Menstruation, Oral Contraceptives and Gum Health

Menstrual cycles certainly don’t cause gum disease, but they can allow a low grade bacterial infection of the gums to blossom into a flare-up that might otherwise be easily ignored.  Hormones such as estrogen, testosterone and progesterone fluctuate on a monthly basis.  For some women, there’s no noticeable effect on the gums and mouth.  For others, however, swollen and bleeding gums, canker sores, gum lesions or swollen salivary glands can appear a few days before a period.  The flare-up usually subsides once the period has started.

Before a period starts, progesterone levels are high, causing blood vessels in the gum tissues to dilate and thereby increasing any pre-existing, low level inflammation of gingivitis.  Progesterone also blocks the repair of collagen, the main protein that comprises the connective tissue of the gums and of the tooth-supporting cells, so that the infected gums don’t heal as well.

Estrogen levels peak and fall twice during each cycle.  While at a high level, estrogen keeps the mucous membranes moist and flexible.  But during low levels, the mouth tissue may become dry and the natural pH of the mouth disturbed, making the gums more vulnerable to infection by the bacteria that cause gingivitis.

If a bacterial infection takes hold and if over time repeated flare-ups lead to deeper penetration by the infection, a common result is periodontal disease, which means the net loss of cells that support the teeth.

Low estrogen levels are also associated with reduced levels of bone remodeling, so that the equilibrium between cell breakdown and cell replacement can be upset in the tooth-supporting alveolar bones.

If in younger years periodontal disease is allowed to take hold, and if tooth-supporting cells become reduced during the periodic slowdowns in cell production, the stage has been set for tooth loss and possible serious diseases later in life .  By the age of 65, almost a third of women have lost many if not all of their teeth.  The situation tends to be worse for impoverished minority women, but a 2005 study in Buffalo, New York on post-menopausal white women showed that over half of them also had problems, having lost at least one tooth to periodontal disease in the previous 10 to 13 years of the study.

But as drastic as these outcomes are, they are far from inevitable.  You can take control of your health by keeping your gum tissue robust and by keeping your gums as free as you can of bacterial infection so that there’s no infection to be aggravated.  We don’t recommend trying to overcome the balances of nature by combining a lifestyle of unhealthy habits with a “magic bullet” of drugs or rinses.  Instead we recommend adopting healthful habits and natural supplementation as described elsewhere on this website.

Oral contraceptives used to be notorious for bringing about inflamed gums, even when there was very little plaque.  The earlier formulations had higher concentrations of hormones, and the progesterone had a similar inflammatory effect as did the high progesterone levels preceding a period as described above.  Newer formulations have reduced concentrations, and recent reports show a lesser tendency for gum problems.  Still, if inflamed gums appear in the first few months of starting an oral contraceptive, consider that the same hormonal influences could be at work as described above.

Also be cautious when taking medications for combating gum inflammation.  The effect of some medications such as antibiotics can reduce the effectiveness of an oral contraceptive.  Ask your dentist about possible interactions.