The Tribune

By DR ANDRE CLARKE

PREGNANCY is a time of great happiness and fulfilment for most women. However, both the woman and her developing child face various health risks during the nine months of pregnancy. It is during this gestation period that the expectant mother’s diet, habits and hormonal changes impact her health and that of her unborn child. It is therefore essential that all pregnancies be monitored by skilled healthcare providers to ensure the health of the woman during the pregnancy, childbirth and the postpartum period (weeks immediately following childbirth).

Anecdotally, it is accepted that approximately 10 per cent of all women in the age group 15 years to 44 years are pregnant and, of course, that all of these women have mouth changes associated with pregnancy. Some changes are minor and may go unnoticed, while others are very noticeable.

There is a notion that pregnancy causes tooth loss (“a teet pull out for ew’ry baby”) and that calcium is removed in significant amounts from the mother’s teeth to supply the unborn child’s needs. There is no scientific evidence to support this. Calcium present in the teeth is in a stable crystalline form, and as such, is not available to the systemic circulation.

Dental cavities

There exists a relationship between dental cavities and pregnancy, although it is not well defined. Pregnancy does not directly contribute to cavities; an increase in cavities during pregnancy can be attributed to a rise in local cavity forming factors. This rise occurs because pregnancy commonly causes an increase in appetite and often a craving for unusual foods. When these cravings are for foods which can cause cavities in the absence of proper oral hygiene, the pregnant woman increases her risk of getting cavities at this time.

Morning sickness vomiting

Sometimes in pregnancy teeth can become worn away because of stomach acid washing over them. This can occur as a result of repeated morning sickness vomiting or esophageal reflux disease. It is advisable for an expectant mother to rinse her mouth with water immediately after vomiting to remove the residue stomach acid from the mouth thereby reducing any potential damage to teeth.

Gingivitis

Gingivitis (inflamed gums) is the commonest mouth change associated with pregnancy. It has been reported to occur in 60 per cent to 75 per cent of all pregnant women. Gum changes usually occur in association with poor oral hygiene and local irritants, especially plaque. However, the hormonal and vascular (blood vessels) changes that accompany pregnancy often exaggerate the inflammatory response to these local irritants. Gum changes are most noticeable from the second month of gestation, reaching a maximum in the eighth month. These changes occur earlier and more frequently to the front of the mouth. The severity of the gum disease lessens after childbirth, but the gums do not necessarily return to its pre-pregnancy condition.

Pregnancy tumours

In addition, pregnancy may also cause single, tumour-like growths on the gums in 10 per cent of pregnant women. It usually occurs on the gum that is between the teeth or other areas of frequent irritation. This localised area of gum enlargement is called a pregnancy tumour, epulis gravidarum or pregnancy granuloma. Generally, the lesion will regress after childbirth, however, surgical removal is often required for complete removal.

Hormonal alterations

Hormonal alterations associated with pregnancy sometimes also cause dry mouth and drinking more water and chewing sugarless gum can help. These hormonal changes can sometimes also cause pregnant women to have excessive secretion of saliva. It usually begins at two to three weeks into the pregnancy gestation and may abate at the end of the first trimester. In some instances, it continues until the day of delivery.

Periodontal disease

All pregnant women want the best for themselves and their unborn baby and must be aware of all the factors that can influence their baby’s health. A preterm birth is one common cause of low birth weight, which has unwanted health impacts of a newborn. Maternal risk factors for preterm low birth weight (PLBW) include: age, low socioeconomic status, alcohol and tobacco use, diabetes, obesity, hypertension and genitourinary tract infections. PLBW results in significant morbidity and mortality of infants.

Recent research suggests a previously unrecognised risk factor for PLBW. Periodontal disease is that risk factor. Health care for the pregnant woman should therefore include an assessment of her mouth and gums. If diagnosed, periodontal disease must be treated. It should include a thorough cleaning or scaling and a root planning, to decrease the infection and subsequent inflammation caused by the disease. This will reduce the risk of PLBW and the unwanted health impacts it has on the newborn.

It is important then, if you are pregnant or considering becoming pregnant, that you seek a consultation with your dentist and doctor for a complete comprehensive assessment. Your unborn child is your most precious gift.

• This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication.”