Thirty-Six Weeks Pregnant With a Toothache

Quick answer: Late in pregnancy the goal changes. Anything urgent still gets treated, but long appointments and elective work are deferred, and the priority is a comfortable patient who can lie back safely for as short a time as possible.

The call

Efrat, 33, from Givat Sharett, at 36 weeks, phoned on a Sunday with two complaints: a specific tooth that ached when she chewed, and gums that had been bleeding heavily for months and had grown a lump between two lower front teeth that alarmed her.

Two problems, and they needed different answers.

What we found

The aching tooth. Upper left second premolar, with a broken filling and decay into dentine, but not into the nerve. Cold gave a sharp response that stopped within a few seconds — reversible pulpitis. The nerve was irritated but not dying.

The lump. A pregnancy epulis, sometimes called a pyogenic granuloma of pregnancy — a soft, red, bleeding overgrowth of gum tissue between the lower incisors. It looks alarming. It is benign, driven by the hormonal changes of pregnancy combined with plaque at that spot, and the overwhelming majority shrink or disappear entirely within a few months of delivery.

Her gums generally were inflamed and bled at the slightest touch. Pregnancy gingivitis affects a large proportion of pregnancies, and she had reduced her brushing because of the bleeding, which had made it considerably worse.

What we did

The appointment was kept to thirty minutes, in the morning, with her positioned on her left side and the chair only partly reclined. At 36 weeks, lying flat is genuinely uncomfortable and can drop blood pressure.

For the tooth: we removed the decay and placed a well-sealed bonded restoration, using local anaesthetic. It settled the sensitivity and, importantly, it was a definitive filling rather than a temporary — no need to repeat it later.

For the epulis: we did not remove it. Surgical removal during pregnancy tends to result in recurrence, and the lesion was not interfering with eating or bleeding uncontrollably. We cleaned the area thoroughly, showed her how to clean around it without traumatising it, and planned to review it three months after delivery.

What we deliberately deferred: a crown she had been considering, and a deep cleaning of the whole mouth. Both could wait.

The outcome

She delivered three weeks later. The epulis shrank steadily and had gone by four months postpartum without any surgery. Her gum health returned to normal once the hormones settled and she was brushing properly again. The filling is still in place three years on.

What to do if this happens to you

1. Do not stop brushing because your gums bleed. Bleeding gums need more cleaning, not less. Use a soft brush.
2. Say how many weeks you are and mention any dizziness lying back.
3. Ask for a shorter appointment and to sit up if you need to.
4. Ask what can wait. A good dentist will separate urgent from elective without being asked, but ask anyway.
5. Do not panic about a gum lump. Have it looked at, but pregnancy epulis is common and benign.
6. Book a check-up for a few months after the birth. That is when the deferred work gets done.

Pregnant with a dental problem? Ramat Beit Shemesh Urgent Dental Care adjusts appointments for late pregnancy. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.