In this article
Are bleeding gums in pregnancy normal?Having bleeding, sensitive gums (gingivitis) is common in pregnancy (PRODIGY 2007). Pregnancy hormones can cause your gums to swell and become inflamed (PRODIGY 2007), making them bleed more easily when you brush or clean between your teeth.
What can I do to stop my gums bleeding?Even though it makes your gums bleed, brushing regularly will actually help. Use a soft brush, and choose a toothpaste for sensitive teeth if your gums are tender (PRODIGY 2007). Try not to rinse after brushing, as this will reduce the desensitising effect of the toothpaste. Don't forget to brush between your teeth.
The film of saliva, bacteria and food that coats your teeth (plaque) between cleaning can make your gums more prone to bleeding. To reduce plaque build-up:
- See your dentist regularly.
- Brush your teeth for two minutes, once in the morning, and last thing at night, using fluoride toothpaste (PRODIGY 2007). Try to leave it at least an hour after eating and drinking before you brush to protect the enamel on your teeth.
- Use a rechargeable electric toothbrush which has a timer and a small rotating, oscillating head. These are more effective at removing plaque and reducing gum swelling than manual brushes (Robinson et al 2005).
- Clean between your teeth at least three times a week to remove plaque and trapped food, and to reduce bleeding. Use interdental brushes and dental floss to help remove the food and plaque that lodges between your teeth (PRODIGY 2007). Your dentist can show you how to do this if you're unsure.
- If you smoke, give up, as smoking makes gum disease worse (PRODIGY 2007).
- If you have diabetes, keep your blood sugar levels under control, and go to a dentist regularly for checkups. Gingivitis and gum disease are more common in people with diabetes (PRODIGY 2007). Treating gum disease can help to improve your blood sugar levels (Preshaw et al 2012, Simpson et al 2010), and improving blood sugar control can, in turn, improve gum problems (Preshaw et al 2012).
- Use mouthwash twice a day (Husseini et al 2008), but check with your dentist which type is safe to use in pregnancy, or while you're breastfeeding. Mouthwash that contains the antiseptic chlorhexidine is fine to use for up to a month, but it may stain your teeth and tongue (PRODIGY 2007) , so brush your teeth before using it (PRODIGY 2007). Chlorhexidine only rarely causes skin irritation and allergic reactions (Sharma A 2009). If you think you are having an allergic reaction, stop using the mouthwash, and see your doctor.
Can bleeding gums lead to other problems?Untreated gingivitis can lead to periodontitis (PRODIGY 2007), which weakens the tissue and bone that keep your teeth anchored in your jaw.
If you don't see your dentist to halt the damage caused by periodontitis, your teeth and gums could get progressively worse. Your gums may become infected and develop pus-filled sacs (abscesses), and come away from your teeth. The ligaments and bone at the base of your teeth will then become damaged.
Pockets between your gums and your teeth will then get bigger, until your teeth start to loosen and one or more tooth falls out (PRODIGY 2007). But don't worry, as this level of damage only happens if the disease is left to get to an advanced stage.
You can limit the damage and prevent periodontitis from getting worse. Keep your teeth and gums clean and visit your dentist regularly (Michalowicz et al 2006) for scaling and root planing. This treatment removes tartar build-up and smoothes the base of your teeth (NHS Choices 2012a, PRODIGY 2007).
Dental care is free from the time your pregnancy is confirmed to your child's first birthday. You will need to apply for your maternity exemption certificate, so ask your doctor, midwife or health visitor for the correct form. If your baby is born late, you may need to apply for an extension (NHS Business Authority nd).
Will gum disease harm my baby?If you have gum disease, there's no clear evidence that it will directly affect your baby's health while you are pregnant (Chambrone et al 2011a, Polyzos et al 2010). But it may mean that your general health isn't as good as it could be. If you are finding it difficult to stay healthy, this can affect the way that your baby grows.
Some experts think there's a connection between periodontitis and:
- babies who are premature
- babies with a low birth weight
- other pregnancy complications (Kinane et al 2008, Menezes et al 2009, Xiong et al 2011)
This may be a result of the inflammation and bacteria that gum disease causes. However we can't be certain about this, because different studies have come up with different findings (Chambrone et al 2011b, Ebersole et al. 2009, George et al 2011, Novak et al 2008, Polyzos et al 2010).
If you don't have a healthy diet and have a stressful home life due to money worries, you have a higher chance of having a baby who is premature (Blumenshine et al 2010, Mortensen et al 2011). Not looking after your teeth properly can be part of not having enough money to eat and live as healthily as you could (Benguigui et al 2012, Vogt et al 2012, Boillot et al 2011, Bower et al 2007, Sabbah et al 2007).
If you are worried about your health, talk to your midwife. She can help you to arrange free dental care, sign up for free antenatal classes, and give you advice about how to stay healthy.
When should I call the dentist?If your gums are bleeding and feel tender, see a dentist straight away. You don't need to wait until your next check up if you're having a problem.
A dental hygienist should be available to scale and polish your teeth and treat your tender gums (PRODIGY 2007). Your dentist can also give you advice about how to care for your teeth.
Remember to tell your dentist that you're pregnant, so you don't have an X-ray unless you urgently need one (NHS Choices 2012b). If you need a local anaesthetic for dental work at any time during your pregnancy, it's perfectly safe.
If your dentist feels unsure about the kind of medication he can safely give you, ask him to check with your GP or midwife.
Find out about natural remedies for teeth and gum problems.
