pregnancy and childbirth.

There are physical, emotional and social changes that have permanent impact.

Changes in one's dental health are usually unanticipated but often occur.

Pregnancy requires an increased caloric intake and this sometimes leads to frequent snacking between meals. Snacking between meals causes an increase in the production of acid in the mouth and dental decay can occur. Acid production can be reduced by practising strict oral hygiene supplemented by rinsing after snacks.

The most common dental problem which occurs during pregnancy is `pregnancy gingivitis'. This usually occurs between the second and the eighth month. A woman may find that her gingiva (gums) are swollen, red and tender. They may also bleed very easily when brushed.

This problem may affect up to three quarters of all pregnant women and it is due to changes in the hormonal levels in the body. There is an exaggerated response to irritants located on the surfaces of the teeth above or below the gumline. These irritants, plaque and calculus (tartar), are the usual causes of gingivitis and periodontitis. However, during pregnancy the response to a small amount of irritant may be intensified. Even a rough or overhanging filling or crown, which would not usually produce a response, may result in a reaction.

About one percent of women with pregnancy gingivitis develop growths on the gingiva which are commonly called `pregnancy tumours'. These benign growths may disappear after childbirth or they may need to be surgically removed.

Sometimes they recur at the same location in a subsequent pregnancy.

If an emergency arises, radiographs may be essential for proper treatment. In this case, the dentist will take as few radiographs as possible and use a protective lead apron with a collar to further reduce the exposure to X-rays.

The best preventive measure is to make sure you are in good dental health before becoming pregnant.

Dr. Celia Musson Nzabalinda HEALTH AND SOCIAL ISSUES HTH