Contrary to popular belief, dental hygiene is critical during pregnancy, when women are most concerned with following the right diet and exercise to ensure a healthy baby. But, according to dental surgeon Dr Mahalakshmi Prasad, pregnancy is the crucial time when a woman is more susceptible to dental infections that could inadvertently cause complications in her pregnancy. Here are her answers to some frequently asked questions...

DO DENTAL INFECTIONS OCCUR DURING PREGNANCY?
It’s not that pregnancy by itself causes any gum issue. If you are completely clean, meaning, there is no plaque, no deposits in your mouth and you don’t have any kind of gum disease, then there is a very good chance that you won’t have a dental issue during pregnancy. What happens is that the body response to things which normally don’t bother us or we are not aware of, tends to get aggravated during pregnancy because the estrogen levels are high. So, those hormones which are now increased, play a role in all the tissues in the body. Especially in the gums, they give an exaggerated swelling or bleeding. That is what causes dental problems during pregnancy.

I have actually seen cases where the gums grow so much that more than half the tooth gets hidden. Though normally our mouth looks clean, if we conduct tests, we will see some deposits come up. They don’t bother us so much because on a daily basis when we clean our mouth, it goes away and our body is able to deal with what little bit remains behind. But in pregnancy, the body response to the hormones and external stimuli gives rise to a swelling. Rarely, we have cases where women come in for cleaning, just before conceiving. We usually get recommendations from gynaecologists during assisted pregnancies and IVF, because they want to eliminate all kinds of infection, particularly any kind of gum disease. So, we do a check up to identify the potential sources of infection and give the patient a thorough clean-up. In 10 years of practice, I have seen very few cases where the gynaecologist has sent the patients for a dental check-up.

WHAT ARE THE COMMON DENTAL INFECTIONS?
Gingivitis or inflammation of the gums: Normally, the most common thing we see in pregnancy is redness or inflammation of the gums. We just let it be, thinking it’s normal. Then, the next thing to happen will be bleeding while you brush your teeth. Initially, when you brush, you will find that your are bleeding a lot more and then, spontaneously even when you run your tongue over your gums, you’ll notice they are bleeding. That’s because the gums have swollen up and this normally starts off during the second or third month of pregnancy. For some women, it begins in the later stages, during the sixth month. In some cases, there is overgrowth of gums on the teeth so it appears that most of the teeth are hidden. Gum overgrowth: There is overgrowth of the gum or the gingiva which means half your tooth would be covered. If you who have morning sickness for an extended period of time, oral hygiene becomes an issue. Brushing becomes difficult and then you have an exaggerated and aggravated gum disease. Later on, you experience a lot of decay. You won’t notice it during pregnancy. We normally get to see it a year down the line, when the baby is a little older. Then, you finally find some time to come to the dentist and say ‘I was perfectly fine. I never had any cavity till about a year or two but now after delivery I have a huge bunch of cavities in my mouth’. Now, cavities take some time to form. They probably start getting initiated at the time you were pregnant and couldn’t maintain oral hygiene because of morning sickness or inability to brush regularly or may have been on bedrest for a long time. Those oral hygiene factors cause decay which were not noticeable during pregnancy.

Pregnancy tumour: A tumour doesn’t mean it’s cancerous. It just means you have a growth of cells. It could be any kind of cells like skin cells, moist cells (conjunctiva) which are different from those on your skin or it could be an overgrowth of the muscle cells or nerve cells.  Any kind of growth is a tumour. But, in pregnancy tumour, a localised area of swelling comes up as a result of the irritation caused by local irritants such as plaque, deposits or bacteria present in the mouth. When the irritation is too much or when you constantly have trauma in that place, then you have certain areas which swell up. So, these areas are generally bluish red in appearance. It will be a little triangular as that is the nature of the swelling. If you touch it, you think it’s going to bleed. It looks scary!

CAN GUM DISEASE CAUSE SERIOUS COMPLICATIONS LIKE A MISCARRIAGE?
There is research which suggests a relation between gum disease and heart disease. So when gum disease can cause heart disease, the toxins that are produced in the mouth because of bacteria, get into your blood stream and they could adversely affect the well-being and growth of the foetus. There are studies which say that if you have very bad gum disease, the disease goes in from the gums  and starts affecting the bone, which is just under it, then it causes an infection which easily gets into the blood stream. In very rare cases, toxic shocks can occur. That’s one in a million. There are instances, where it could lead to infection in the blood. So, if you have a constant source of infection, there can be complications in pregnancy, particularly when you have an assisted pregnancy. You won’t be affected so much, in terms of general health, but the baby could be affected.

To say that only gum disease could cause a miscarriage or spontaneous abortion may be harsh, but there could be five factors which could contribute to it, out of which one could be the result of gum disease. Medicines have to cross a placental barrier to get to the foetus, so if the toxins get across the barrier, they may or may not cause a miscarriage but they can cause an intrauterine growth retardation, which means that the baby doesn’t grow to the fullest extent possible and isn’t as healthy as it should be under normal circumstances. But that would be the case if the woman suffers from a lot of gum disease, which is uncared for. There is a mixed bunch of bacteria which cause gum disease.

The major one called AA gets your bone into trouble, but how much AA would directly cause miscarriage is still debatable.