Importance of Good Oral Health During Pregnancy-Unveiling Facts and Clearing Myths!

Pregnancy is a duration in a females lifetime that is associated with several physical changes in the body which lasts for at least 9 months. Changes occur in the entire body, including the oral cavity. 

Not much is known about the relationship between oral health and pregnancy. As expecting families have a lot on their minds as well as lack of knowledge on oral care often leads to complicated oral health especially during pregnancy. Poor oral health of expecting mothers can result in Adverse Pregnancy Outcomes (like miscarriage, Preterm low birth weight delivery, perinatal morbidity and mortality)

Preterm Low Birth Weight delivery (PTLBW) has become a common problem in the recent time, which accounts for neonatal deaths as well as the high-cost neonatal care that cannot be afforded by all the strata of the society. Studies have shown that - Gestational Diabetes, Smoking by expecting mothers, obese/overweight expecting mothers, hypertension and higher age of expecting mothers are few of the known causes of PTLBW deliveries, still a large number of cases do occur in the absence of the above-mentioned risk factors. 

So, what could be the cause of PTLBW delivery?

Several studies in the past 2 decades have shown that expecting mothers with poor oral health had increased risk of neonatal deaths as well as preterm labour. Further, detailed studies have shown that females especially with existing gum disease, have a risk of preterm delivery. 

How does gum disease cause preterm delivery?

Gum disease is caused a constellation of gram +ve and gram -ve bacteria that increase in number and reside in the suitable habitat provided by the teeth and within the gums. The gram -ve anaerobic bacteria release certain powerful toxins from their oral environment and keep the host (expecting mother) immune system activated, resulting in a low-grade inflammatory state all the time. As a natural response, there is an increase in the inflammatory mediators, mainly prostaglandins (PGs) during the inflammatory period. Increased PG levels in blood contribute to premature uterine contractions and labour. 

Why do gum problems occur during pregnancy?

  • Pregnancy is associated with a 100-fold rise in female hormones- Progesterone and estrogen. Both these hormones have receptors in the gums (epithelial cells of gums). As the levels rise, proportionately there is dilatation of capillaries and increased the permeability of vessels in the cells as well as a diminished immune response by leukocytes in the gums, making the gums more susceptible to bacterial ingress and altering the response to bacteria. 
  • Also, a particular bacteria Prevotella intermedia increases several folds in the gums as it utilizes the female hormones as its source of nutrition.  

PREGNANCY GINGIVITIS:

  • As early as 19th century, it has been known that pregnancy leads to gingivitis. But, lately it has been understood that it is the routine dental plaque that leads to gingivitis, pregnancy tends to alter the response and aggravates it and hence, it is now known as Pregnancy Associated Gingivitis. 
  • Previously unnoticed gum inflammation (due to plaque bacteria) may suddenly become aggravated resulting in acute pain, pus discharge, redness and erythema with bleeding from gums, most frequently from the lower front teeth. 

PREGNANCY TUMOR:

Some women also develop what is alarmingly called "pregnancy tumours" due to hormonal changes during pregnancy.  According to the American Dental Association (ADA), the growths most often appear during the second trimester and look like little raspberries that form between the teeth. These small growths do resolve by themselves after delivery, but if they cause discomfort, they have to be surgically excised. 

MORNING SICKNESS AND ORAL HEALTH:

Morning sickness is a part of pregnancy for many women. It also brings up concerns about oral health and pregnancy, as the acid from your stomach can be strong enough to contribute to tooth erosion. 

MYTHS ABOUT DENTAL TREATMENT DURING PREGNANCY: 

  1. ALL DENTAL TREATMENT SHOULD BE AVOIDED DURING PREGNANCY- Dental treatment should be avoided only during the first trimester (0-3 months) of pregnancy as this is the period of organogenesis. It is safest to do elective (planned) dental treatment during the second trimester (3rd-6th month). During the third trimester (6th month to delivery), as there is an increase in the size of the foetus, there are chances of inferior vena cava compression in a semi-supine position (dentist chair position) causing hypotension. Hence, dental treatment during the third trimester has to be done with certain precautions. 
  2. DENTAL X-RAYS SHOULD NOT BE TAKEN DURING PREGNANCY- Although X-rays are harmful to the foetus, dental X-rays contribute to insignificant exposure. If a tooth X-ray is necessary, it can be done using protective barriers like lead aprons and thyroid collars. 
  3. ANY MEDICATION GIVEN DURING DENTAL TREATMENT SHOULD BE AVOIDED- Although some medications have certain ill-effects on the foetus, there are a certain set of SAFE drugs that can be prescribed during pregnancy by the dentist. Dentists generally consult the Physician prior to prescribing any medication to pregnant females. 

WHAT TO KEEP IN MIND PRIOR TO CONCEPTION?

  1. Maintenance of a good oral health all the time is important and especially during pregnancy. 
  2. PRE-CONCEPTION ORAL HEALTH CHECK-UP AND COUNSELLING- As an initiative to maintain good overall health during pregnancy, a preventive dental check-up and counselling could eliminate existing dental and gum problems and in addition, prevent dental problems during pregnancy and minimize the risk of PTLBW. 
  3. Taking extra care for oral health maintenance methods during pregnancy, which can be conferred by the dentist. As pregnancy limits the interventive dental procedures, preventive dental care becomes all the more necessary and important. 
  4. As morning sickness and acid reflux in the mouth causes tooth erosion, frequent rinsing of the mouth to clear off excess acid is advised. Massaging the teeth with a pinch of baking soda can neutralize excess acid and reduce tooth erosion.
  5. Frequent Scaling and polishing of teeth, especially in females with excessive/faster plaque, build up.
  6. Use of alcohol-free mouthwash or simply warm salt water rinsing help in maintaining healthy gums. 
  7. Speaking to your dentist or Periodontist (specialist for gums) for maintaining optimum oral health.