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Pregnancy Dental Care

The joys of pregnancy are so overwhelming that it should not get dampened by any health problems. During this period a lot of changes takes place in the body both hormonal and emotional. The health (mental and physical) should be maintained for the whole nine months and beyond because it is not one but two lives getting affected by it. During the pregnancy period a lot of changes takes place in the mouth and teeth which are very commonly overlooked. The reason being that there are so many changes in the body during pregnancy which draw the patients’ attention that teeth are many times overlooked. To be informed about the dental problems and taking care of the symptoms is as important as another problem faced during pregnancy. The main changes are the hormonal changes that take place during this period.

The most advent dental manifestation of hormonal change seen during pregnancy is gingivitis that is, inflammation of the gingiva or the gums.This causes swelling of the gums which makes the cleaning of the teeth difficult. Here a point should be cleared that pregnancy itself does not cause gingivitis. Gingivitis in pregnancy is caused by the bacterial plaque, just as it is in non pregnant individuals. Pregnancy just concentrates the response of the gums or gingival to plaque and changes the basic picture of it. The saying that ‘A tooth for every child’ has been widely quoted for many years. It is definitely a misconception. It should also be remembered that there is no mechanism for the physiologic withdrawal of calcium from tooth as there is from bone, so that a developing foetus cannot calcify at the expense of the mother’s teeth. Some studies also show that, pregnant women are more likely to have a premature babies of low birth weight and other health problems if their dental/health is not optimal. The effect of pregnancy on the gums in respect to the local irritants are explained on a hormonal basis.

During pregnancy there is an increase in the oestrogen and progesterone levels and a reduction after delivery. Due to the change, there is an aggravation of gingivitis as the blood flow to the body tissues increases. There would be no notable changes in the gums during pregnancy in the absence of factors contributing to gingivitis that is, dental plaque etc. From the second or third month the sensitivity of gingiva is increased. But the awareness of the symptoms become excessive if slight chronic gingivitis was present before pregnancy. The gums become enlarged, swollen and discolored. Gingivitis becomes more severe by the eighth month and declines during the ninth month. With time there is a partial decrease in the severity of gingivitis by two months after delivery. After one year the condition of the gums or gingiva in comparison to people who have not been pregnant is seen to be the same. However, the gingiva does not return to normal as long as the local irritants such as plaque, food debris and bacteria are present. A very striking clinical feature seen during pregnancy is increased vascularity, that is, increasing of blood flow to the site. The gums are inflamed and swollen and the colour varies from being bright red to bluish red. The gums on the margins of the tooth and the inter dental gingiva, that is, gums in between the teeth are swollen and soft, gets pressed or pits on pressure and appear smooth and shiny. Due to the increased blood flow, the tendency to bleed is accentuated. It has also been suggested that the severity of gingivitis in pregnancy occurs in two peaks. First, during the first trimester when there is an over production of gonadotropins and the second in third trimester when the levels of estrogen and progesterone are the highest. As the gums become very fragile and bleed easily during this period, a widely propagated habit of not brushing the teeth is seen during pregnancy as there is an upward fragility and tendency of bleeding gums. This has led many people to believe the theory that pregnancy causes tooth loss and brushing would also lead to the loss of blood due to gingivitis. Due to this myth, pregnant women avoid brushing which further leads to worsening of the problem.

A visit to a dentist for complete assessment of your dental health is essential before conception. Good and apt oral hygiene measures are essential during the period of pregnancy along with flossing. Flossing clears the areas where a tooth brush is not able to reach. A dentist would ideally not prefer to carry out any extensive treatment during the pregnancy. So it is very important to get all medical and dental checkups done before you plan a pregnancy to prevent any eventuality. However, if any, extensive treatment has to be undertaken, it is advisable to get it in the second trimester when the foetal development is complete. But it is better to consult a gynaecologist before undergoing any treatment. One should always inform the dentist of their pregnancy status because certain medication should be avoided during this period. Being pregnant should not stop you from seeking the help of a dentist for your dental problems, as pain or swelling should not be ignored. Delay may cause complications and by consulting on time for more damage can be avoided to both the mother and to the developing foetus. Adding all up, if you are pregnant, you should have special oral health care. As mentioned earlier, a complete oral examination is important before and very early in pregnancy. .

Hormonal contraceptives and gums
If any plaque or tartar is already present, the contraceptives will aggravate the condition similar to that seen in pregnancy. The contraceptive pills contain hormones which cause increased vascularity which can aggravate already existing gingivitis. The hormones do not cause any kind of gingivitis in a clean and healthy mouth.

1. Dr. Sachin Arora, Defeat Dental Problems, 2010, 132p

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