That Gummy Feeling
December 2009 Issue, Motherhood Magazine
Do your gums bleed easily when you brush? Chances are, your answer is affirmative, given that 85 per cent of Singapore’s population are prone to gum problems, especially women. If you’re pregnant, you have even higher chances of developing gum problems. Dr Tan Thiam Chye, consultant obstetrician and gynaecologist with KK Women’s and Childnren’s Hospital, explains. “Morning sickness and tiredness in the first trimester can result in dental neglect and poor oral health.”
Why oh Why?
There is another reason for it and it starts with the letter H – hormones. Says Dr Mervyn Ng, a registrar with the Periodontic Unit from the Department of Restorative Dentistry at the National Dental Centre of Singapore (NDC).
"Hormonal changes occur during pregnancy and these alter the response to plaque in the mouth. Pregnant women may have an accentuation of gingivities and gum disease." Some pregnant women may even develop gum tumours, which refer to growths in their gums. Though they are usually harmless, they may be painful. Dr Jane Tan, a dentist in private practice, says, "Gingival epulis (another term for gum tumour), is usually benign and treatable with professional deep cleaning. Some resistant ones require ones require surgical removal. It is advisable to check with your dentist if you notice any swelling of the gums to rule out anything malignant.”
The tendency for pregnant women to develop food craving is another contributing factor. Dr Tan Thiam Chye says, “Food cravings during pregnancy may result in higher or more frequent sugar intake, also increasing the risk of developing caries (dental decay).” Periodoontitis refers to a more severe form of gingivitis where the supporting bone structure around the tooth gets destroyed which might lead to the loss of the affected tooth.
Pregnancy & Oral Health
Not many people know this but good oral health for the expecting mother plays an equally important part for the proper development of her baby before and after birth.
“Pregnant women are under the misconception that gum problems are part and parcel of pregnancy like stretch marks, and there is nothing they can do about it. Many are oblivious of the impact of oral health on their foetus,” warns Dr Ng. Moreover, it is possible for caries-causing bacteria to be transmitted from mother to her baby and cause teething problems during infancy. Explains Dr Tan Wee Kiat, senior consultant, Paediatric Dentistry Unit from the Department of Restorative Dentistry with NDC, “Infants can be infected with strep mutants, a caries-causing bacteria as early as nine months of age. This predisposes them to a severe and aggressive form of decay known as early childhood caries.”
Teething Problems
Studies have shown that it could lead to preterm delivery and low birth weight babies. “Evidence has shown a strong co-relation between severe gum diseases in pregnant women and early labour,” says Dr Ng. Preterm delivery refers to premature delivery before 37 weeks of pregnancy. Agrees Dr Tan Thiam Chye, “Pregnant women who have moderate to severe periodontal disease may be seven times more likely to deliver a premature child, according to a five-year study conducted at the University of North Carolina.” He adds, “It is not completely understood how periodontal disease affects pregnancy. Research suggests that the inflammation in the gums can stimulate prostaglandin release into the bloodstream which can trigger womb contractions and lead to premature labour and low-weight babies.”
Says Dr Ho Hon Kwok, consultant obstetrician and gynaecologist at H K Ho Women & Fertility Clinic at Mount Alvernia Medical Centre, “Poor periodontal health is associated with delivery of a low birth weight infant."
Prevention is Better
Treatment is not recommended during the first trimester and the types of treatment carried out are limited to cleaning. Says Dr Jane Tan, “This is because when there is pain, ideal treatment usually involves taking x-rays and injecting anaesthesia to make the patient numb.” These procedures, however, may put the pregnancy at risk. Unless the condition is really bad, she would not recommend going beyond safe painkillers to help the pregnant patient.
Says Dr Tan Wee Kiat, “Pregnant women who need dental treatment can be treated during the second trimester.” However, he recommends that if one has a serious dental infection, prompt attention is required, the stage of pregnancy notwithstanding. The good new is – you can do something about. All doctors have the same piece of advice – prevention is always better than cure. If you’re trying to conceive, schedule a dental appointment early.
Says Dr Tan Wee Kiat, “Prenatal care does not just involve visiting the doctor but the dentist as well. Timely intervention can be taken to avert oral diseases which can impact a baby’s health.” Agrees Dr Jane Tan, “Other than practicing good oral hygiene at home, women should have a dental check-up, if possible, before they plan to start a family.” A simple daily routine of brushing, flossing and swishing may sound mundane but they are common sense advice that you should heed.
Advises Dr Tan Thiam Chye, “Make the extra effort to practice good oral hygiene as it is essential in preventing caries and gum disease. This includes brushing after each meal, flossing at least once a day and using an anti-plaque mouth rinse. Visit the dentist at least once every six months to check that your gums are healthy and for professional cleaning of your teeth. This should be practiced even prior to conception to ensure healthy gums right from the start of pregnancy.”
“Gingival problems when diagnosed early can easily be reversed with a good oral health care program,” says Dr Ng. He stresses, “All parents want to give their child a head start in life. Birth is an important event in a child’s life, therefore it is desirable to reduce risk factors which may have an impact of delivery."
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