Bleeding gums and looking after your teeth in pregnancy

What causes bleeding gums in pregnancy?

Bleeding gums in pregnancy is known as ‘pregnancy gingivitis’. During pregnancy, hormones soften everything up in readiness for birth – that applies to everything from your cervix to your gums. Your blood volume also increases by a whopping 30 to 40%, so it’s little wonder everything is a bit quicker to bleed (you’ll possibly have more nose bleeds, too). Hormonal changes also affect the way your mouth deals with bacteria, so plaque can build up more easily. This can make the gums inflamed, which subsequently causes them to bleed.

Are bleeding gums dangerous for me or my baby?

It’s very unlikely that bleeding gum are dangerous for yourself or your baby – as long as they are looked after. Bleeding gums are easily sorted but if not addressed, pregnancy gingivitis can lead to periodontitis (more commonly known as gum disease). Gum disease can move into our teeth and jaw bone, meaning the tissues and bones that keep your teeth in place are weakened and, if unchecked, the teeth may eventually fall out (hence the old adage about losing a tooth for every child you have).

There’s no proven link between bleeding gums and your baby’s health but if your own health is compromised, that can obviously have a knock-on effect on your baby. Some experts believe there may be a link between maternal periodontitis and low birth weight and premature birth.

Is there a treatment for pregnancy gingivitis?

Though they’re unpleasant and uncomfortable, the good news is that bleeding gums are very treatable – and for most people, this can be done at home. To treat gingivitis, all you need is good dental hygiene and common sense (but when you have the attention span of a goldfish, you’re often lacking the latter).

If the problem persists or worsens, you can make an appointment with the dentist – they’ll be able to give your teeth a really good clean to reduce the plaque build-up and treat the sore gums.

Here’s a few tips to help keep your mouth clean:

Keep teeth and gums extra clean

• Brush for at least two minutes, at least twice a day (preferably before breakfast and before bed).

• Use a small soft-headed toothbrush – brushing will initially make the gums bleed more but keeping them clean is vital. A rechargeable electric toothbrush is often best at cleaning plaque away.

• Floss once a day to remove any additional plaque and trapped food.

Kick bad habits that make things worse

• Smoking is a no-no during pregnancy and if you needed any more reason to quit, it can make bleeding gums much worse.

• Sweets are never good news for teeth, particularly hard-boiled or chewy ones that you suck and chew for a long time. Some women find that sucking sweets helps with nausea in early pregnancy – if that’s the case, find sugar-free versions.

Consider your diet as a whole

• Taking extra care of your general health in pregnancy is important – you need to ensure your diet is balanced and that you’re getting all the nutrients your body needs. As well as remembering what foods to avoid, think about eating plenty of ‘good’ foods, too, and look for recipes that are low in sugar and acidic ingredients.

• Avoid fruit juices and fizzy drinks. If you do eat them, wait a little while after you’ve finished eating before brushing your teeth, as the abrasion of the toothbrush combined with the acid from the food or drink on our teeth can erode teeth and gums further.

Give other lifestyle factors some thought

• On a less savoury note, if you’re suffering from pregnancy sickness or, worse still, hyperemesis, acid from your stomach will also be contributing to the problem. Rinse with plain water after each time you’re sick, but wait an hour to clean your teeth. As with the acidic drinks, brushing while the teeth are still coated in acid will make erosion and gum bleeding worse. It’s very tempting to want to brush your teeth straight after vomiting but it’s not a good idea. Look into other tips for coping with morning sickness to take your mind off it for an hour.

• Give mouthwashes containing alcohol a miss as they can make things worse, too.

Are there any natural treatments for bleeding gums?

• Rinsing your mouth with warm water with half a teaspoon of salt dissolved in it is very healing (though it tastes pretty foul).

• Some fans of homeopathy swear by arnica or hypercal tincture, though there’s no hard evidence this has an effect and you should always consult a practitioner who's qualified to help pregnant women.

• Chewing veggies, such as raw carrot or radish, helps exercise and clean the gums.

Mumsnetters on bleeding gums in pregnancy:

• ‘My gums are extra sensitive at the moment (11 weeks). They’re OK when brushing, but flossing is painful and sometimes results in bleeding. Apparently it’s not just plaque, but that you have extra blood flow in the gums which makes them more sensitive and prone to bleeding.’

• ‘I had this throughout my pregnancy and it was my first pregnancy symptom. I had twins and the dentist said it was due to more pregnancy hormones. I also had nose bleeds.’

• ‘I was looking like a vampire every time I brushed, having had almost no problems pre-pregnancy and up to 30 weeks. I managed to improve it after really upping my oral hygiene – including an electric toothbrush – but still a bit tender. The best thing was to go and get a full clean from the hygienist – I had to pay because it was more than a standard NHS clean, but it was worth it for the relief.’

