There’s one mistake I made as a dentist for a long time. For many years, I wasn’t addressing kid’s dental health early enough. Oral health during pregnancy is a sign of your diet and future kid’s dental health.
Kid’s Dentistry normally starts in the first few years of life. But the factors that influence your child’s oral health begin well before that. Bleeding gums during pregnancy could even shape the future of your kid’s teeth. And taking it one step further. Your oral health, even before pregnancy, is handed on to your unborn child.
What is there to know about pregnancy and bleeding gums?
Pregnancy and teeth have a love hate relationship. During pregnancy, it’s likely that you’ve also had bleeding gums. When I see to my patients who have fallen pregnant, they often tell me how easily their gums bleed during pregnancy.
But are your bleeding gums putting your kid’s health at risk?
Pregnancy gingivitis (bleeding gums) is extremely common. Studies report that 30-100% of all pregnant women have bleeding gums.
The reason is that pregnancy takes your body through large hormonal changes. They underpin the natural and necessary processes of pregnancy. Your mouth is a good gauge of these changes occurring. Gums are a network of blood vessels that deliver protective immune cells from your gut. They also nourish and support your teeth and periodontal tissues with nutrients.
Hormonal changes in the body can directly alter the health of your gums. The mouth-body connection may suggest it’s normal for gums to bleed during pregnancy. After many years of seeing pregnant patients with bleeding gums, I did too. And my advice would reflect this. I would tell them that being more vigilant with oral hygiene and regular dental visits would keep it under control.
Studies have long shown that gum disease links to systemic health problems. My thinking was that if we kept good care of the gums, then these problems would be averted. While I wasn’t wrong, per se, I was missing a big piece of the puzzle. Bleeding gums not only cause other problems in the body; they tell us how your other systems are going too.
Bleeding gums is the early stage of gum disease. Your dentist can detect the difference between bleeding gums and gum disease. It’s important because women with gum disease may be more likely to have health problems during pregnancy.
So are bleeding gums during pregnancy normal? The answer isn’t as straightforward as you might think. Bleeding gums can be a general sign of changes to a woman’s body during pregnancy. They are also the first signs of gum disease.
There are three factors in pregnancy that influence bleeding gums
- Sex hormones
- The immune system
- The oral and gut microbiome
In this article, we’re going to look at how the first two points relate to bleeding gums during pregnancy. In later articles, we will dive deeper into the healthy oral microbiome during pregnancy.
Gum disease and health problems in newborns
Gum disease during pregnancy is linked to diseases such as:
- low weight at birth,
- giving birth too early in the pregnancy
- dangerously high blood pressure (pre-eclampsia) during pregnancy
These links were only first noticed recently in 1996. But since then research hasn’t been able to prove causality between pregnancy gum disease and birth problems.
The CDC reports that babies with a birth weight of fewer than 5.5 pounds may be at risk of long-term health concerns. These include delayed motor skills, social growth, or learning disabilities.
15 million babies are born too early every year. Problems associated with pre-term birth include respiratory problems, vision and hearing loss, or feeding and digestive disease.
So you wouldn’t be surprised for the AAPD to say that:
Routine brushing and flossing, and seeing a periodontist, dentist, or dental hygienist for a comprehensive periodontal evaluation during pregnancy may decrease the chance of pregnancy complications.
However, this is where things get murky. Research is yet to prove a conclusive link between pregnancy conditions and gum disease. Four large trials have all shown no benefit to pregnancy outcomes with periodontal treatment.
So does this mean that we shouldn’t worry about bleeding gums and pregnancy? The research and what we recommend about bleeding gums in pregnancy doesn’t quite match up.
Like all things in life, there’s a bit more to the picture. The oral-systemic link can guide us to see that bleeding gums are a warning sign of other issues in the body.
Can you lose teeth during pregnancy?
About 40% of pregnant women have some form of gum disease. We know the risk of severe gum disease and heart disease as well as other conditions like rheumatoid arthritis. Type II diabetes and gum disease also have a two direction link.
One large study showed there is the risk of gum disease and gestational diabetes. It’s pretty clear that gum disease has an impact on your health during pregnancy.
Bleeding gums during pregnancy are more common and get worse faster. Mothers will often notice that their gums begin to swell, bleed and redden. Bleeding gums can even occur when your oral hygiene and plaque control is good. But if your gums are healthy before pregnancy, you are less likely to have problems.
Gingivitis generally begins to increase in the second or third month. It tends to become more severe throughout the second and third trimester. Then at the end of the third trimester, in the ninth month, it starts to decrease.
If your bleeding gums or pregnancy gingivitis are left untreated, it can worsen. This can lead to damage of your gums, bone, and ligaments that support your teeth. That’s gum disease, which will put you at risk of other health problems.
Bleeding gums, sex hormones, and the oral microbiome
Remember the three shifting factors in pregnancy that influence bleeding gums.
- Sex hormones
- The immune system
- The oral and gut microbiome
There are generally two theories that explain why pregnant woman experience bleeding gums.
- There are changes to the immune system and oral flora relationship
- The balance of repair and maintenance of collagen in the gum tissue also shifts.
Bleeding gums are a sign of inflammation. The gums are a battleground where the body defends against microbes that can cause gum disease.
If you’re pregnant and you have bleeding gums, there’s an imbalance between your oral flora and immune system. Sex hormones play a role in changing both oral bacteria and your immune system.
Bleeding gums is your body recruiting immune cells to fight certain bacteria in the mouth. In general, pregnancy makes you more prone to infections. Your immune system has to be tweaked to allow for a growing fetus.
