Pregnancy and gum disease (What’s the link and is treatment safe?)

When it comes to pregnancy and gum disease, there are two scenarios. Firstly, you’ve noticed blood in the sink after brushing or flossing. Maybe you’ve heard of  ‘pregnancy gingivitis’, but you want to know more and what, if anything, you should do. 

Secondly, you already have periodontitis and have fallen pregnant. In which case, you’re probably wondering if periodontal therapy is safe for you and your baby. 

Find out the causes of bleeding gums in pregnancy. Learn about the benefits of periodontal treatment during pregnancy. Plus, explore the link between periodontal disease and pregnancy outcomes. 

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What causes bleeding gums in pregnancy?

Tender, swollen and bleeding gums in pregnancy​ is a sign of pregnancy gingivitis — a mild form of gum disease. And yes, it’s very common. According to the Australian Dental Association (ADA), around 38% of pregnant women experience symptoms of gum disease. 

Causes of swollen and bleeding gums in pregnancy can include:

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Hormone levels

During pregnancy there’s a surge in estrogen and progesterone levels. These hormonal changes lead to an increased inflammatory response to plaque, causing the gums (AKA gingiva) to swell and bleed. 

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Skipping regular dental visits

Visiting the dentist for a check-up is recommended if you're planning to get pregnant or already pregnant. However, it’s possible that some pregnant women skip their regular dental visit due to fear. In fact, a study by the ADA showed that one in two (53.7%) women avoided the dentist while pregnant. More than one in four did so because they believed it to be unsafe.

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Changes in oral hygiene habits

During pregnancy, some women may develop a dislike for mint tasting toothpaste. This can impact their daily brushing and flossing habits resulting in a build up of plaque, which increases the risk for gum disease.

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Can pregnancy increase the risk of tooth decay?

Pregnancy-related changes in lifestyle, habits and hormones can not only increase the risk of gum gum disease, but also dental decay. Yet, despite bacteria being a common factor in both gum disease and tooth decay, it’s possible to have cavities without gum disease and vice versa.

The bacteria in plaque that causes inflammation, which can lead to gum disease. In the case of tooth decay, bacteria in the mouth creates acid that attacks the surface of the tooth (enamel) and creates small holes in the tooth (cavities). 

Dietary changes during pregnancy, as well as frequent vomiting (due to morning sickness) can increase acid in the mouth, eroding tooth enamel and increasing the risk of decay. Likewise, changes in oral hygiene habits (for example, due to bleeding gums, morning sickness or reflux) can cause plaque buildup, which can lead to tooth decay.

Just like gum disease, tooth decay should be treated. If left untreated, the decay-causing bacteria can be passed on to the baby post birth. 

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A word on fertility treatment and gum inflammation

There’s increasing awareness that oral health and reproductive health are connected. Interestingly, research suggests that some infertility treatments may contribute to gum problems. One study found that women taking the fertility drug clomiphene citrate (CC) for more than three months—or combining it with other hormone treatments—were more likely to experience gum inflammation, bleeding, and swelling. This highlights the importance of paying extra attention to oral care during fertility treatments.

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Can you treat pregnancy gingivitis?

While you can’t control your hormones, there are a few ways to prevent and treat inflamed and bleeding gums. This includes:

• Brushing teeth twice daily with toothpaste
• Cleaning in between your teeth daily, ideally with interdental brushes or floss
• Maintaining good oral health with regular dental visits

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Is it safe to have periodontal therapy in pregnancy? 

Yes. Non-surgical periodontal therapy carried out in the second trimester of pregnancy is considered safe and effective in improving periodontal conditions and it might have a positive effect in reducing the likelihood of preterm birth, low birth weight and pre-eclampsia.

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Periodontal disease and pregnancy outcomes: What’s the connection? 

Several studies have identified a potential link between periodontitis and adverse pregnancy outcomes. Some interesting studies include:

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• Padilla-Cáceres, T et al (2023): The study found a link between the risk of preterm birth and low birth weight in babies born to mothers with periodontitis. A pregnant woman with periodontal disease is two to three times more likely to have these adverse pregnancy outcomes.

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• Xiong, X et al (2006): This examined the existing evidence on the relationship between periodontal disease and adverse pregnancy outcomes. The findings link periodontal disease with an increased risk of adverse pregnancy outcomes. Managing periodontal treatment during pregnancy may have a beneficial effect on preterm birth and low birth weight, but more rigorous studies are needed for confirmation.

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• Daalderop, L et al. (2017): The authors of this comprehensive overview of 23 existing reviews say the association between periodontal disease and adverse pregnancy outcomes is now sufficiently established. Despite the absence of a conclusive causal association, research is now needed to inform the development of targeted therapies and preventive strategies.

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• Castano-Suarez, L et al (2024): This systematic review of existing evidence supports a moderate association between periodontitis and low birth weight, as well as a weak association with preterm delivery. Additional high-quality research is required to show a definite causal association between periodontitis and pregnancy outcomes.

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The European Federation of Periodontology’s manifesto states that while a potential association exists, further research is needed to establish a conclusive causal association and identify specific populations that may benefit from periodontal therapy.

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Final thought…

Good periodontal and dental health is important at all stages of life. If you have a diagnosis of gingivitis or periodontitis before or during pregnancy, it’s important to seek treatment. Periodontal therapy can not only improve the condition of your teeth and gums, but also your overall health. If you have any uncertainty, talk to your dentist or periodontist.