Women Oral Health

October 23, 2021

Women Oral Health

।।नास्ति मातृसमा छाया, नास्ति मातृसमा गति:। नास्ति मातृसमं त्राणं. नास्ति मातृसमा प्रिया।।
There is no shadow like a mother; there is no support like that of a mother. There is no protector like a mother and there is no dear thing like a mother”.

-Maharshi Ved Vyas (Skanda Purana)

Last fortnight, the world celebrated Durga Puja, Navratri, and Dussehra. On that note, I hereby present my 1^st post dedicated to all mothers, of now and the future.


Courtesy: Jagriti Mishra(https://www.pinterest.ca/jagriti9893)

“Mother”- the mere word is synonymous with sacrifices. Such is the magnitude of it, that everybody around her and she herself, often neglect one of the important entities of life; health. Being a dentist, I strongly advocate oral health. Therefore, today we will have a brief discussion about women oral health.

 Keywords: women health, oral health, dental, puberty, pregnancy, menopause

A woman’s body faces a great amount of hardship throughout her lifespan. From the onset of puberty, through pregnancy, and till menopause, the body rides through a rough road with frequent bumps and craters. Moreover, the lifestyle factors, like heavy workload, erratic food habits, and deleterious habits worsen the situation even more. In such a scenario, we cannot ignore the significance of oral health and its connection with overall being in women. As experts, adverse pregnancy outcomes, respiratory disease, cardiovascular disease, and diabetes have been cited as likely results of poor oral health.

The drastic changes in women health commence as early as puberty. The surges of the reproductive hormones, chemically steroids, modify the blood flow and permeability not only in the uterine lining but also the gums. Gums respond differently to the microflora in the mouth of pubescent women resulting in cavities and bad breath, along with gingivitis.

Ulcers and puffed-up salivary glands are also symptoms that a woman may experience during her menstrual rounds. Redness, swelling and bleeding in the mouth are very prevalent in adolescent girls. Increased permeability of the oral lining coupled with mood swings and altered metabolism modifies food habits. Therefore, girls also experience an increase in dental calculi (stones) and caries formation owing to food lodgement in the mouth.

The use of birth control medications by young women is no more taboo and rather very general. However, as our elders say “a little knowledge is a dangerous thing”. the wellbeing of the mouth, while taking contraceptive pills is critical. Hormone levels in women using birth control pills, especially those containing progesterone, can increase blood flow to the gums. This aggravates the risk of gum ailments.

The working ladies, who undergo extended periods of starvation due to excess work followed by binge eating; as well as the fitness conscious ones, who prefer low intake of “calories”, either munching throughout the day or skipping an entire meal; please stop doing that! Not only are you ruining your gut with chronic diseases like gastric ulcer, but also your teeth by caries and erosion. Frequent exposure to food increases chances of food lodgement, which results in heightened bacterial activity decreasing oral pH resulting in cavities. Gastric problems like GERD (gastro-oesophageal reflux disease) result in erosion of the front teeth.

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By the time a woman is planning to conceive, she is already accustomed to rather indifferent and habituated to the experiences habits which she has been facing since puberty. Little is known to the “would-be mother” about the storm the body is going to endure. A mother's oral health can influence in general the health of her child, so it's vital to pay heed to dental care and any changes that may arise during pregnancy. An abundance of oestrogen and progesterone is the major offender behind the countless changes during pregnancy. While oestrogen causes gum redness and bleeding, progesterone results in swollen gums. “Pregnancy gingivitis”, “Morning Sickness”, and Hyperemesis gravidum^* (excessive vomiting during pregnancy) are some relative terms among dentists and gynaecologists.

A mother’s body, being relatively immune sensitive, acts as a harbour for infections. If not timely attended, the bone that supports the teeth would be lost, and the gums would become infected. Teeth with little bone support can become loose and may eventually have to be extracted. Periodontitis during pregnancy has also been linked to unwanted pregnancy outcomes, like preterm birth and low birth weight.

Excessive craving and altered eating habits, like frequent snacking and too much intake of seasoned food, lead to cavities. Mothers with untreated caries tend to transfer them to their newborns. A quarter of the women population of childbearing age has untreated cavities. Children, whose mothers have high levels of untreated cavities or tooth loss are thrice more liable to the same. Early childhood caries increases because of transmission from mother, added with poor feeding practices.