Last reviewed: March 2013
ReferencesBenguigui C, Bongard V, Ruidavets JB, et al. 2012. Evaluation of oral health related to body mass index. Oral Dis 18(8):748-755
Berchier CE, Slot DE, Haps S, et al. 2008. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hyg 6(4):265-79
Blumenshine P, Egerter S, Barclay CJ, et al. 2010. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 39(3):263-72
BNF. 2012. Chlorhexidine gluconate. British National Formulary
Boillot A, El Halabi B, Batty GD, et al. 2011. Education as a predictor of chronic periodontitis: a systematic review with meta-analysis population-based studies. PLoS One 6(7):e21508 www.ncbi.nlm.nih.gov [pdf file, accessed October 2012]
Bower E, Gulliford M, Steele J, et al. 2007. Area deprivation and oral health in Scottish adults: a multilevel study. Community Dent Oral Epidemiol 35(2):118-29
Chambrone L, Guglielmetti MR, Pannuti CM, et al. 2011a. Evidence grade associating periodontitis to preterm birth and/or low birth weight: I. A systematic review of prospective cohort studies. J Clin Periodontol 38(9):795-808
Chambrone L, Pannuti CM, Guglielmetti MR, et al. 2011b. Evidence grade associating periodontitis with preterm birth and/or low birth weight: II: a systematic review of randomized trials evaluating the effects of periodontal treatment. J Clin Periodontol 38(10):902-14
v Ebersole JL, Novak MJ, Michalowicz BS, et al. 2009. Systemic Immune Responses in Pregnancy and Periodontitis: Relationship to Pregnancy Outcomes in the Obstetrics and Periodontal Therapy (OPT) Study. J Periodontology 80(6):953-60
FSA. 2003. Expert Group on Vitamins and Minerals. Safe upper levels of vitamins and minerals: water soluble vitamins: vitamin C. Food Standards Agency. pp 100-101. cot.food.gov.uk [pdf file, accessed October 2012]
George A, Shamin S, Johnson M, et al. 2011. Periodontal treatment during pregnancy and birth outcomes: a meta-analysis of randomised trials. Int J Evid Based Healthc 9(2):122-47
Husseini A, Slot DE, Van der Weijden GA. 2008. The efficacy of oral irrigation in addition to a toothbrush on plaque and the clinical parameters of periodontal inflammation: a systematic review. Int J Dent Hyg 6(4):304-14
Kinane D, Bouchard P, Group of European Workshop on Periodontology, et al. 2008. Periodontal diseases and health: consensus report of the sixth European workshop on periodontology. J Clin Periodontol 35(8 Suppl):333-7
Menezes EV, Yakoob MY, Soomro T, et al. 2009. Reducing stillbirths: prevention and management of medical disorders and infections during pregnancy. BMC Pregnancy Childbirth 9(Suppl 1):S4 www.biomedcentral.com [pdf file, accessed October 2012]
Michalowicz BS, Hodges JS, DiAngelis AJ, et al. 2006. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med 355(18):1885-94 www.nejm.org [pdf file, accessed October 2012]
Mortensen LH, Helweg-Larsen K, et al. 2011. Socioeconomic differences in perinatal health and disease. Scand J Public Health 39(7 Suppl):110-4
NHS Business Authority. nd. Maternity exemption certificate. www.nhs.uk [Accessed October 2012]
NHS Choices. 2012a. Gum disease. NHS Choices, Health A-Z. www.nhs.uk [Accessed October 2012]
NHS Choices. 2012b. Can I have an x-ray if I'm pregnant? NHS Direct, Common health questions. www.nhs.uk [Accessed October 2012]
Novak MJ, Novak KF, Hodges JS, et al. 2008. Periodontal bacterial profiles in pregnant women: response to treatment and associations with birth outcomes in the obstetrics and periodontal therapy (OPT) study. J Periodontol 79(10):1870-9
Polyzos NP, Polyzos IP, Zavos A, et al. 2010. Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis. BMJ 341:c7017
Prodigy. 2007. Gingivitis and periodontitis – plaque-associated. PRODIGY Clarity, Clinical topic. prodigy.clarity.co.uk [Accessed October 2012]
Preshaw PM, Alba AL, Herrera D, et al. 2012. Periodontitis and diabetes: a two-way relationship. Diabetolgia 55(1):21-31 www.ncbi.nlm.nih.gov [pdf file, accessed October 2012]
Robinson P, Deacon SA, Deery C, et al. 2005. Manual versus powered toothbrushing for oral health. Cochrane Database of Systematic Reviews (2): CD002281. onlinelibrary.wiley.com [pdf file, accessed October 2012]
Sabbah W, Tsakos G, Chandola T, et al. 2007. Social gradients in oral and general health. J Dent Res 86(10):992-6
Sharma A, Chopra H. 2009. Chlorhexidine urticaria: a rare occurrence with a common mouthwash. Indian J Dent Res 20(3):377-9 Simpson TC, Needleman I, Wild SH, et al. 2010. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews (3): CD004714. onlinelibrary.wiley.com [pdf file, accessed October 2012]
Slot DE, Dorfer CE, Van der Weijden GA. 2008. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: a systematic review. Int J Dent Hyg 6(4):253-64
Vogt M, Sallum AW, Cecatti JG, et al. 2012. Factors associated with the prevalence of periodontal disease in low-risk pregnant women. Reprod Health 9:3
Xiong X, Buekens P, Goldenberg RL, et al. 2011. Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy? Am J Obstet Gynecol 205(2):111