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Pregnancy & Birth Control

The effects of pregnancy and birth control on gum disease

A Consultation with Dr. Susan Karabin

Dear Doctor,
I am a 30-year old woman with gum disease: why are my gums so bad at my age — and could there be a genetic link? Just so you know, I had bleeding gums during my pregnancy three years ago and haven't taken good care of my teeth since then due to the pressures of taking care of my child, work and family. I've just recently seen my dentist who referred me to a periodontist. Please help!

Pregnant woman

Dear Gina,
Don't be alarmed — your periodontal (gum) condition is probably quite treatable. Your dentist was right to send you to a periodontist, a dentist who specializes in the study and treatment of the supporting structures of the teeth, and how these structures may be affected by the individual's general health.

Here are some helpful facts to allay your fears. Firstly, nearly all forms of gum disease are caused by dental (bacterial) plaque (an organized mass of bacteria), which generally accounts for 90% of the problem. Bacteria causes gum inflammation (noticed as bleeding or swelling) when it remains on the teeth for extensive periods of time. Daily effective brushing and flossing help minimize this condition. You should therefore have your dentist or hygienist review your techniques after your teeth have been thoroughly cleaned.

The effects of bacterial plaque are especially apparent in some pregnant women during their first trimester — a condition known as “pregnancy gingivitis” — or in some women who take certain birth control pills. In both cases the elevation of female hormones (estrogens) causes blood vessel changes in their gums, making them more susceptible to the effects of bacteria. Regular check ups and cleanings are the best method for discovering and treating gum problems early.

Recent studies have shown a statistical relationship between pre-term low weight babies and mothers with severe periodontal disease, implying a relationship between the two. These trends, however, were seen primarily in low socio-economic groups. It does not affect all women, particularly those who are otherwise healthy with normal pregnancies and normal birth weight babies; such studies, though, are good to keep in mind.

Diabetes, however, is a known condition with extensive documentation in the scientific literature on its connection with periodontal disease. The presence of diabetes should be checked for during pregnancy, especially if periodontal disease is evident.

The effects of bacterial plaque are especially apparent in some pregnant women during their first trimester — a condition known as “pregnancy gingivitis” — or in some women who take certain birth control pills.

There are also many “risk factors” that further increase your susceptibility to infection and disease. The most important of these is smoking, which affects how you respond to other health issues and, more importantly, how you heal. Smoking affects the level of periodontal disease directly by causing greater amounts of plaque accumulation, and indirectly by affecting every other body system, including your immune system. If you smoke, you should try to cut down or stop altogether with a helpful smoking cessation program.

Your inquiry about genetics is a good one. We all inherit “traits” from our parents and grandparents — including to an extent our resistance response to disease (which is why family histories are important). While a genetic predisposition — particularly with a family history — may increase your susceptibility to periodontal disease, tooth loss is not inevitable. In many cases our parents — and certainly our grand parents — didn't always have access to the great dental and periodontal care commonly available today.

Stress can also affect your immune system and impact your periodontal health. We're generally referring to severe stress, though, either emotional or physical, which can reduce your resistance to disease by lowering your immunity, the way your body copes with or resists disease or infection. For example, stress increases the levels of hormones such as cortisol and adrenalin, both of which modulate your resistance and susceptibility to inflammation and infection. Make sure you are sleeping and eating well.

That brings us to the issue of age and the severity of disease. Generally speaking, the more bacterial plaque on your teeth and the longer it's there, the more periodontal disease you may have. Periodontal disease is also a catch-all phrase for a group of diseases that generally have the same outcome — the progressive loss of attachment of the gum and bone tissues to the teeth, which may eventually loosen and be lost. However, only about 10% of the population develops advanced or severe periodontal disease that endangers teeth. At age 30 you may have some of the signs and symptoms of periodontal disease, but your periodontist will be able to make a specific diagnosis of what your condition is and the extent of the problem. In all likelihood, a lot can be done to treat you and prevent further recurrence by controlling the cause of the disease and treating its effects.

The best way to protect yourself is to take the recommendation of your dentist and see a periodontist. No doubt your dentist has referred you to someone he or she trusts and has great confidence in their knowledge and skill in helping you get your gums and periodontal tissues back to a healthy state, in the most conservative low risk way possible.