By Sheila Wolf, RDH
"There's no way you're gonna be able to clean my teeth today" Amy asserted. "And look at this!"
I looked to the end of her index finger at the reddish, lumpy, ulcerated growth between her lower incisors. I began her medical history update and looked in her mouth. Hmm. Childbearing age, red, swollen, bleeding gums. Tender to touch. I was pretty certain of the telltale signs. Probably a pyogenic granuloma, a benign pregnancy tumor found in about 1 percent of pregnant women.
"Amy, could you be pregnant?"
"Well, I'm sorta gaggy in the morning and I can hardly brush my teeth. I think I might be."
It turned out she was.
Fifty to 75 percent of pregnant women develop an acute infection in their mouths known as pregnancy gingivitis. If left untreated, it may lead to more serious periodontitis, a chronic infection causing bone destruction and eventual tooth loss. It has also been linked to heart attack, strokes, respiratory problems, diabetic complications, ulcers, and other serious systemic illnesses. Not only is that a problem for the mother, but this bacterial infection can be a threat to her unborn baby as well.
The mouth is a portal of entry to the body. Think of a mouth infection as an open wound. "Periodontal toxins or other products generated by mouth bacteria in the mother may reach the general circulation, cross the placenta and harm the fetus," according to the Surgeon General's Report of May 2000.
Since estrogen and progesterone are secreted progressively throughout most of pregnancy, between the time of conception and the seventh month, hormones will triple in quantity and then remain at that heightened level until delivery, making the gums puffy with fluid retention.
Dr. Thomas Rams, professor and chairman of the department of periodontology at Temple University School of Dentistry in Philadelphia, says, "There are hormonal shifts in pregnancy that reduce the gingival tissue resistance to infection, and there is also an increased risk that the hormones circulating will help promote the growth of certain bacteria and plaque, which causes inflammation."
However, despite the influx of hormones, they alone are not the problem. We must blame those aggressive microorganisms that lurk between the teeth, in the crevices beneath the gums, and in the nooks and crannies of the tongue. As the bacteria take a foothold and the disease process progresses, serious consequences — besides tooth loss — can ensue.
Inflammation, with its consequential cytokine production and early release of prostaglandins, may trigger preterm labor (Hillier et al, 1988) causing a baby to be born too soon and too small. Immature organs, mental retardation, a weak heart, poor eyes or ears, are just some of the devastating consequences that can be to a child and the entire family. We have a responsibility as hygienists, to properly educate our mothers-to-be in anti-infective self-care to eliminate dangerous infections in the mouth.
In my book "Pregnancy and Oral Health," I teach a simple, ten-minute-a-day program that is fun, easy, and inexpensive. It includes brushing with baking soda, salt, and peroxide, (Mama Gums' Magic Mix) using floss and other aids to clean in-between teeth, and irrigating with warm water and a good antibacterial — essential tools for great periodontal health.
Teaching patients to minimize the bacterial biofilms in their mouths is the key factor in preventing pregnancy gingivitis and tooth decay. Not only will you help your pregnant patient have a beautiful smile but you will also enhance her chance to deliver the healthiest baby possible.
With patients who have morning sickness I suggest:
• Do the most thorough brushing at a time of day when you feel your best, not when your gag reflex is at its peak
• Lean your head forward while brushing to minimize anything in the back of your throat
• Choose a low-suds toothpaste (like Mama Gums' Magic Mix, Closys ll, or Arm and Hammer Toothpowder)
• Chose a smaller-sized toothbrush to reach those back molars easier without triggering your impulse to gag
Sheila Wolf, known affectionately as "Mama Gums," has been practicing dental hygiene since 1971. Working at the leading edge of non-surgical periodontal care, her mission is to educate and empower people to take control of their own mouths. She has brought her message to places as far apart as California and Connecticut, Israel, Africa, and the hills of Kentucky. Her book, Pregnancy and Oral Health: The critical connection between your mouth and your baby, published 2004, has won a national book award as well as Finalist in the 11th annual San Diego Book Awards. It is available on her website www.mamagums.com, through Amazon, and at finer bookstores everywhere.