Thursday, September 29, 2016

Our Gums, Ourselves

By Jacqueline Mitchell

Hormonal changes make women prone to periodontal disease, researcher says

gingivitis bacteria

Gingivitis, which affects adults of both sexes, is caused by an increase in disease-causing bacteria such as these in the mouth. Photo: BSIP/Photo Researchers Inc.

It’s not news that the female sex hormones affect more than a woman’s reproductive system. Scientists studying the seemingly unlikely relationship between reproductive health and oral health have discovered that pregnant women with periodontal disease are at increased risk for having premature and/or low birthweight babies. That’s why periodontal care is now a routine part of prenatal care.

But the relationship between periodontal health and female reproductive hormones goes beyond pregnancy. Fluctuating hormone levels over the course of a woman’s life can lead to changes in her oral health. In a review published last year in the Spanish language journal Perínatologia y Reproducción Humana, Eduardo Marcuschamer, DG09, an instructor in periodontology at the School of Dental Medicine, describes how the hormones estrogen and progesterone put women at increased risk for gingivitis, even if they are not pregnant.

Gingivitis, which affects adults of both sexes, is caused by an increase in pathogenic—or disease-causing—bacteria in the mouth. Some 700 different species of bacteria can live in the mouth, usually harmoniously. But poor oral hygiene, tobacco use or a depressed immune system can throw the mouth’s delicate ecosystem out of balance, favoring the bad guys. The resulting bacterial infection leads to the swollen, red gums that are the hallmark of gingivitis. Periodontal disease, which causes tooth loss, may follow.

“Hormones travel in the bloodstream and act on every single tissue,” says Marcuschamer, who wrote his review article when he was a resident at Tufts following a stint as a dental resident at the Instituto Nacional de Perinatología in Mexico, which specializes in high-risk pregnancies. And estrogen and progesterone are especially likely to accumulate in the gum tissues, which are physiologically similar to the mucosal tissues of the reproductive system.

It all starts in puberty, when a dramatic surge of the two female sex hormones can trigger gingivitis in young girls. Scientists suspect that progesterone increases the permeability of blood vessels in the gums, making them more susceptible to swelling. Luckily, this adolescent gingivitis is short-lived and not associated with the increase in oral bacteria that generally accompanies adult gum disease. Good oral hygiene before, during and after puberty can prevent this temporary discomfort from becoming more severe, says Marcuschamer.

The monthly ebb and flow of the female sex hormones continue to affect the oral tissue for as long as a woman menstruates. Researchers have found that cellular fluids related to gingivitis increase in the gum tissue during ovulation, although most women never notice this. Again, the condition is usually minor and temporary, but women with pre-existing gingivitis or periodontal disease may suffer exaggerated symptoms. Additionally, ovulating women may be at increased risk for other oral lesions, including herpes and thrush.

Prevention Is the Key

But it’s during pregnancy—when estrogen and progesterone levels skyrocket 10 to 30 times higher than before conception—when women are most at risk for gingivitis and periodontal disease. And because birth control pills work by tricking the body into thinking it’s already pregnant by increasing levels of progesterone and estrogen in the blood, women taking oral contraceptives are at risk for gum disease, too.

“Pregnancy is a time of life when the hormonal changes are most notorious,” says Marcuschamer, who is using the findings from his review paper to develop a lecture for Tufts periodontal students.

Gingivitis most often appears during the second or third month of pregnancy, peaks in the eighth month, and then decreases in the ninth month as a woman’s hormone levels begin to subside in preparation for childbirth.

More alarming, a small number of pregnant women develop “pregnancy tumors” called pyogenic granuloma. These small red or purplish-blue masses often occur along the scalloped edge of the gum line; they’re painless, but prone to bleeding. Unlike gingivitis, pregnancy tumors usually shrink or disappear completely after childbirth.

Older women are also susceptible to oral health problems. During menopause, when levels of estrogen and progesterone decline, the mucosal tissues throughout the body—including vaginal and oral tissues—can become thin, dry and prone to bleeding. Dry mouth can accelerate tooth decay and cause discomfort while eating or speaking.

Throughout a woman’s life, says Marcuschamer, an ounce of prevention is worth a pound of cure. Good oral hygiene, regular check-ups and treatment when necessary will keep gingivitis at bay and prevent the onset of periodontal disease. Perhaps more important, Marcuschamer recommends more coordination among a woman’s physician, general dentist and periodontist. “We shouldn’t wait until a woman is pregnant to start worrying about gingivitis,” says Marcuschamer. “We should work on prevention throughout her lifetime.”

Jacqueline Mitchell can be reached at jaqueline.mitchell@tufts.edu.

Posted November 03, 2010