It tends to arrive sideways. A woman is writing a list of everything that has gone strange — the sleep, the joints, the ears — and somewhere near the bottom, between the dry eyes and the plantar fasciitis, are her gums.
I pulled on my pjs which are way tighter than they were 6 months ago and brushed my receding gums.
That line comes from a post titled What is this life, which scored 1,324. It is a diary of an ordinary evening in perimenopause, and the gums are in it the way they are in a lot of these posts: as one more thing, mentioned in passing, that nobody had warned her about.
Before anything else: when a mouth problem needs someone today
Mouth symptoms get waved off because they feel small. Most of the time they are. These are the ones that are not.
Go now, to an emergency department or an urgent dental service:
- Swelling in your face, jaw or under your tongue, especially with a fever.
- Any difficulty swallowing or breathing alongside a mouth or tooth problem.
- Bleeding from the gums that does not stop with firm pressure.
See a doctor or dentist this week, not at the next check-up:
- Gums that bleed together with bruising you cannot explain, frequent nosebleeds, or periods that have become much heavier. Ask for a blood test.
- A dry mouth that comes with constant thirst, passing more urine than usual, or weight loss you did not try for.
- A dry mouth together with gritty, dry eyes, and especially with joint pain as well.
- A sore, ulcer, lump, or a white or red patch anywhere in your mouth that has not healed in three weeks.
- A tooth that has become loose.
- A burning mouth or tongue, so that someone can look for anything visible before it is put down to anything else.
And one that belongs with a pharmacist: if the dryness began around the time you started a new medicine of any kind, read the leaflet and ask. That is a five-minute conversation and it is often the whole answer.
Why are my gums bleeding and my mouth so dry?
The honest short answer is that we cannot tell you, and neither can anyone who has not looked in your mouth. What we can tell you is that you are not imagining it and you are not the only woman asking.
Gums, teeth and a dry or burning mouth sit in an odd place. They are rarely the reason a woman starts reading about perimenopause, and they are rarely what she raises at the appointment where perimenopause comes up. They turn up instead in the long lists, written by women who have just worked out that ten unrelated-seeming things might be one thing.
Burning tongue with nothing to see
That line is from a list in a post that scored 396. It ends with the sentence many of these lists end with:
It took me seeing 3 doctors to find that out.
This is the pattern across the whole subject, not just mouths. She almost always works it out herself — from a community, a podcast, a friend or her mother. Rarely from a clinician. And because a dentist and a gynaecologist do not usually compare notes, the mouth is one of the places where nobody is in a position to join the dots unless she hands them the list.
It is also worth being exact about the word. Perimenopause is the years before periods stop; menopause is the point after twelve months without one. A woman of forty-three with bleeding gums and a cycle that has gone strange is talking about the first of those, and that is worth saying to the dentist in those terms.
What a dentist can see that you cannot
You can see your gums in a bathroom mirror. You cannot see most of what a dentist and hygienist are checking for, which is the point of going.
The gum line, measured
At a check-up a hygienist can measure the small gap where each tooth meets the gum, all the way round, and write the numbers down. That is a record you can compare next time. Ask whether it was done and what the numbers were. A record from this year is far more useful in two years than your memory of how your gums used to feel.
What happens between the teeth and below the gum
Early decay between teeth and changes below the gum line do not show in a mirror. That is what x-rays and a trained eye are for. If the last set was a long time ago, ask whether it is time.
Wear from grinding
Grinding mostly happens asleep, which means the person doing it is the last to know. A dentist can see wear on the biting edges and may ask whether your jaw aches in the morning.
I ended up having such bad nightmares that I was grinding my teeth so bad that I damaged one of the molars in my mouth so badly that it may actually have to be taken out at some point.
That comment scored 9, in a thread about not being listened to. If your sleep has gone to pieces, mention the sleep to the dentist as well as the teeth. The two conversations are connected even when the appointments are not.
The soft parts of the mouth
A dentist looks at the tongue, the cheeks, the floor of the mouth and the roof of it, not just the teeth. That examination is the one that matters most for a burning tongue, a patch that will not go away, or a sore that keeps coming back.
The midnight snack problem
The perimenopause communities have a running joke about eating at three in the morning. A post titled Whoever posted about 3 am applesauce scored 1,318. Underneath it, one commenter who said she was a dentist left this:
Please rinse your mouth with water or fluoride mouthwash while in the bathroom after these midnight snacks.
She went on to say she was worried about cavities appearing out of nowhere from middle-of-the-night food. The comment scored 11. The reply below it scored 4 and is the best thing in the thread:
My teeth are plastic, but good advice
If your nights are broken and you are eating during them, that is a habit your dentist should hear about. The fix she suggested costs nothing: a glass of water by the bed and a rinse before you lie back down. If the waking itself is the problem, the article on waking at 3 a.m. is where to start.
What to do this week
None of this treats anything. It gets you into the right chair, with the right information, sooner.
Book the check-up now, not at the recall
The recall letter is a routine interval for a mouth that has not changed. If yours has changed — bleeding, new sensitivity, a tooth that feels different, a dry or burning mouth — book now and say on the phone what has changed, so the appointment is long enough to look properly. If the hygienist and the dentist are separate appointments at your practice, ask which one to book first for what you are describing.
Track the dryness for two weeks
A dry mouth is hard to describe in a surgery and easy to describe from notes. Once a day, write down three things: when the dryness was worst (night, waking, afternoon), what you drank the evening before, including coffee and wine, and whether you woke in the night. Two weeks of that turns "my mouth is dry" into a pattern someone can work with. The guide to tracking symptoms for an appointment has a simple format.
Keep water where the dryness happens
A glass of water by the bed and one at the desk. Not as a treatment, as an experiment: notice whether sipping through the day changes what you write in the notes. If the dryness is worst after an evening drink, the notes will show you that too, and it is worth knowing.
Read the leaflets
Gather every medicine, prescription or otherwise, that you have started in the past year. Check each leaflet for dry mouth. Take anything that lists it to a pharmacist and ask whether it could be part of the picture. Do not stop anything on your own.
Write the list for the hygienist
Before the appointment, on one sheet, write what has changed and when. Bring it and hand it over at the start, before anyone has a mirror in your mouth.
What to tell the hygienist
Hygienists and dentists see the mouth twice a year at most. Everything that happens in between, they only know if you tell them.
That last question matters. If the dentist sees something that should go to a doctor, ask them to write it down, so that it reaches the next appointment in their words rather than yours.
Why the mouth is worth the bother
The odd symptoms get skipped because each one alone looks too small to raise. A bleeding gum is not an appointment. A dry mouth is not an appointment. A burning tongue sounds like something you would be embarrassed to say out loud.
Put them on one page with the dates, though, next to the sleep and the cycle and the itching, and they stop being small. They become part of a picture that someone with the right training can read. The mouth is one of the few places where a professional looks closely at you twice a year whether or not anything is wrong. It is worth making sure they know what to look for.