Tracy B McGinnis
"I was nervous and thought it was some weird gum disease that might compromise my pregnancy," she says. "The dentist explained it was an oral pregnancy tumor due to hormones, and that once the baby was born, it would disappear."
What are pregnancy tumors?
Pregnancy "tumors" are found on the upper gum line, and while on their own, they're not harmful or cancerous, they can ulcerate and bleed easily.
Hormonal changes, along with tartar and plaque, are believed to be causes associated with pregnancy tumors, says Cate Vieregger, DDS. "Pregnancy tumors (Pyogenic Granulomas) aren't really tumors, but red/purple nodules that range in size from a few millimeters to several centimeters on the gum in between the teeth."
So what happens then? In addition to starting a strong oral health regimen, Dr Carmen Schuller, a DDS in New York City, says pregnancy tumors are usually surgically removed after the baby is born.
How the problems begin
If you think those tumors sound painful, realize that it doesn't necessarily have to be like that for you! The three keys: Prevention, prevention and prevention.
"Pregnancy tumors usually start as 'pregnancy gingivitis,'" says Dr Jaime L Johnson, DDS in Colorado, and creator of the Smiles for a Lifetime. DVD. "If you are eating more frequently during pregnancy, than you need to be brushing and flossing more than usual, too."
Dentists like Dr Michael Reddy, DMD, professor and chairman of the Department of Periodontics at the University of Alabama Birmingham School of Dentistry, estimates 1 out of 3 pregnant women may get pregnancy gingivitis.
Dentist and Chief Dental Officer for Health Net of California, Dr Robert Shechet, says oral hygiene can be difficult during pregnancy because of factors such as nausea, gum sensitivity, and the stress and fatigue of being pregnant. "This, combined with a reduced resistance to infection caused by the elevated hormones, results in pregnancy gingivitis."
And let's not forget that hormonal factors can accelerate tooth decay. "During pregnancy, progesterone levels can be 10 times higher than normal, says Cate Vieregger, DDS. "This causes enhanced growth of some oral bacteria that can cause gingivitis." If left untreated, Vieregger says gingivitis can progress to periodontitis. "This can cause bad breath, loose teeth, and systemic inflammation which can affect the health of the unborn baby as well as that of the mother."
Dentists agree that a regular regime of brushing and flossing may prevent pregnancy gingivitis altogether. "Normally after you brush and floss, you only have 100,000 germs in your mouth, but 12 hours later, you can have 3 to 6 billion," explains Sadie Sallie Mestman, BS, DMD, and author of "What to do for Healthy Teeth."
Dr Mestman, BS, DMD, recommends flossing and brushing three times a day to avoid gingivitis during pregnancy, in addition to getting a cleaning before pregnancy. "Once you get pregnancy gingivitis, it can last through breastfeeding, but will usually diminish after delivery."
Getting off to a good start
In addition to brushing properly, regular cleanings and X-rays can help prevent gingivitis and other dental problems, but you need to plan ahead: Dentists suggest taking care of some dental procedures before getting pregnant to avoid potential risks.
Mestman agrees, and advises women to have dental exams and necessary X-rays before getting pregnant. "I try to avoid any dental treatment that can wait until the pregnancy is over, and prefer to avoid X-rays, drilling small cavities and doing any cosmetic work during pregnancy."
But what if you're already expecting?
During the nine months
Despite restrictions with dental care during pregnancy, dentists agree that routine visits while pregnant benefit both mother and child. Dr Michael Reddy, DMD, professor and chairman of the Department of Periodontics at the University Of Alabama Birmingham UAB School Of Dentistry and a Harvard graduate says, "Dental care should ideally be delivered in the second trimester to prevent complications later in pregnancy."
Dawson, who is currently pregnant with her second child, says she saw the dentist prior to conceiving to have minor work and a cleaning done, and so far she reports only having sensitive gums throughout her pregnancy. "I have cleanings each trimester -- I don't want to take any unnecessary chances."
The bottom line: If your gums bleed when you brush and floss and you haven't seen a dentist during your pregnancy, schedule an appointment -- and be sure to let the office know that you're expecting.
What if you need some major dental work?
Chief Dental Officer of Health Net of California Dr Robert Shechet, DDS, says it's a judgment call to determine when and if the risks of a treatment outweigh the risks of postponing said medical attention. It primarily depends on the severity of the situation. "Having a massive dental infection when ready to deliver is more dangerous to mother and child then having a root canal treatment in the second trimester," he says. "The dentist, in consultation with the obstetrician, should make decisions on treatment."
"Dental anesthetics can enter the placenta, but most doses used are considered safe. Acceptable antibiotics are penicillin, amoxicillin and clindamycin. Tylenol can be used for pain, but avoid narcotics, aspirin and ibuprofen," says Dr George Phillips of Phillips and Phillips Dental Associates in Atlanta. "The best option is no medication."
And when treatment is deemed to be necessary, Nancy Cibulka, PhD, APRN, BC Associate Professor at Barnes Jewish Hospital and Maryville University, notes, "Local anesthesia and X-rays with the proper coverage of the abdomen are acceptable."
There are several insurance carriers that now encourage dental care during pregnancy and pay for periodontal care. "This is a huge leap in prevention on the medical/dental front," says Vieregger.
Johnson also suggests talking to your dentist about fluoride levels in your local water supply -- and avoid teeth bleaching, nitrous oxide and local anesthetics during pregnancy.
Gum disease and labor?
While further studies need to be done in order to determine if the bacteria that cause gum disease can also stimulate labor, many healthcare professionals accept that there may be a link.
"The oral bacteria that cause gum disease stimulate over production of labor-inducing regulatory proteins called cytokines and prostaglandin," explains Vieregger. "This influx of proteins induces contractions and a cascade of events leading to premature birth."
Or, as Dr Shechet says, "The current explanation is that when bacteria from gingivitis enters the blood stream, the mother's body interprets this as trauma releasing prostaglandins, which are also a signal for labor to start."
But the impact doesn't stop there. Vieregger says, "Gum disease may even influence infertility due to systemic inflammation."
Much of the danger, says Dr Cibulka, comes from the fact that "anytime there is an inflammation in the body, it's not localized -- it sets off changes in entire body."
What else can you do?
Other tips on dental care during pregnancy include cutting down on sweets and brushing gently with a soft toothbrush. And if you have been dealt the morning sickness card, Carmen Schuller, DDS in New York City reminds, "If you vomit, brush your teeth afterwards to clean your teeth and mouth."
Dr Cibulka is currently doing a study at a clinic at Barnes Jewish Hospital. "Most women had no idea that oral health is important and plays a role during pregnancy," she says. "We're focusing on increasing the use of preventative practices, like brushing and flossing, and getting check-ups during pregnancy."
With more awareness about oral health, there will be more healthy moms and babies than ever before. -- and that is definitely a great reason to smile.