One of the most common problems during pregnancy is swelling of gums. Swelling or inflammation of gums is known as gingivitis. Common symptoms of gingivitis are bleeding gums, inflammation of gums and redness of gums. Pregnancy itself doesn’t cause significant gingival disease. Gingivitis in pregnancy is caused by bacterial plaque. Pregnancy accentuates the gum response to dental plaque and causes swelling of the gums. No noticeable changes occur in gums in case of absence of local factors (plaque deposits).

During pregnancy, there is increase in levels of estrogen and progesterone. These hormonal changes induce dilatation and increased permeability of gums and increased inflammatory response to dental plaque occurs. In this way, altered tissue metabolism causes gum overgrowth.

Severe gingivitis during pregnancy

Gum enlargement during pregnancy

Gum swelling in pregnancy can either be:
1. Marginal gums enlargement
2. Tumor like gum enlargement or pregnancy tumor

Marginal gums enlargement:

1. It results from aggravation of previous inflammation and will not occur in case of absence of local factors. Increased estrogen and progesterone levels accentuate response to dental plaque.
2. Incidence of marginal gum enlargement during pregnancy is 10-70%.
3. Marginal gum enlargement during pregnancy is generally generalized that is it affects almost all teeth.
4. It is more prominent on interproximal surface of teeth as compared to other teeth surfaces.
5. Enlarged gums will appear as bright red or magenta and gums will appear soft and friable.
6. Gums will have smooth and shiny surface.
7. Bleeding from gums will appear spontaneously or on slight provocation.

Tumor like gum enlargement or pregnancy tumor

1. Incidence of tumor like gum overgrowth in pregnancy is 2-5%. It is not any malignant condition but is an inflammatory response to local irritation or bacterial plaque.
2. It usually occurs after first trimester that is after 3 months of pregnancy but can also occur earlier.
3. Pregnancy tumor will appear as discrete, mushroom like spherical mass and will protrude from the gum margin or from interproximal space.
4. Tumor like gum enlargement during pregnancy expands laterally and because of pressure from tongue and cheeks, it will appear more flattened.
5. Pregnancy tumor is dusky red or magenta in color and has smooth, glistening surface present. Surface has numerous deep red, pin point markings.
6. Consistency of lesion is usually semifirm and may have varying degrees of softness and friability.
7. Tumor like gum swelling during pregnancy is usually painless. It becomes painful in case of accumulation of deposits below the margins or in case pregnancy tumor interferes with occlusion. Painful ulcerations develop if it interferes with occlusion.

Management of swollen gums during pregnancy

Maintaining good oral hygiene is very important during pregnancy. Pregnant women should brush twice regularly and should do regular flossing to remove the deposits from teeth. Soft tooth brush can be used for brushing.

Expecting mothers should get regular dental check-ups done. Dental cleaning is advised after every 6 months that is twice a year. If the gums bleed more during pregnancy, then dentist may recommend more frequent dental cleaning to expecting mothers.

A severe form of gum infection that is periodontitis can occur if gingivitis is left unchecked. Periodontitis occurs by spread of infection from gums into the supporting structures of teeth which can further lead to loss of attachment and bone loss and an also lead to mobility of teeth. Severe gum infection during pregnancy will also endanger health of the baby. Studies have shown that Periodontitis during pregnancy increases the incidence of preterm birth.

If tumor like gum enlargement is present, then surgical excision may also be required if it interferes with chewing and causes disfigurement or if the patient wants to get it removed willingly.

If expecting mother maintains good oral hygiene and get regular dental cleaning done, then swelling and bleeding from gums will not occur.

To avoid gum swelling during pregnancy, pregnant women should:

1. Get dental scaling i.e. teeth cleaning done during pregnancy to prevent plaque and calculus build up. Dental cleaning can be done after interval of 3-6 months.
2. Expecting mother can also do warm saline rinses periodically to reduce the swelling.
3. Pregnant women should brush her teeth twice every day for 2 minutes each time and should brush especially after vomiting from morning sickness. An anti-bacterial tooth paste may also be recommended by the dentist.
4. Healthy nutritious diet should be taken.
5. Most importantly, Medications should be taken after consultation of dentist or gynecologist in case of pregnancy.

After delivery of the child, gums usually become normal and swelling and bleeding of gums will regress. If swelling continues after pregnancy, then dentist should be consulted.

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