everyone, so read the manufacturer’s instructions before taking them.

Mouthwash

Mouthwash containing chlorhexidine or hydrogen peroxide may be prescribed to treat acute necrotising ulcerative gingivitis. Some chlorhexidine mouthwashes are also available over the counter, though they may not be as effective as a hydrogen peroxide mouthwash.

You should always read the instructions before using mouthwash. Some types may need to be diluted in water before they’re used.