Good oral health is an important part of good overall health. Oral disease during pregnancy may affect not only the health of a pregnant woman, but may also affect the health of her pregnancy and possibly, the health of her child.

Oral health is also important for looking and feeling good. Oral health is also linked to overall health. Cavities and gum disease may contribute to many serious conditions, such as diabetes, respiratory diseases, and infections.

Also, a mother’s oral health is linked with her child’s oral health. The best predictor of a child having tooth decay is the mother or primary caregiver having decay. Taking care of your mouth while you are pregnant is important for your own health AND your baby’s health. Pregnancy can make teeth and gum problems worse. Sometimes people don’t know they have gum disease.Hormonal changes and changes in eating patterns, such as increased snacking, increases the risk for oral disease.

Research estimates that:

•       30-100% of pregnant women have gingivitis (mild gum disease)

•       5-20% of pregnant women have severe gum disease

•       25% have at least one untreated cavity

A significant number of women enter pregnancy with oral disease. Pregnancy can trigger oral health problems or make them worse. Many women are not aware they have oral disease – it is often called an “invisible” disease. Oral disease symptoms are not always noticeable. These are some signs to pay extra attention to while you are pregnant.

•       Red or swollen gums

•       Tender gums

•       Bleeding gums

•       Loose teeth

•       Sensitive teeth

Signs of Cavities or Gum Disease

  • Pain when chewing
  • Pus around teeth and gums
  • