JULIA IS A 20-YEAR-OLD hairdresser whose presenting complaint was enhanced gingival bleeding following toothbrushing from the majority of her teeth. She also noticed gingival swelling occurring around the maxillary incisor teeth, and that these swollen areas appeared to be the most hemorrhagic. Julia has a moderately restored dentition, and previously had numerous incisor restorations for caries. She is an irregular flosser, and until twelve months ago, was smoking one to two packets of cigarettes per day.
Julia recently underwent a pregnancy test and this was found to be positive. A salivary test revealed a dramatically depressed buffer capacity of the stimulated saliva. However, the pH of the stimulated saliva was normal. This apparent anomaly correlates with the possibility that the salivary changes and gingival changes are due to pregnancy. Given her high caries rate in the past, enhanced prevention during the period of pregnancy would be very worthwhile, since it is during this time that alterations in salivary flow and changes in the buffering capacity of saliva may make her oral environment more conducive towards dental caries. If nausea develops during the first trimester of pregnancy, this will increase the risk of tooth structure loss from dental erosion.
An appropriate preventive agent for use at night before bed is GC Tooth Mousse Plus which can deliver fluoride, calcium and phosphate in the correct ratio for remineralization of enamel. The casein phosphopeptide can also provide buffering of plaque acids and by elevating levels of calcium in dental plaque fluid can reduce plaque acid production through fermentation.