Gastric discomforts during pregnancy also manifest symptoms in the mouth as dryness or increased drooling, erosion of teeth, ulcers etc. An expecting mother also possibly suffers from a deficiency of nutrients like vitamin C and iron, which causes dryness of mouth, sores, bleeding gums and tongue infections.

Pyogenic granuloma, a common benign tumour that arises in the skin and mucous linings, is another exhibited ailment during gestation, probably due to hormonal factors. It is believed to have a high incidence in women, typically during childbearing years probably because sex hormones exaggerate inflammatory reaction in gingival tissue, chiefly in pregnancy. They can be caused by excess dental plaque accumulation. Pregnancy tumours look red and raw, and they bleed easily. These tumours mostly recede automatically after childbirth.

The ordeal of hormones in a female body is usually concluded with menopause. However, being a gradual process, the conclusion is often hurting. Postmenopausal women experience dry mouth due to a drop in saliva production, time and again. Saliva shields against periodontal diseases and tooth decay as it naturally washes the mouth off lodged food, balances acids in the mouth, fights germs and checks bad breath/halitosis.

The hormonal changes that occur during menopause can also increase a woman's risk of osteoporosis, which is shown to cause bone loss in the body (including jaws) and, as a result, tooth loss.

Dental health has mostly been on the back foot in a developing nation like ours, where providing medical aid itself is still a challenge. However, I feel if we can educate and make people aware of the bare minimum about oral health, things might slowly improve. Ours is a country where goddesses are worshipped, so it is a small and easy step to take care of the women in our houses.

It all starts with proper cleaning of the mouth by brushing, tongue cleaning, and flossing. Next is a healthy diet, high in fibre content for natural cleansing and nutrient-rich to prevent deficiency diseases. Frequent snacking should be discouraged and should be replaced with frequent rinsing, even by regularly drinking water. In my opinion, lukewarm saline water is one of the best home remedies to wash your mouth at regular intervals. A psychology expert should be consulted in case a woman is suffering from depression-induced eating disorders.

The use of contraceptive pills and hormonal therapies should always be under the supervision of a gynaecologist and a dentist should be consulted simultaneously.

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It is a notion in our country, that pregnant women should not undergo any kind of treatment during gestation. Well, I thwart it. Dental treatment during pregnancy is completely safe. The so-called “white coat hypertension”, that people have with doctors and particularly dentists, is just a myth. All possible, simple, and preventive care should be encouraged. A thorough history taking, with short appointments, prompt examinations, and drug prescription in accordance with treating gynaecologists are among the safest practices in such crucial times. The second trimester is considered safe enough for dental treatments and drug administrations. Common oral treatments and follow-ups during gestation include excavation and filling of untreated caries, oral prophylaxis (we know it better by the common name “scaling”), extraction of grossly destroyed carious teeth, and prescribing light oral gels for ulcers and sores. A general physician should also be consulted regularly for gastric ailments and deficiencies. All elective procedures are generally postponed during pregnancy. Even dental radiographs can be done during pregnancy, under extreme caution to safeguard the mother and the baby.

The use of bland-tasting toothpaste, under the prescription of the dentist, with optimum amounts of calcium and fluoride is an essential and useful alternative to counter morning sickness, and proving necessary calcium and fluoride to the baby as well. Ever heard of cavity preventing chewing gums? Well, I presume the answer is yes, thanks to those advertisements of models with blinding white light from their teeth. What I am implying is there are specialised medically prescribed chewing gums that have proven to be effective for mothers and their offspring in caries prevention. These contain xylitol, a sugar alcohol competing with the sugar in the mouth. Xylitol attracts the germs to itself, preventing them to act on the sugar on the tooth surface. This checks further damage to destroyed teeth and avoids the development of new cavities. Dental prescriptions often include salivary substitutes and mouthwashes as well. Dentists are also helpful with treating problems like bad breath, and osteoporosis through supportive treatments in regular discussion with other specialists.

The various stages in the life of a woman and their implications on well being are inevitable, but they don't have to deprive women of the gift of a healthy smile at all times. To quote Professor Mahmoud F Fathalla, former president of the Federation Internationale of Gynaecology and Obstetrics-

“Society has an obligation to fulfil a woman’s right to life and health when she is risking death to give us life.”

Women can uphold their oral health through fine healthy habits and oral health maintenance, regularly visiting the dentist and following a healthy diet. Every woman deserves good oral health and we can together plant the foundation stone of it right from birth. So let us resolve to do our bit for the healthy smile of the living goddesses at home.