Why are my teeth more sensitive during pregnancy?

Gastric reflux or morning sickness can cause erosion and, as a result, sensitivity. Talk to your dentist as they may be able to prescribe a fluoride product that will help neutralise the acid in the mouth.

In the meantime, make a note of any trigger foods – usually it’s hot drinks and cold things like ice-cream that set it off – and try to avoid them.

Why is my mouth so dry?

Your body needs to store more water to feed your increased blood supply – this can leave you feeling dehydrated and make your mouth feel dry. A dry mouth is a reasonably common symptom of pregnancy (as is excess saliva production, interestingly), but it can contribute to tooth decay as saliva neutralises acids and keeps teeth cleaner.

You can try chewing sugar-free gum to increase saliva in the mouth if this affects you, and make sure you keep drinking plenty of water.

When should I visit the dentist during pregnancy?

It's worth going for a check-up and a hygiene appointment as soon you find out you're pregnant, as teeth and gums are more vulnerable to problems in pregnancy. However, many women find that when they’re suffering from nausea, the thing most likely to set it off is someone poking about with mirrors and brushes! If you think you won’t be able to stand it, leave the check-up until the nausea has subsided.

If you’re suffering from bleeding gums or have other concerns, however, you should make an appointment to see your dentist straight away.

Between week 14 and week 20 is the ideal time for a routine dental visit.

How do I get free dental treatment in pregnancy?

All pregnant women are entitled to free dental treatment, which continues up until the baby is 12 months old. To get free NHS dental care, you just need to have a MatB1 form or a maternity exemption certificate. The MatB1 can be supplied by your GP or midwife and to get your maternity exemption form, you just need a midwife, GP or health visitor to sign an FW8 form.

The certificate runs from a month before the date your application is received until 12 months after your due date. Once your baby is born, you may also need to show your baby’s birth certificate (though if you’re pushing the pram they might not question you too closely). It’s worth checking up on what your other rights and benefits during maternity leave are, too, to make sure you’re getting everything you are entitled to.

Are any dental treatments not covered?

Your free treatment covers any essential dental treatment you may need during this period. If there are treatments you can’t have during pregnancy, such as removal of an amalgam filling, don’t forget you can schedule this for after your baby is born. Free treatment continues until your child’s first birthday so there’s plenty of time to get it done.

Obviously, any non-essential or cosmetic work (such as braces or tooth-whitening) are not covered so alas, if you ‘save up’ everything you’ve ever wanted done for when you’re pregnant, you’ll be sorely disappointed.

Is dental treatment safe in pregnancy?

Most dental treatments are safe but always tell your dentist you are pregnant, as there may be some things they’ll want to avoid. Here are a few common questions about dental treatment during pregnancy answered.

Can dental x-rays harm my baby?

Most dentists try to avoid x-rays in the first trimester (and beyond) unless absolutely necessary. If an x-ray is needed, they will probably suggest waiting until after your baby is born to do it – although they are thought to be safe as the x-ray is going nowhere near your abdomen. If you have one, you will be provided with a lead apron and collar and the use of digital and high-speed films has lowered the exposure needed.

Is it safe to have local anaesthetic if I have to have a filling when pregnant?

Yes, local anaesthetics used in general practice, are safe during pregnancy. If you think about it, an epidural is a local anaesthetic, too, and there’s no problem with them.

Are amalgam fillings dangerous in pregnancy?

Using amalgam as a filling is still a controversial issue. It is recognised that amalgam restorations release mercury, which is also known to cross the placenta and cause congenital malformation. But the mercury vapour released by amalgam filling is well below the toxic level. However, there are various alternative materials for filling teeth that offer a safe and aesthetic option, and that’s what your dentist will probably recommend.

If I have a tooth infection, can I take antibiotics or painkillers when I'm pregnant?

Penicillin V and amoxicillin can be given to pregnant women. You won’t be offered most of the others drugs available unless in very special circumstances when pregnant. In terms of painkillers, the NHS recommends you avoid all painkillers if possible in the first trimester but paracetamol can be taken if you need to later on. If you’re in real agony though, speak to a midwife as other painkillers can be recommended for safe use.

Will it be uncomfortable or dangerous to sit back in the dental chair?

Sitting comfortably in a dentist's chair can be a problem in the third trimester because the uterus may obstruct the vena cava (the large vein that carries blood back to your heart) and pelvic veins. If treatment is necessary, place a small pillow under your right hip. This will make you lean on your left-hand side and take pressure off the vena cava.