Gum Health in Pregnancy: Pregnancy Gingivitis and Safe Treatment

Redness and swelling of the gums and bleeding during brushing are common in pregnancy; this condition is called pregnancy gingivitis. Hormonal changes increase the gums' response to bacterial plaque. Gum care and any necessary treatment during pregnancy can be planned safely with appropriate timing and in cooperation with your obstetrician.

What is pregnancy gingivitis?

Pregnancy gingivitis is gum inflammation that develops when, under the influence of hormonal changes during pregnancy, the gums mount a stronger inflammatory response to bacterial plaque. In the 2017 AAP/EFP classification of periodontal diseases, this condition is included as a form of plaque-induced gingivitis modified by systemic factors such as sex hormones.

Symptoms can usually appear from the second month of pregnancy onward and may become more pronounced in the following months. Although its frequency varies between studies, it is reported in a significant proportion of pregnant women. The main symptoms are:

• Gum bleeding during brushing or flossing,
• Redness, swelling and a shiny appearance of the gums,
• Tenderness at the gum margins,
• Bad breath.

After delivery, when hormone levels return to normal, the condition often subsides. However, if plaque control is inadequate, the inflammation may persist. For people who had periodontitis before pregnancy, follow-up becomes even more important to prevent the disease from progressing during pregnancy.

Why do gums bleed more easily during pregnancy?

The main reason gums bleed more easily during pregnancy is that rising estrogen and progesterone levels increase the permeability of the blood vessels in the gums and the inflammatory response of the tissue. Hormones alone do not cause gum inflammation without plaque; they amplify the response to the plaque that is already there. For this reason, plaque control is more important than ever during pregnancy.

There are other factors that make oral health more challenging during pregnancy:

• Increased acidity in the mouth due to nausea and vomiting,
• Difficulty brushing the back teeth because of the gag reflex,
• Frequent small meals, especially sugary snacks,
• Evening oral care being neglected because of fatigue.

For other possible causes of bleeding gums, you can read our article Why Do Gums Bleed?

What is a pregnancy tumor (pyogenic granuloma)?

Despite its alarming name, a pregnancy tumor is not cancer; it is a benign, red tissue growth that bleeds easily and develops on the gum, most often between two teeth. Its medical name is pyogenic granuloma. Hormonal effects and local irritants such as plaque and tartar play a role together.

It occurs in a small proportion of pregnant women and often shrinks or disappears after delivery. If it interferes with chewing, bleeds frequently or makes cleaning difficult, the dentist may recommend removing it at an appropriate time. Lesions that do not regress after delivery are also assessed. Any new tissue growth that appears in the mouth needs to be examined.

Can gum treatment be done during pregnancy?

Yes; scaling and non-surgical gum treatment can be done during pregnancy. Pregnancy is not a reason to postpone necessary oral care. Studies report that non-surgical periodontal treatment performed during pregnancy is safe for both mother and baby.

The second trimester of pregnancy (approximately months 4–6) is generally considered the most suitable time for planned treatment. In the first trimester nausea is pronounced, and in the final months lying on your back for a long time can cause discomfort and dizziness. Emergencies such as pain, swelling or an abscess, however, are treated at any stage of pregnancy.

• Local anesthesia: The local anesthetics commonly used in dentistry can also be used during pregnancy at appropriate doses; the procedure is performed under local anesthesia, with the aim that you do not feel pain.
• X-rays: These are taken only when necessary for diagnosis and with protective measures.
• Medications: Any medications that may be needed are assessed for their suitability during pregnancy, and your obstetrician is contacted when necessary.
• Position: In the later weeks of pregnancy, being tilted slightly onto your left side in the dental chair and keeping sessions short helps with comfort.

Some studies have reported an association between periodontitis and preterm birth, low birth weight and preeclampsia. However, it has not been established whether this association is one of cause and effect, and studies have not consistently shown that periodontal treatment during pregnancy reduces these outcomes. Even so, the mother's oral health is important in its own right. Details on this topic can be found in our article Gum Disease and General Health.

How should you care for your mouth during pregnancy?

The foundations of oral care during pregnancy are brushing twice a day with fluoride toothpaste, cleaning between the teeth every day and handling vomiting correctly. Practical recommendations include:

• Use a soft-bristled brush with a small head; if you have a gag reflex, tilt your head slightly forward while brushing.
• If strongly flavored toothpastes make your nausea worse, try a toothpaste with a milder flavor.
• Clean between your teeth every day with floss or an interdental brush of the right size.
• After vomiting, rinse your mouth with water instead of brushing right away; wait a while before brushing.
• Reduce how often you have sugary snacks, and drink water throughout the day.

It is also important to keep up your oral care in the months after delivery. With the demands of caring for a newborn, it is easy to put off your own care; however, it is helpful to schedule a check-up to see whether gum inflammation that started during pregnancy has subsided after delivery.

For brushing technique, you can refer to our Guide to Proper Toothbrushing and Interdental Cleaning.

When should you see a dentist?

It is recommended that you schedule a dental check-up once you learn you are pregnant. In addition, see a dentist without waiting in the following situations:

• If gum bleeding continues despite good care,
• If there is marked swelling, pain or pus discharge from the gums,
• If you have noticed a growth on the gum that bleeds easily,
• If your teeth feel loose or you have a bad taste in your mouth.

During pregnancy, periodontist Dr. Nadin Gemrekoğlu, DDS, PhD, plans gum treatment taking into account the week of pregnancy and the person's general health. To make an appointment, you can reach us through our contact page.