IT is a myth that calcium is lost from the mother’s teeth during pregnancy. The calcium your baby needs is provided by your diet — not by your teeth. However, if dietary calcium is inadequate, your body will access this mineral from stores in your bones.

An adequate intake of dairy products, green leafy vegetables (broccoli, kale, mustard greens), or the supplements your obstetrician may recommend will help ensure that you get all the calcium you need during your pregnancy.

You may experience some changes in your oral health during pregnancy. The primary changes are due to a surge in hormones — particularly an increase in oestrogen and progesterone — that can cause your gum tissues to exaggerate a normal reaction to plaque.

Plaque is a sticky, colourless film of bacteria that covers your teeth. If plaque isn’t removed daily, it can eventually harden into tartar and may increase your risk of gingivitis, a condition with symptoms of red, swollen and tender gums that are more likely to bleed. So-called “pregnancy gingivitis” affects most pregnant women to some degree, and it generally begins to surface as early as the second month. If you already have gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead to periodontitis — a more serious form of gum disease.

Physiological changes during pregnancy may result in noticeable changes in the oral cavity. These changes include pregnancy gingivitis, benign oral gingival lesions, tooth mobility, tooth erosion, dental caries, and periodontitis. It is important to reassure women about these various changes to the gums and teeth during pregnancy and to reinforce good oral health habits to keep the gums and teeth healthy.

ORAL PROBLEMS THAT MIGHT DEVELOP DURING PREGNANCY

PREGNANCY GINGIVITIS

An increased inflammatory response to dental plaque during pregnancy causes the gingivae to swell and bleed more easily in most women. Rinsing with saltwater, (ie one teaspoon of salt in one cup of warm water), may help with the irritation. Pregnancy gingivitis typically peaks during the third trimester. Women who have gingivitis before pregnancy are more prone to exacerbation during pregnancy. Pregnancy gingivitis is most common in the front of the mouth.

BENIGN ORAL GINGIVAL LESIONS (ALSO KNOWN AS PYOGENIC GRANULOMA)

In approximately five per cent of pregnancies, a highly vascularised, hyperplastic, and often pedunculated lesion, up to two centimetres in diameter, may appear.

Pregnancy granulomas usually develop in the second trimester. They are red nodules, typically found near the upper gum line, but can also be found elsewhere in the mouth. These lesions may result from a heightened inflammatory response to oral pathogens and usually regress after pregnancy. Excision is rarely necessary, but may be needed if there is severe pain, bleeding, or interference with mastication. Pregnancy granulomas will disappear after your baby is born.

TOOTH MOBILITY

Ligaments and bones that support the teeth may temporarily loosen during pregnancy, which results in increased tooth mobility. There is normally not any tooth loss unless other complications are present.

TOOTH EROSION

Erosion of tooth enamel may be more common because of increased exposure to gastric acid from vomiting, secondary to morning sickness, hyperemesis gravidarum, or gastric reflux during late pregnancy. It is important not to brush right away after you vomit, since the acid in your mouth will only help erode the teeth as you brush. Rinsing with a baking soda solution (ie, a teaspoon of baking soda dissolved in a cup of water) may help neutralise the associated acid.

Dental caries

Pregnancy may result in dental caries due to the increased acidity in the mouth, greater intake of sugary snacks and drinks secondary to pregnancy cravings, and decreased attention to prenatal oral health maintenance.

Periodontitis

Untreated gingivitis can progress to periodontitis, an inflammatory response in which a film of bacteria, known as plaque, adheres to teeth and releases bacterial toxins that create pockets of destructive infection in the gums and bones. The teeth may loosen, bone may be lost, and a bacteraemia may result.

Dry mouth

Many pregnant women complain of dry mouth. You can combat dry mouth by drinking plenty of water and by using sugarless, hard candies or gum to stimulate saliva secretion and keep your mouth moist. These should contain xylitol, which reduces the harmful bacteria that cause cavities.

How to take care of teeth and mouth while pregnant

Eat a well-balanced, nutritious diet with plenty of protein, calcium and vitamins A, C and D.

Brush your teeth twice a day for two minutes each time. Use fluoride toothpaste. Floss at least once a day. Using an antibacterial mouthwash can help destroy bacteria that contribute to gingivitis. Mouth rinses that lower the acid level (pH) of your mouth are also suggested.

The best approach to dental care is to see your dentist for an exam and cleaning before you get pregnant. Periodontal disease treatment can also be done at this time.

During your pregnancy, the second trimester is the best time to receive routine dental care. If possible, avoid major procedures, reconstruction and surgery until after the baby is born.

Dr Sharon Robinson DDS has offices at the Dental Place Cosmetix Spa located at Shop #5, Winchester Business Centre, 15 Hope Road, Kingston 10. Dr Robinson is an adjunct lecturer at the University of Technology, Jamaica, School of Oral Health Sciences. She may be contacted at 630-4710 or visit the website www.dentalplace4u.com