Bleeding Gums during Pregnancy

Do not be too surprised if you find your gums more prone to soreness, swelling and even occasional bleeding while you are pregnant. It is yet another ‘normal’ symptom of pregnancy ^[1] along with nausea, fatigue, and nosebleeds. Pregnancy gingivitis, a bacterial dental disorder characterized by inflamed bleeding gums, affects around 60% to 75% of all pregnant women ^[2]. Although often considered a non-contagious condition, bacteria present in the saliva of an affected person may be transmitted by kissing or sharing foods.

You may also notice some red fleshy bumps inside your mouth that may also bleed during brushing. These are pyogenic granulomas, also known as pregnancy granulomas or pregnancy tumors, a completely benign growth despite its scary name ^{[3, 4]}.

Is bleeding gum an early sign of pregnancy

Although quite common in the first trimester, itchy, swollen bleeding gums are not considered an early pregnancy symptom as they usually occur between the 8th and 30th weeks ^[5], often increasing in severity towards the second trimester ^[6].

What causes swollen and bleeding gums during pregnancy

After you conceive, your blood volume increases by up to 50% to provide your baby with enough oxygen and nutrients. As a result all your tissues and organs, including the gums, have a higher blood circulation. It often leads to swelling and bleeding, usually after brushing or flossing, increasing their risk of getting inflamed ^[7]. The symptom is more likely to occur if you are carrying twins as the increase in blood volume is even higher in a multiple pregnancy ^[21].

Pregnancy gingivitis causes

The higher pregnancy hormone levels, especially the estrogen and progesterone, are known to be responsible ^{[8, 9]} for making the gums more sensitive to the toxins resulting from dental plaque, while also providing a suitable atmosphere for the growth of some gingivitis-causing bacteria ^[6]. Pregnancy is also known to worsen any chronic gum disorders in the mother ^[5].

How can pregnancy gingivitis affect your pregnancy

With a prevalence of over 50%, the mild form of the condition does not harm you or your baby in any way, provided you take proper care of your gums and teeth ^[10]. However, leaving gingivitis untreated can lead to periodontal disease or periodontitis that may even cause your teeth to fall out by destroying the bone and gum fibers holding the roots ^[11].

Additionally, the harmful bacterial activities involved in periodontal disease often cause recurrent bacteremia, which in turn may induce higher production of certain protein and lipid compounds (cytokines, prostaglandins etc.) that can have a negative effect on pregnancy and labor ^[2].

Researches show that the risks premature delivery and low birth weight are eight times higher in women with periodontal gum disease ^{[11, 12]}. According to studies, eighteen out of every one hundred cases of premature deliveries have the gum condition as a possible triggering factor ^[13].

Additionally, recent researches have associated poor dental health with increased chances of preeclampsia in expecting women ^[22].

Gum care to prevent and manage gingivitis during pregnancy

The symptoms of sore and bleeding gums occurring in pregnancy do not usually cause any permanent damage ^[14], resolving on their own shortly after delivery ^[15]. One study shows that proper gum care reduces the risk of preterm birth by over 80%, even in case of gingivitis and periodontal disease ^{[13, 11]}. Here are some tips and home remedies to help you avoid any serious issues:

Making sure to brush twice a day (once in the morning and once before bedtime), preferably with an electric toothbrush, brushing for at least two minutes each time ^[16].
Using an anti-plaque fluoride toothpaste and flossing daily to prevent bacterial accumulation in the mouth.
Rinsing your mouth with a mouthwash at least twice a day; consult your dentist regarding what is safe while pregnant or breastfeeding ^[1]. You may also opt for warm salt water (1 teaspoon salt in 1 cup water) for rinsing your mouth ^[6].
Brushing or at least rinsing your mouth well every time after you throw up as it removes the bacteria and stomach acids that remain in your mouth after vomiting ^[17]. However, brushing immediately might harm your gums as they may be softened by the acids; so make sure to wait for about an hour ^[18].
Including lots of calcium rich foods in your daily diet as sufficient calcium is necessary to maintain your bone and teeth health while providing adequate nutrition to your developing baby ^[13].
Getting enough vitamin C to keep your gums strong, reducing the chances of bleeding.
Avoiding sticky sweets and sugary drinks as much as possible.
When you can’t brush immediately after a meal, chewing a sugarless gum, or having some nuts or a small piece of cheese might help as they all have considerable antibacterial properties ^[17].
Giving up smoking as it may worsen any gum problems.

Safety of dental procedures in pregnancy

Consider going for a periodontal examination before planning to get pregnant. Seeing your dentist regularly during pregnancy is strongly advised, especially if you have diabetes or a family history of the condition, as women with diabetes are more at risk of developing periodontal disease ^[15]

All dental procedures and surgeries are usually postponed until after your baby is born unless absolutely necessary. Antibiotic medications should also be avoided without proper medical guidance. Make sure to inform your dentist about your pregnancy as common medical procedures such as replacement fillings and x-rays are not recommended in pregnancy ^[18].

Warning signs: When to call the doctor

Watch out for the following symptoms as they may indicate a severe case of gingivitis or even periodontal disease ^[15]:

Considerable toothache that refuses to go away
Severely inflamed, swollen or painful gums
Excessive or prolonged bleeding from the gums
Sensitive or loosening teeth ^[19]
Persistent bad breath
Unusual growths in your mouth that may or may not be painful ^[20]
An unpleasant taste in the mouth

Make sure to contact your health care practitioner or dentist in case you experience any of the above symptoms to prevent any possible complications.

ICD-9 and ICD-10 Codes

Gingivitis

ICD-10: K05.0 – K05.1 ^[24]

ICD-9: 523.0 – 523.1 ^[25]

Periodontitis

ICD-10: K05.4 ^[23]

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