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A case of florid pregnancy gingivitis

From Volume 46, Issue 2, February 2019 | Pages 166-170

Authors

Lewis Hua

Dental Core Trainee, Restorative Dentistry, Cardiff University School of Dentistry, Heath Park, Cardiff CF14 4XY, UK

Articles by Lewis Hua

Matthew Locke

Senior Clinical Lecturer/Honorary Consultant in Restorative Dentistry, Cardiff University School of Dentistry, Heath Park, Cardiff CF14 4XY, UK

Articles by Matthew Locke

Abstract

Abstract: The aim of this case is to demonstrate an exaggerated appearance and subsequent management of a florid combination of pregnancy gingivitis and multiple pregnancy epulides. Pregnancy-associated periodontal conditions constitute benign overgrowth that histologically may be indistinguishable from pyogenic granulomata. The literature has described presentation from the first trimester, peaking in the third trimester before an amount of spontaneous resolution post-partum. This paper describes a 26-year-old woman at 33 weeks of gestation who was referred for significant generalized enlarged gingivae with accompanying soreness and discomfort in oral function. Florid gingivitis and epulis represents important periodontal manifestations during pregnancy and can be troublesome in providing meaningful immediate pain relief.

CPD/Clinical Relevance: The dental clinician should be aware of pregnancy-associated gingivitis/epulis, the aetiology, presentation and be able to provide necessary steps for diagnosis, treatment and referral pathways in the primary care setting. These lesions should always be included in the differential diagnosis of oral mucosal soft tissue masses.

Article

There is consensus that physiological changes may occur in a person's periodontium during pregnancy1, 2 The expectant mother must adapt to the changes that occur during the period of pregnancy.3 The most noteworthy physiological change is the increase in production of the androgens, specifically the hormones oestrogen and progesterone. These steadily increase until the eighth month of pregnancy when progesterone remains constant and oestrogen continues to increase during the luteal phase.3 The increase in hormones is due to the placenta, which controls production in early pregnancy from the luteal phase (which results from the implantation of the embryo).3, 4 The oestrogen levels rise to more than 100 times by the time of birth, then during labour, with the placenta withdrawn, there is a significant decrease in the levels of both progesterone and oestrogen. Within 2−3 days post-partum, the levels of these hormones are reduced to those found pre-pregnancy.3

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