Shifts in pregnancy hormones are known to influence your immune system. Certain types of immune cells are suppressed so that they don’t attack your child.
Your oral flora then changes in response to different immune system cells in the mouth. This includes strains of bacteria in the oral microbiome that trigger an increase in bleeding gums. So bleeding gums may be a normal part of pregnancy.
But this situation puts a mother at higher risk of gum disease. The pregnancy oral microbiome has lost diversity. This is an opportunity for bacteria in the mouth that cause gum disease to thrive. These are oral flora that live in the absence of oxygen begin to appear in the oral flora.
Harmful oral bacteria cause an immune response to recruit antibody immune cells. Antibody driven cells (B-cells) are known to cause breakdown of support ligament and bone in gum disease.
In later articles, we will further explore the pregnancy gut microbiome and its influence on an unborn child.
For now, let’s take a deeper look at pregnancy hormones and bleeding gums.
Sex hormone changes during pregnancy
Hormonal changes during pregnancy have a profound impact on maternal oral health.
The three most important sex hormonal changes during pregnancy are found on estrogen, progesterone, and relaxin.
The primary hormone to prime your body for the growth of your child. It enables the uterus and placenta to increase blood flow for nutrients. It is also involved in hormonal signaling for a fetus to grow and mature.
During the first-trimester estrogen levels increase rapidly. It is thought to trigger nausea or morning sickness. In the second trimester, it plays a major role in the milk duct and breast growth in a mother.
Throughout pregnancy, estrogen levels increase steadily during until reaching their peak in the third trimester.
The other hormone that increases during pregnancy. Its general job is to ‘loosen’ up your body for the ‘job’ of carrying your unborn child. This helps organs, joints and vessels ‘stretch’ for a growing child, such as the rapid growth of the uterus.
It acts to relax smooth muscle tension. This acts to decrease blood pressure that can cause dizziness, digestive problems symptoms of pregnancy that include heartburn, reflux, belching, nausea, vomiting, gas, and constipation.
The hormone that relaxes the ligaments just before childbirth so the pelvis can open widely to allow the safe passage of the fetal head.
Pregnancy hormones and bleeding gums
The levels of sex steroid hormones in saliva increase during pregnancy. By the second trimester, plaque levels also show increased in sex hormones.
Estrogen directs vascular changes in the uterus.
But studies have shown that progesterone has a bigger influence on oral blood flow. Progesterone reduces the flow rate of blood corpuscles. This means that inflammatory cells tend to build up in gum tissue. It may also affect the barrier function of gum cells, that impairs your gum’s defense against the oral microbiome.
This means swollen, red and gums that are prone to infection. (Every mother will agree with this).
A pregnancy granuloma is a red swelling that is more common during pregnancy. Their increased frequency is likely because of the impact of sex hormones on the gums.
Bleeding gums are also more common in puberty and menstruation periods. These are all times of shifting sex hormones.
Pregnancy gingivitis and gum disease
Local changes to bleeding gums blood flow and immune cells increase a pregnant woman’s risk to bleeding gums.
How does this increase the chances of gum disease? Gum disease is the progression of bleeding gums to the loss of gum tissue and bone. Hormonal changes can cause the body to lose minerals from bones. Post-menopausal woman with osteoporosis are at higher risk to develop gum disease.
Your gums are a network of collagen and ligament fibers. Their role is to hold the teeth in place in the jaw bone. Each one of your teeth has a ligament that holds it the gums.
Sex hormones play a role in collagen and joint maintenance. They tightly manage collagen balance throughout your body. Estrogen helps to lay down collagen, and progesterone acts to break it up. To repair and maintain your gums, there needs to be a balance between the two hormones.
Throughout your body, progesterone acts to loosen the joints up. This is why pregnant women are at higher risk of joint injury. During menstruation, women have also reported painful, hypermobile joints and.
These changes also affect your gums. Studies show that teeth are more mobile during and after pregnancy. This may be due to more ‘volume’ held in the blood vessels.
Sex hormones have also been shown to increase the rate of folate metabolism in the oral mucosa. Since folate is required for tissue repair, an absence during pregnancy in your gum tissues may prevent healing.
Your body is also more prone to inflammation during pregnancy. Prostaglandins are natural fatty acids that control inflammation and increase during pregnancy.
However, changes in sex hormones don’t mean you have to get gum disease. During menstruation, hormonal shifts do increase bleeding, but not necessarily lead to gum disease. But if gum disease exists to start with, the situation is made worse by hormonal changes.
Pregnancy and sex hormones have a profound influence on the mouth and oral health. Bleeding gums are a very common occurrence. However, they do not have to progress to gum disease.
When we assess oral health, we must also take into account the pregnancy microbiome and your kid’s oral and gut health. Pregnancy nutrition guides all of these factors. And here’s where we come to the problem. Bleeding gums are a sign that mothers aren’t eating the right pregnancy diet. That means their kid is also not getting the right resources to develop properly.
A mother’s oral health before and during conception is crucial. This includes the gut microbiome, oral microbiome, and immune balance.
All of these factors play a huge role in your health and your kid’s future dental health. The mouth-body connection is a complex and multi-factorial system.
If your gums are bleeding during pregnancy, you should see your dentist and take action to heal your oral microbiome.
In the next article, we’ll explore the pregnancy microbiome and the role of pregnancy hormones in shaping your newborn’s microbiome.
Now we want to hear from you. Please leave your questions in the comments below.
Want to know more? Dr Steven Lin’s book, The Dental Diet, is available to order today. An exploration of ancestral medicine, the human microbiome and epigenetics it’s a complete guide to the mouth-body connection. Take the journey and the 40-day delicious food program for life-changing oral and whole health.
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