Setareh Pirmorad explores the different conditions pregnant patients might present with and how dentists can treat them.
Every dentist recommends their patients to attend regular examinations. However, those patients that are expecting may not know the importance of this. They may forget to visit with the excitement of preparing for the newest chapter of their lives.
It’s our role to explain the importance of visiting the dentist whilst pregnant. Maintaining a healthy and effective oral hygiene routine could prevent developing gum disease during that time period.
Other than the fact that we may be able to detect the patient’s baby bump or if they inform us through the medical history forms, there can be a few other ways we can detect pregnancy including via the oral cavity.
What we can detect: gingivitis and periodontitis
Patients may experience bleeding of the gums either spontaneously or even after brushing their teeth.
Factors that can cause this are usually due to:
- Poor dental plaque removal when brushing (possibly because of a gag reflex or feeling nauseous while brushing)
- Pregnancy hormones (mainly estradiol, estriol and progesterone)
- Diseases or other factors.
This leads to inflammation of the gingivae due to the accumulation of dental plaque. This proliferates, increasing the blood flow in the gums making them look red, inflammed and feel tender.
Parameters such as gingival probing depths (Hugoson, 1970; Miyazaki et al, 1991), bleeding on probing (Miyazaki et al, 1991) and crevicular fluid flow (Hugoson, 1970) were found to also increase.
One species found in subgingival plaque is anaerobic gram negative bacteria, prevotella intermedia. This has also been associated with gingivitis during pregnancy.
During the third trimester, the rise in sex steroid hormone levels in pregnant women has also been associated with having gingivitis.
An epidemiological study showed: ‘A 55-fold increase in the proportion of P intermedia has been demonstrated in pregnant women compared with non-pregnancy controls’ (Jensen et al, 1981).
Not improving oral hygiene can lead to periodontitis and tooth mobility.
Increased levels of plaque can lead to further multiplication of bacteria down to the root surfaces. This creates deep pockets between the gums and the roots.
Gingiva tend to recede, which exposes the roots and causes further destruction of the tooth supporting bone. For these reasons the teeth can become mobile.
Ide and Papapanou (2013) concluded that maternal periodontitis is modestly, but significantly, associated with pre term birth, low birth weight, and pre-eclampsia.
However, research also shows these factors reduce after the pregnancy. This is why educating patients on having a regular and effective oral hygiene routine is the key to preventing further complications down the line.
What we can detect: pregnancy granuloma
Aside from the generalised changes to the gums, pregnancy can also give rise to the formation of pregnancy granulomas or epulis.
Despite looking quite sinister (which they are not), they usually manifest as pedunculated, asymptomatic, red and fleshy, enlarged benign masses interproximally. Usually arising on sites with pre-existing gingivitis.
They are highly vascularised and therefore tend to bleed quite frequently and rapidly. Especially if they interfere with your chewing.
Usually appearing in the third trimester but they may occur earlier than that (Bhashkar and Jacoway, 1966).
Pregnancy granulomas arise in association to the hormonal changes. These occur naturally with pregnancy and especially when there is an increased level of plaque that can lead to gingivitis.
The good news is that you can let your patients know that the lesions usually regress after birth as the hormone levels also change. However, an optimal oral hygiene regimen is still necessary.
If these lesions fail to disappear or start causing a functional problem, then the patient should be made aware to book another appointment for further investigations and treatment options such as removal of the lesions and with eliminating the irritating local factors.
What we can detect: erosion due to vomiting
Dental erosion is the loss of the surfaces of your teeth due to increased acids.
This can either be related to what they are consuming or from the acids in the gastric content which can travel back into your mouth from morning sickness during pregnancy.
The acid will cause dental erosion. However, a lot of patients may not be aware that brushing their teeth after morning sickness can cause further damage and destruction to the enamel surfaces.
It is important to let patients know that it is more beneficial for them to rinse their mouth with water after these events, rather than brushing their teeth immediately after to get rid of the taste.
Our role is to educate our patients as much as possible on the consequences of pregnancy and gingival involvement. Answer any questions they might have and treat them along the way. This will help with a smooth and healthy pregnancy and baby.
Our patient’s role is to stay motivated to maintaining a good oral hygiene routine. Make sure they keep monitoring any changes they detect in their mouth.
For further information on pregnancy in patients or even dental related posts please feel free to follow this Instagram page – @dr.setarehpirmorad.
References
Bhashkar SN and Jacoway JR (1966) Pyogenic granuloma: clinical features, incidence, histology, and results of treatment report of 242 cases. J Oral Surg 24: 391
Ide M and Papapanou P (2013) Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes – systematic review. J Periodontol 40(s14): S181-94
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