A Tooth For Every Pregnancy? – Dr Husna Razak

It was drizzling outside. A heavily pregnant lady walked with difficulty into a dental clinic, pausing after a few steps to catch her breath. She was clutching the left side of her face. After being registered, she was ushered into the treatment room. “Doctor, I was supposed to be admitted to Hospital X today to deliver my baby but they refused to accept me because my face is swollen,” she claimed.

On close inspection, I found that she had facial cellutis (massive infection of the face) caused by decayed teeth and gum disease. I wasted no time and immediately referred her to the nearest public hospital where she would be treated accordingly.

You might ask, can this distressing situation be avoided? And what is the implication of dental infection to a pregnant mother? Perhaps you have heard of an old wives tale, “a tooth for every pregnancy?” I certainly have heard many claimed that every time they get pregnant, at least one of their teeth had to be extracted. In fact, some even regard losing a tooth during pregnancy is normal and an act of sacrifice by a mother to her baby.

How far is this true?

“Doctor, my teeth become very mobile and loose when I get pregnant that eventually they all fall off.” Pregnancy does not cause gum disease such as gingivitis and periodontitis but it can accentuate pre-existing mild gum disease that was present before pregnancy. This simply means that if you do not already have gingivitis before you get pregnant, your gum may remain healthy during pregnancy and hence, no loose teeth.

“But how does pregnancy aggravate my pre-existing gingivitis?”

Pregnancy hormones.

Estradiol or progesterone that is present in abundance during pregnancy have been linked to exaggeration of gingivitis. Studies found that these hormones can increase gum swelling and bleeding, making the gum redder, softer and bleeds more easily. Bacteria in dental plaque (white soft layer covering the outer surfaces of the teeth) use menadione (Vitamin K) as a growth factor. However, the authors also suggested than estradiol or progesterone can be used as substitute to menadione, and subsequently increases the number of bacteria causing gum diseases.

Maternal immune response.

It is thought that the maternal immune response is suppressed during pregnancy. The number of defence cells that guard your body against infection decreases, making the gum more susceptible to gum diseases. The pregnancy hormones also stimulate the production of prostaglandin which is a chemical mediator that further suppresses your immune system.

 

“Why is it so important to take care of my teeth and gum when I’m pregnant? My mouth isn’t connected to my womb.”

Wrong! Having a gum disease or a decayed tooth can be harmful for you AND your baby. Bacteria or the toxins produced by the bacteria present in your mouth can travel through the bloodstream and….enters the womb. As the bacteria or toxins are foreign to the womb environment, the womb may try to defend itself by expelling its content (your baby!) earlier than expected. This can result in preterm, low birth weight infants.

“Wow, I did not know it could get that scary! How can I avoid this?”

Pregnancy itself DOES NOT cause gum disease. Pregnancy only accentuates it. You might have been having mild gingivitis that went unnoticed when you were not pregnant. If you are planning to get pregnant, dental treatment should ideally be completed before the start of your pregnancy. However, it is never too late to start. Under the Ministry of Health programs, all expecting mothers should be referred to a dentist for comprehensive dental treatment, if necessary. Most dental treatments for pregnant mothers are free at government dental clinics everywhere in the country.

 

Here are some simple steps on dental care during pregnancy that you can practice:

Dental plaque control.

If money is the root of all evil, plaque is the root of all dental-evil. Plaque is whitish or yellowish soft deposits present on the surfaces of the teeth that harbours millions and millions of bacteria. Because it is soft, removing it is as easy as 1,2,3. Brushing your teeth with soft-bristled toothbrush and dental flossing twice a day or after meal is adequate to remove plaque. No accumulation of plaque, no oral disease, as simple as that.

Pay your dentist a visit.

Your dentist will examine and may perform the necessary treatment such as scaling, polishing and filling of decayed teeth with aim to control the spread and progression of the existing oral diseases. The second trimester (4-6 months) is the safest period for providing routine dental care. Although the safety of dental radiographs has been well established, most dentists find it desirable to avoid any kind of x-ray during pregnancy especially during the first trimester (1-3 months) as the foetus is most susceptible to radiation damage at this time. However, if an x-ray is deemed necessary, a protective lead apron will be used to cover your body. Studies have shown that when a protective lead apron is used, the amount of radiation that reaches your body is virtually immeasurable.

Know how to deal with morning sickness.

Vomiting of stomach contents can cause erosion of the teeth. If this continues, your teeth will be thinned, worn out and appear yellow. This is because stomach contents are very acidic. You should not immediately brush your teeth right after throwing up as this can further aggravate erosion by rubbing the acid onto your teeth. Instead, rinse with water and wait for about half an hour before brushing your teeth.

If you have not been visiting your dentist for a while, now is the right time. Not only they can professionally clean your teeth but they can also give you useful health tips that you can apply throughout your pregnancy. So make the right choice. Your child’s oral health starts with you!

 

Dr. Husna Razak (BDS) (KLE VK) is a dental officer working in the Oral and Maxillofacial Surgery Department in Kota Bharu. Know more about her in The Team page.

 

[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.] 

 

References:

• http://www.joponline.org/doi/abs/10.1902/jop.1996.67.10s.1103
• http://www.jisponline.com/downloadpdf.asp?issn=0972-124X;year=2010;volume=14;issue=2;spage=114;epage=120;aulast=Gandhimadhi;type=2
• http://eiso-oralhealth.moh.gov.my/eiso/bkpkdh/admin/upload/doc_DL_20120806110949_514976102.pdf
• Carranza’s Clinical Periodontology, 10^th edition.

Related Posts via Taxonomies

• OMG! My newborn baby has teeth!- Dr Nurjasmine Aida Jamani & Dr Nor Asilah Harun
• Pemutihan Gigi, Apakah Kesan Kepada Gigi? – Dr Anis Ezrina
• Cervical Cancer: What You Should Know? – Dr Roslan Ridzuan
• Ketahui tanda-tanda gigi palsu bermasalah di kalangan warga emas – Prof Madya Dr Nosizana Mohd Salleh & Prof Madya Dr Nor Azlida Mohd Nor
• Patients with artificial joints: do they need antibiotic cover for dental treatment? – Aws Hashim Ali Al-Kadhim, Azlan Jaafar & Nor Azura Ahmad Tarmidzi
• Kaunseling Pemakanan kepada Ibu Hamil yang Mempunyai Kencing Manis – Dr Mohammad Hj. Che’ Man
• Dental Bleaching: What to Expect? – Dr Aws Hashim Ali Al-Kadhim, Dr Muhammad Syafiq Alaudin & Dr Azlan Jaafar
• Why my child suddenly has white spots in his eyeteeth – Dr Aws Hashim Ali AlKadhim, Dr Mohamad Syafiq Alauddin & Dr Azlan Jaafar
• Fibroid: Learn the Causes, Symptoms, and Treatments – Dr Muhammad Izzat
• Kekurangan darah haemoglobin (Anemia) semasa kehamilan – Dr Mohammad bin Hj. Che’ Man & Dr. Shahidah Che Alhadi