The pregnant pause

FROM times immemorial, women have been perceiving pregnancy with mixed emotions. The excitement and awe of impending motherhood in most cases erases all minor issues from the mind, oral hygiene being among the first to go under the axe. ‘A tooth for a child’ is an age old saying that does not have to essentially hold good in today’s times provided a few precautions and guidelines are followed

1.Chloasma gravidarum: It is the tanned mask seen on cheeks, nose and skin right below the eyes in pregnant light skinned women during the latter half of pregnancy. It is accompanied by diffuse browning of the inside of the mouth.

What to do for it: Nothing. It is thought to be due to an increase in the adrenocorticotropic hormone (ACTH). It disappears soon after delivery.

2. Gum diseases in pregnancy: Bacterial plaque which is a thin film of micro organisms is the cause of infection in the gums just as it is in non-pregnant individuals. Gingivitis as it is called is accentuated by pregnancy and the resultant clinical picture is modified. It begins in the second or third month of pregnancy and becomes severe by the eighth month but decreases in the ninth month. Previously inflamed areas of the gums become noticeably discoloured, enlarged and edematous (swollen) with an increased tendency to bleed. Pregnancy affects the severity of previously inflamed areas; it does not alter healthy gums.

What to do for it: Severe gingivitis during pregnancy is attributed to increased levels of progesterone and estrogen due to which there is circulatory stasis and susceptibility to mechanical irritation. Meticulous plaque control, cleaning, root planning and polishing should be the only non emergency procedures performed preferably at the beginning of the second and third trimester.

3. Pregnancy tumor: In pregnancy, enlargement of the gums may be marginal and generalized or may occur as single or multiple tumors like masses.The so-called pregnancy tumor is not a neoplasm. It is an inflammatory response to local irritation and is modified by the patient’s condition. The reported incidence is 1.8 to 5 percent and usually appears after the 3rd month of pregnancy. The lesion appears as a discrete dusky red mushroom – like flattened spherical mass that protrudes from the gums. It is usually painless unless its size and shape foster accumulation of debris under its margin in which case painful uncertain may occur.

What to do for it: This condition can be preventaged by the removal of local irritants and institution of fastidious oral hygiene at the outset, although spontaneous reduction in the size commonly follows the termination of pregnancy. In case surgical excision of the tumors is to be done, it is best done in the second trimester.

4. Tooth mobility: is increased in pregnancy and is associated with hormonal changes in the body and physico chemical changes in the gum tissues

What to do for it: It subsides spontaneously post mortem.