On at least three separate occasions, I can remember having the privilege of breaking the news of a young woman's pregnancy from my side of the dentist's chair. I use the word "privilege" with my tongue planted firmly in my cheek, however. After all, the diagnosis was only determined because of the patient's tender, red, swollen gums. Ouch!



Talk about taking the good news with the bad . . .

Known as pregnancy gingivitis, this unpleasant condition is often assumed to be one of the natural consequences of the hormonal changes often found in pregnant women. The hormones involved, estrogen and progesterone, are secreted in progressively greater concentrations throughout most of pregnancy. While this reaction is necessary for preparing a woman's body for the journey ahead, the resulting flood of hormones results in a variety of effects.

Hormones tell the kidneys to retain water in order to build blood volume to have enough to nourish the placenta. Thus a pregnant woman has 40% more fluid in her body. As a result, this increases the amount of fluid in all the cells in the body, including the gum tissues, which causes them to become "puffy." Between the time of conception and the seventh month of pregnancy, hormones will triple in quantity, and then remain at that heightened level until delivery.

Meanwhile, as if she doesn't have enough to contend with, the pregnant patient with hormones out of whack is swollen and tender and sometimes cannot do an effective job with her oral hygiene.

I am pleased to tell you that with above standard oral hygiene, this condition can be almost entirely avoided. Remember, it is the bacteria, not the hormones, which cause the gingivitis. Despite the fact that the statistics reveal 50-75% of all pregnant women develop pregnancy gingivitis, that doesn't have to mean you. If you are reading this book after the fact, you can be assured that this condition is reversible with proper home care, techniques, tools, and medicines.

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."

Rams also says, "In periodontitis, bacterial plaque infection not only causes inflammation of gingival tissues like gingivitis, but also progressively destroys connective tissue fibers and surrounding bone anchoring teeth to the jaws, resulting in the loss of teeth."

Knowing how to minimize the bacterial biofilm in your mouth, and especially along the gum line, is the key factor in preventing pregnancy gingivitis and the escalating symptoms that often continue during pregnancy. However, a woman needs to be taught before she gets pregnant how to eliminate bacteria on a daily basis.

Because gums can be painful, puffy, and bleeding during pregnancy, the tendency is to avoid touching them. However, it is imperative that you practice good oral hygiene during pregnancy to avoid both tooth decay and gum infections. Pregnancy, with its three-fold increase in hormones, may exaggerate the body's normal response to dental plaque.

It need not increase your risk of getting gum disease . . .

Although relatively rare, the body's response to inflammation may produce another offset of the "joy" of childbirth: a pregnancy "tumor" (also called pyogenic granuloma). This "tumor" may develop on the gums in response to the irritating bacteria that collects there. Rest assured, however, that these growths of extra tissue are usually painless, and totally benign. However, if they get large these "pregnancy tumors" can become annoying and should be treated. Meticulous oral hygiene is the answer to avoiding the inflammation associated with these growths, and it is comforting to know that they usually subside after childbirth.

Fascinating Factoid: "Occasionally chewing sugarless gum is helpful to increase the amount of saliva in your mouth, without contributing to the risk of gingivitis. It may also be helpful in averting the nausea so common in the first three months of pregnancy."

Brushing, flossing, and irrigating daily (all done gently but deliberately) are important in preventing gingivitis, during pregnancy and anytime in your life. In addition, it is important to pay attention to eating more healthfully for yourself and your baby, by substituting fruits, cheese, nuts, and vegetables for those sugary foods you might have enjoyed before becoming pregnant. If your gums are tender and brushing is painful, try ice, or several helpful over the counter products that will soothe painful gums. These include:

*Gly-oxide

*Peroxyl mouth rinse

*Amosan oral rinse

*Anbesol liquid

*Orajel Mouth-Aid

(Please be sure to ask your doctor if she has objections to any of these products.)