Menstruation Could Be the Cause of Your Mouth Pain

Cramps, bloating, fatigue, irritability—the common symptoms of premenstrual syndrome (PMS) are bad enough. But it turns out there are some lesser-known PMS symptoms that can affect your health as well. Let's talk about menstruation gingivitis.

Menstruation gingivitis is the increased gum inflammation, tooth pain and mouth discomfort that some women experience in the days leading up to their period.

"According to the American Academy of Periodontology, more than 38 percent of women undergo gum disease due to hormonal changes," stated Fatima Khan, D.M.D., a dentist in Houston and the co-founder of Riven, a probiotic-based mouthwash.

These hormonal changes can be caused by several factors, Khan said, including:

• Puberty
• Menstruation
• Pregnancy
• Menopause
• Birth control

How hormones affect mouth health

Hormone fluctuations caused by these factors can lead to unique oral health challenges for women, according to Cleveland Clinic.

"Estrogen and progesterone increase prior to menses, increasing blood flow to the gums, thus, making them more sensitive to bacteria and plaque buildup," said Kecia Gaither, M.D., M.P.H., board-certified in OB-GYN and maternal-fetal medicine and director of perinatal services/maternal fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx in New York City.

"As a result, the gums become swollen, reddened and inflamed, and bleed more often with brushing and flossing," Gaither continued.

Symptoms of menstruation gingivitis

There are several common symptoms that may indicate you are suffering from menstruation gingivitis, such as:

• Red or brighter gums
• Puffy or inflamed gums
• Gums that are tender or bleed when you brush
• Canker sores or mouth ulcers
• Bad breath
• Swelling of the salivary glands
• Tooth pain or sensitivity to hot and cold

In essence, the symptoms of menstruation gingivitis are the same as those for gingivitis in general. Unlike regular gingivitis, however, the symptoms of the PMS version are short-lived.

"Menstruation gingivitis is different in that the increase in hormones during the luteal phase of the menstrual cycle causes these symptoms to be exacerbated. In fact, during this time frame may be the only time the symptoms are noticeable to the patient," explained Whitney White, D.D.S., dentist and managing clinical director at the Aspen Dental location in Cedar Park, Texas.

You may start experiencing symptoms a couple of days before the start of your period and then they should be gone a day or two after its onset, Khan said.

"If the symptoms still present after your period or symptoms become worse, address this with your dental provider," Khan said.

How common are dental issues before a period?

"Menstruation gingivitis is a relatively common clinical entity," Gaither stated.

More than 24 percent of women have symptoms of gingivitis during PMS, according to a 2019 study of 318 women published in the Journal of International Oral Health. In comparison, only 4.7 percent of participants who were currently menstruating experienced gingivitis, and none of the women in the postmenstrual period group had symptoms of the condition.

"Menstruation gingivitis occurs higher in the premenstrual period," researchers concluded.

Some women are more susceptible to menstruation gingivitis than others. Menstrual cycle irregularity may be a risk factor for tooth pain and chewing discomfort, such as throbbing and sensitivity when eating or drinking hot or cold food and beverages, according to a 2019 study of more than 4,500 participants published in the Journal of Clinical Medicine.

Additionally, women with preexisting dental conditions may find their symptoms flaring up more than usual during PMS. A 2012 study published in the journal Oral Health & Preventive Dentistry found "women with gingivitis showed aggravated inflammation during ovulation and premenstruation as compared to menstruation."

"With research, they've shown that someone who has healthy gums will not have menstruation gingivitis," White stated. "If you have preexisting inflamed gums, you already have gingivitis. These hormones in the luteal phase will exaggerate those preexisting gingivitis symptoms of inflammation and bleeding."

Treating mouth pain caused by PMS

It may be tempting to forgo brushing and flossing during PMS if your teeth are sensitive and your gums are inflamed. However, healthcare professionals strongly recommend you maintain a regular dental hygiene routine.

"If you have excellent oral hygiene habits, you're not going to have the redness, the bleeding and that sensitivity," White said.

Khan and White suggested the following if you're experiencing menstruation gingivitis:

• Brush twice a day for at least two minutes each time
• Floss daily
• Invest in an electric toothbrush, which may help eliminate plaque better
• Eat well-balanced and nutrient-rich meals
• Rinse with warm saltwater to decrease inflammation
• Visit your dentist for regular cleanings

"Having routine professional dental cleanings, practicing good oral hygiene with brushing and flossing post-meals [and] utilizing mouthwash rinses after meals as well can be of help to remove plaque and food debris," Gaither added.

When to see a dentist

The good news is that gingivitis is reversible.

"If you do good oral hygiene habits at home…gingivitis and, subsequently, menstruation gingivitis is something that's reversible," White confirmed.

"Although gingivitis is reversible, it is important you do not allow it to progress, and early intervention is key," Khan cautioned.

"It's important to take gingivitis seriously because it can lead to a much more serious gum condition called gum disease or periodontitis," White explained. "Gum disease can lead to tooth loss and it's actually the number one cause of tooth loss."

Bleeding gums should also be taken seriously, White added.

"There should be an urgency for patients to see their dentists when they have any bleeding happening to see if it is indeed gingivitis or if it's progressed to gum disease," White said. "Gum disease is an active infection and, unlike gingivitis, its effects are irreversible."

It may be helpful to keep a journal to track your period so you have a record of when PMS symptoms, such as menstruation gingivitis, flare up and dissipate. This practice can empower you with information you can then share with your healthcare providers, so they can help determine the right treatment for you.