Good oral health for two: Mother and baby
- Part 1 -

Dr Kh Eremba *

Good health starts with a healthy mouth.

Pregnancy is a unique period during a woman's life and is characterized by complex physiological changes which affect the oral health. Health professionals often don't provide oral health care to pregnant women and at same time pregnant women themselves often avoid dental care with obvious signs of oral disease and resist to seek or receive care. They also are not aware that oral health care is an important component of a healthy pregnancy.

Most common oral problems during pregnancy:

Pregnancy gingivitis: Pregnancy does not cause gingivitis (inflammation of gingiva). If pregnant women do not clean their oral cavity thoroughly, the hormonal changes during pregnancy may exaggerate the response of the gum tissues to the plaque bacterial toxins resulting in red, puffy, sore, swollen and bleeding gums. This is called "Pregnancy Gingivitis".

Remedy: Preventive aspects like maintaining good oral health (brushing properly after every meal, flossing, using antimicrobial mouth rinses) and treatment aspect like getting an oral prophylaxis. Pregnant women should not skip professional oral prophylaxis (scaling) just because of pregnancy.

Periodontitis: It is a chronic oral disease which attacks the supporting structures of the teeth. Some symptoms will include food lodgment, gums beginning to separate from the teeth, halitosis (bad/foul odor from mouth), recent spacing between teeth or teeth becoming loose. Periodontal treatment is rather necessary during pregnancy, owing to the fact that hormonal changes taking place during pregnancy can render the women more susceptible to plaque accumulation and gingival inflammation. Any acute periodontal infection should be treated as soon as possible to avoid any harm to the mother and the developing fetus.

Periodontal disease can affect a developing baby

Mothers with severe periodontitis have high levels of "Prostaglandin" in their gingival crevicular fluid and blood. These increased levels of prostaglandins may be associated with uterine contractions leading to preterm deliveries with increased risk of range of health conditions. Children of preterm birth are prone to many serious medical problems, such as cerebral palsy, seizure disorders, severe mental retardation, and lower respiratory tract infections.

Preterm birth also deleteriously affects the structure of dental enamel, which is likely to increase susceptibility to dental caries.

Remedy: Preventive aspects like use of proper oral hygiene habits, balanced diet, discontinuation from tobacco and its products and alcohol use, use of anticalculus and antiplaque mouth rinses. The treatment aspects would include professional oral prophylaxis.

Tooth sensitivity:

During pregnancy, an expectant mother may crave for acidic food or vomit easily. These acidic food and vomit will erode the outer layer of the teeth (enamel) and expose the inner layer (dentine), resulting in tooth sensitivity.

Remedy: Baking soda rinse for "morning sickness" or acid reflux- Baking soda will help restore pH balance in the oral cavity. Rinse with water after having acidic food and vomiting. Don't brush teeth immediately after vomiting.

Tooth decay

A pregnant woman is often at considerable risk of caries development. The mother's teeth do not lose calcium as postulated in a number of myths; instead, the risk of dental caries probably increases because of changes in eating habits. Pregnant women may often crave for sweet and sour food due to dietary change.

Food and drink intake may also become more frequent. Therefore, the chance of getting tooth decay may increase if proper oral hygiene is not maintained. For example, the sucking of hard candy to reduce nausea, dietary cravings, and frequent between-meal snacks of refined carbohydrates can raise the caries potential of the dental plaque.

Remedy: Brushing twice daily with toothpaste containing FLUORIDE, chlorohexidine and fluoridated mouth rinses, topical fluoride application, xylitol-containing chewing gum, flossing at least once daily, limiting sugary foods and drinks.

Pyogenic Granuloma: The pyogenic granuloma is a common tumor-like growth of the oral cavity and is considered to be non-neoplastic in nature. It can be seen as raised, red, peripheral growth, sessile or pedunculated, usually originating from a minor trauma. Its healing response is exaggerated in proportion to the degree of injury, which results in a localized overgrowth of granulation tissue.

The tissue overgrowth varies from small growths of only a few millimeters in size to larger lesions that may measure 2 to 3 centimeters in diameter. Surface ulcerations are usually present in areas where the tumor is subjected to trauma. Typically, the mass is painless, although it often bleeds easily due to its extreme vascularity.

Pregnancy is NOT a reason to defer dental cleanings or treatment for oral health problems.

Emergency or non-elective dental treatment and dental x-rays:

Dental treatment, if needed during pregnancy, is optimally performed during the 2nd trimester but can be performed at any time during pregnancy including the 1st trimester. However, owing to the various physiological changes occurring during pregnancy, the dental treatments and procedures need slight modifications and considerations to prevent any harm to the mother and fetus.

Dental treatment can be safely administered during any of the three trimesters of pregnancy, but due to the morning sickness experienced by most pregnant women during the first trimester and the great deal of risk of postural hypotension during the third trimester, second trimester of pregnancy is the ideal period of delivering efficient dental care.

Dental x-rays to diagnose disease processes that need immediate treatment can be undertaken safely with the use of a thyroid collar and abdominal apron but it is always a good idea to take no more x-rays than necessary (and particularly so during pregnancy),

Routine dental cleanings and elective dental procedures:
o All women should have their teeth cleaned before or during the pregnancy; there is no benefits in delaying the treatment.
o Elective dental procedures should be deferred until postpartum if possible.

(To be contd ....)