Among the numerous problems that a woman faces during pregnancy, those commonly related to oral cavity are bleeding gums during pregnancy and swollen gums (pregnancy gingivitis). Female hormones have a huge impact on every part and system of the body, including gums or gingiva. The increased bleeding tendency that accounts for bleeding gums during pregnancy is due to progesterone hormone. It promotes proliferation of newly formed capillaries in gingival tissues. Similarly, progesterone and estrogen contribute to pregnancy gingivitis by altering the normal physiological activity in various ways. Progesterone increases vascular dilation thereby increasing permeability of vessels, resulting in edema (collection of fluid). During pregnancy the composition of microorganisms also changes significantly in the oral cavity, favoring those that may cause increased accumulations on teeth and lead to gingivitis.
Some of the problems associated with pregnancy and gums are discussed below:
Clinically, it is characterized by erythema (redness), edema (accumulated fluid), hyperplasia and increased bleeding. The severity of these symptoms varies from individual to individual. Some experience only the mildest swelling and inflammation, some experience bleeding along with it. Others might suffer from a more severe form of it with severe inflammation, pain, bleeding.
Gingival enlargements can present in a variety of ways. There may be generalized enlargement of the gums, there may be enlargement over a certain part of gums. The enlargement could either be diffuse and spread in general or it may present as outgrown tumor like masses. The body has an increased immune response to the plaque that is already present during pregnancy, hence these manifestations which result from an aggravation of the mild inflammation already present.
In case of generalized or marginal gingival enlargement, the gums appear bright red or magenta. They are soft and friable with a smooth and shiny surface. Gingival enlargement also increases the tendency of bleeding gums during pregnancy.
‘Tumor-like’ gingival enlargements
These are also called Pyogenic Granulomas or pregnancy tumors. Contrary to what the name suggests, these are not actually tumors. They only share the appearance. These appear as a small discrete mushroom like mass protruding from the gums. It is a superficial entity that is semi-firm and usually painless. It appears red or magenta colored with a smooth glistening surface with numerous pin point red marks.
Pregnancy tumors mostly appear in the second or third trimester of pregnancy. They can be easily excised and do not leave behind a large or prominent defect upon removal. These tumors also bleed easily so they might be a cause of increased bleeding from a certain point at the gums too.
Aggravation of pre-existing periodontal disease
Any previous periodontal infection can get activated or aggravated during pregnancy. Hormones can also speed up the progression of gingival disease to periodontal disease. This means that periodontal pockets may develop or deepen (if already present) and result in transient tooth mobility during pregnancy. The periodontal pockets are soft and friable so any minor insult i.e tooth brushing can cause them to bleed easily.
Treatment of Bleeding gums during pregnancy and pregnancy gingivitis
Most of the problems mentioned during the course of this article can be prevented by maintaining meticulous oral hygiene. With the removal of insults like plaque and calculus, it is possible to not have to face any of these problems in pregnancy. Like it is common to focus on all aspects of health during these 9 months, the care of oral hygiene should also be a priority. Most of the times the gingival inflammation, bleeding and and/or enlargement recedes spontaneously without treatment after the completion of pregnancy. In certain cases, like that of Pyogenic granulomas, intervention might be required.
Your dentist may also advise some antibiotics for treatment of gingivitis in pregnancy. Do not use any medicine without consulting your doctor and dentist. Some commonly used antibiotics include Amoxicillin, Ampicillin, Erythromycin, Penicillin & Nitrofurantoin.
Call and consult your dentist immediately if you feel severe toothache, persistent bad breath, painful and bleeding gums or receding gums etc.
Home remedies for swollen gums during pregnancy
Pregnant women suffering from pregnancy gingivitis or swollen gums may use home remedies for preventing plaque and bacteria and to reduce the swelling and bleeding. Green tea is the best home remedy for pregnant women. Olive oil, honey, and clove oil have anti-bacterial and antiseptic qualities. While olive oil and honey strengthen your teeth, applying clove oil or chewing a clove keeps the teeth healthy. Apart from this, Aloe vera significantly reduces swelling and pain. To kill harmful microorganisms in the mouth, use sage tea mixed in water to rinse the mouth.