Gum disease is the single most common cause of tooth loss in the western world today. Also known as periodontal disease,  it will affect approximately 90 per cent of the population at some time.  It’s a disease that destroys the supporting structures of the teeth, without which the teeth become loose and are eventually lost.

Stages of gum disease

During its early stages, gum disease is known as gingivitis.  This literally translates as inflammation of the gums.  With treatment, it is a reversible condition and no long term damage is sustained.

If left to progress, untreated gingivitis may lead to a more destructive and severe form of the disease, which is known as periodontitis.  This involves the destruction of bone and soft tissues that hold the teeth in place.  Pockets develop between the teeth and gums making good oral hygiene very difficult to maintain.

What is the cause of gum disease?

All gum disease is primarily caused by plaque bacteria.  After 48 hours of growth, these bacteria start to release toxins which irritate the gums and initiate inflammation.  This is the beginning of the process that leads to gum disease.

How do I know if I have gum disease?

There are some signs to look for:

• Redness or tenderness of the gums;
• Bleeding gums with brushing or flossing;
• Persistent bad breath or bad taste in the mouth; or
• Loose teeth or teeth that appear to have moved

Treatments of gum disease

Treatment involves professional cleaning of the teeth and the removal of harmful bacteria that cause the disease.  This may involve a series of appointments with a dental hygienist or a one off visit, depending on the severity of the condition.  Oral Hygiene instruction features heavily in the treatment of gum disease.  The daily removal of plaque is essential if treatment is to be a success and in the prevention of future episodes.

The increase in hormone levels during pregnancy comes with a range of oral health and dental issues to expect.

Among the oral health and dental issues to expect are:

• Morning sickness including feelings of nausea and vomiting episodes
• Sore and swollen gums. If an underlying gum disease exists, an exacerbation of this condition can occur
• Gum ulceration
• Occasionally there is a gum growth that occurs called a pyrogenic granuloma
• Mobile teet
• Decreased salivary flow, that can lead to a dry mouth sensation;
• Cravings and snacking to reduce nausea
• The need to eat smaller meals more frequently.

Dental Protocol for the Pregnant Woman

Before Pregnancy

• Full check up and examination;
• Set of radiographs as necessary, usually bitewings only;
• Proper Scale and Clean by a Dental Hygienist; and
• Education as to what to expect with oral changes and preventative measures during pregnancy.

If a gum condition is diagnosed, it may be necessary to undertake further gum cleaning. This may include approximately two to four appointments with a dental hygienist. A check is required one month post treatment to ensure that the condition has stabilised.

If there was no check up and examination prior to pregnancy, then it is best to wait until late in the first trimester for a full examination and clean, with a set of bitewing radiographs (clinical call after appropriate discussion with patient). Dental radiographs are safe to be used. However, if possible it is best not to have dental radiographs done in the first six weeks of pregnancy.

General Prevention

Prevention is the key for pregnant women due to the physical changes and also habit changes causing the oral environment to be more susceptible to dental decay, gum disease and other irritating oral problems.

A full clean every three to four months during pregnancy. Ideally these would be done just before the pregnancy, late in the first trimester, late in the second trimester and just before delivery. It may be necessary that more than one appointment is required to return the periodontal tissue (gums and supporting tissues of the teeth) to base line health or, at the minimum, a stable condition. It has been speculated in current literature that there is a link between poor gum health and preterm and low birth weight delivery.

Use a fluoride mouthwash, containing no alcohol, every night before bed or after a vomiting event. The eating or drinking of basic pH foods such as yoghurt, milk and cheese, will also help to rebalance the oral pH. Even chewing sugar free gum will help the salivary flow to achieve this. Clean teeth 2-3 times daily. We would encourage three times daily.

Wait until at least one hour after a vomiting event to clean. Vomiting events cause not only a decreased oral pH, but also an increase in the direct acidic attack on the teeth. Luckily, the teeth are always in a state of breakdown and repair. Swishing extra fluoride across the teeth enables the repair mechanism to work more efficiently and the repaired structure is stronger against further attacks. Cleaning teeth directly after a vomiting event is damaging. Using a fluoridated, alcohol free mouthwash or chewing sugar free gum is a better way to freshen breath.

Watch for snacking. Having regular meals, at least 1-2 hours apart is ideal. If at all possible, avoid constantly snacking.

If feeling nauseous, avoid fatty foods and foods that are highly acidic or spicy.

If using indigestion or reflux formulations, ensure that they are sugar free.

In the case of gingival ulceration (gum ulcers), warm salty water mouthwashes are appropriate. If necessary, a chlorhexidine or a low strength peroxide based mouthwash can be used. Only use this mouthwash while symptoms persist and do not swallow.

It is important that the mother-to-be is informed of any medical changes recommended by her doctor so that this information can be passed onto the dentist. An example is if they are placed on anti-coagulant medication.

Conditions such as mobile teeth will return to normal post birth. Pyrogenic Granuloma’s can be dealt with if necessary by removing them. However, removing the stimulator factors like plaque and calculus caught under the swollen tissues will help to control these issues. Otherwise this condition is best left until after the birth, generally after 6 weeks.

Why?

Having the ability to diagnose prior to pregnancy is the most important aspect of this protocol. If this time has passed, then late in the first trimester is the other appropriate time for diagnosis, allowing any necessary treatment to be carried out in the second trimester.

By taking a preventative approach we can reduce the likelihood of dental issues developing down the track. It is necessary that, while a mother-to-be is in a phase of her life where medical issues are of an upmost priority, that the dentist is also involved in the initial stages. This will enable any dental conditions to be diagnosed early and treated at the most appropriate times.

Appropriate Treatment Times

If possible, any necessary treatment should be carried out in the second trimester. Always watch the supine position, especially late in the second trimester and third trimester. The right hip should be elevated 10-15cm. Try and find an appropriate time that suits.

Emergency treatment can be carried out whenever necessary. There is more risk to the baby from being stressed due to pain, anxiety, or having an ongoing infection than from having dental treatment carried out, at any stage.

Elective procedures should be carried out at least 6 weeks post birth.