I commonly hear patients tell me that their 'teeth were fine until they got pregnant; and it was all down hill from there.' This does not sound all that far-fetched with the understanding that commonly there were some predisposing factors that were undetected prior to the pregnancy.  Periodontal disease is a problem that can exist rather quietly in the mouth for some time without any overt signs of pain or discomfort to the sufferer.  The disease is caused by bacteria that live in the mouth; these bacteria, called plaque will build-up and can precipitate into something known as calculus or 'tartar'.  This is calcified plaque material that generally builds up at or below the gumline.  Normal brushing and flossing can slow the deposition process down but to remove it adequately and thoroughly a qualified dental hygienist or dentist must clean these surfaces with special instruments.  Brushing and flossing alone does not suffice--particularly in a case where the immune system is compromised; either debilitated or exaggerated.

Studies show a direct correlation between periodontal disease and pre-term, low birth weight babies.  In fact, pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.  The culprit is likely a labor-inducing chemical found in dental plaque called prostaglandin.  Very high levels of this chemical mediator are found in women with severe periodontal disease.

A study published in 1999 reports that at least 23% of women ages 30-54 have periodontitis (an advanced state of periodontal disease) Many are unaware of the condition because it progresses so quietly.  This disease can ravage out of control quickly on some pregnant patients.  Although the disease can be treated, commonly the damage that is caused becomes a permanent issue, the bone around the teeth can be lost due to the inflammation and infection and the gums can recede in a very unaesthetic and unhealthy way.  Commonly gum surgery is the only treatment left to get control of the problem. Antibiotics, although quite effective at helping an infection to quiet down temporarily are only an interim measure and would best be avoided if possible during a pregnancy.  Prevention is the best protection. Make sure you are current with regular dental check-ups and cleanings prior to trying to become pregnant.  Also make sure you get a full set of radiographs to help elucidate any potential problems that may exist prior to your pregnancy if possible.

Additional complications and predisposing factors may be involved as well.  Diabetes either being pre-existing or gestational (during pregnancy only) can cause a dramatic worsening of gum disease or can be the cause of the periodontal disease in an otherwise healthy individual.  Proper monitoring and balancing of blood sugar can be very important, especially in the chronic diabetic.  Vomiting caused by 'morning sickness' can leach the teeth of their protective minerals quite rapidly.  And commonly tooth brushing and flossing is difficult for women who suffer severe pregnancy-related nausea.  Impacted wisdom teeth or other dental crowding type issues can become a cause for a flare-up of disease during pregnancy as well.  Partially erupted wisdom teeth are common culprits for oral infection at this time as well as being especially difficult to treat.

Home care during pregnancy should be diligently maintained to eliminate the bacteria and food deposits along the teeth and gums at least twice a day.  Flossing is also necessary to properly clean in-between the teeth.  If nausea causes problems with normal home brushing or flossing than possibly an electric toothbrush or some oral rinses could be used; you should consult with your dentist concerning which ones would be best for you.  If vomiting occurs regularly, rinse your mouth out afterward to wash the lingering acid.  There are many fluoride products available to help strengthen the teeth if this is a problem; again, consult with your dentist regarding this.

Women who use oral contraceptives may be susceptible to the same oral health conditions that affect pregnant women; the gums may become red swollen and bleed easily.  This can become a predisposing factor for more significant disease changes.  Also, women who take oral contraceptives should be aware that taking drugs sometimes used to help treat periodontal disease such as antibiotics, may render the contraceptive ineffective for an extended period of time.  Always tell your dental professionals what prescriptions you are taking.

Lastly, if you live in a community with town water, check with the public health department to see if the water has adequate fluoride levels for your child's tooth development after birth.  If you have well water and aren't sure what your levels are then you can get a test kit from your dentist.  The appropriate levels of fluoride for should be 1.0 part per million and the test costs about $7.00.  If you need a supplement, this prescription can be obtained from your pediatrician or dentist and should be administered to the child starting at about 6 months after birth.

Dr.  Schell maintains a general family dental practice in Lebanon, NH and is a consultant on staff at Dartmouth-Hitchcock Medical Center.  He resides in the Upper Valley with his wife and their two children.  For more information or questions you can email Dr Schell's directly at TSchell@gentledentalcare.com

Read more articles by Dr. Schell here.