October 27, 2009

Girly Teeth

After 32 years of decent dental health, in which I had one occlusal lesion in my lower left first molar (albeit one that was filled three separate times because the first and second dentists did a crappy job), I suddenly realized yesterday that I had not one but two smooth surface lesions on my lower left premolars, both along the buccal gumline. Carious lesions don't just appear. It takes a while for the munchy little bacteria to eat away at the enamel, turning it yellow then brown. Somehow I had two surprisingly large brown spots on my poor premolars. As an osteologist, I look at my teeth at least once a day. Sure, I don't inspect every single millimeter of them with a dental mirror, but as they're the only inside part of my skeleton on the outside, I gaze at them more than is probably healthy. So it's odd that I wouldn't notice the classic signs of dental caries in my own mouth.

But then I thought back to the outrageous amount of information I read over the course of my pregnancy last year. There was always a warning about dental procedures: some people seemed to think they were harmful, particularly in the first trimester, and some felt that good dental health was necessary for a healthy baby. I didn't think about this too much and did what I'd always done: brush at least twice a day. No flossing, in spite the ravages of periodontal disease I've seen in ancient skeletons. No cleanings at the dentist, in spite of the nasty tartar buildup I've seen on every single skull I've ever examined.

It seems, though, that I'm not alone in my confusion about dental care during pregnancy. A 2008 article notes that dental care in pregnancy is misunderstood by even doctors and dentists. What I should have searched for was the effects of pregnancy on dental health. I would have quickly found this 2002 review article that has two key findings: 1) Pregnancy-related changes are most frequent and most marked in gingival tissue; and 2) Changes in salivary composition in late pregnancy and during lactation may temporarily predispose to dental caries and erosion. Granted, as spelled out in the article, it's not that pregnancy causes carious lesions, rather it creates a better environment for bacteria to multiply and attack teeth and gums. One of my pregnancy side-effects, as it were, was sensitive gums, particularly in my first trimester. Even with the softest toothbrush, my gums would bleed every time I brushed. I thought, however, that my gums would go back to normal soon enough with no lasting effects, much like how the rest of my pregnancy-related complaints disappeared within a couple weeks after delivery. Although my gums seem fine, the changes in gingival tissues (especially the periodontal membrane) I had during pregnancy (and possibly now, as I am still nursing) must have contributed to these lesions.

But it got me thinking... I don't specialize in dental anthropology, but I can't remember ever having read that females of childbearing age have higher rates of carious lesions (and their inevitable result in antiquity, antemortem tooth loss) on average than males. Or that females have a higher rate of periodontal disease, the bony reaction to untreated gingivitis. I've already analyzed my Roman dental data for these disease processes, but I didn't think to specifically examine reproductive-age females. In antiquity, the creation of a better environment for hosting oral bacteria would have meant far more carious lesions than it does for today's hygiene-conscious woman. We really should be able to see this increase in the skeletal record - provided, of course, that men weren't doing something similarly cariogenic with their mouths. I doubt we could say much more than that women in the population likely had prenatal and postpartum caries, because the etiology of caries is multifaceted and there are tons of variables affecting it, although it would be cool if we could isolate the women who had given birth using their dental remains.

At any rate, a dentist appointment on Thursday will confirm just how rampant the decay is and how many fillings I need. Yay, pregnancy. Just one of the many things veteran mothers don't tell you about.

UPDATE: No cavities here, oddly enough. It seems I brush too hard, and my gums are receding slightly in the area of my mandibular premolars, exposing a bit of the somewhat darker and more sensitive root. That's good news, but I still need to be vigilant so that I don't get root caries - and now I know why some osteologists advocate counting root lesions differently than occlusal and smooth surface caries.

3 comments:

Anonymous said...

I recently found your blog and love it. I also recently saw some old posts; what happened to pathology Tuesdays and taphonomy Thursdays?

Kristina said...

Path Tues and Taph Thurs were weekly blog posts when I was in the field, examining skeletons every day. Maybe if I'm back in Italy this summer, I'll re-institute that. But right now, I'm writing up all the interesting stuff I found during analysis!

Bianca Jackson said...

Hi Kristina! So, how did your pregnancy go? Yeah, doctors say that the teeth are very sensitive when a woman is pregnant because of some lack of nutrients in the body. Did you take supplements by the time?

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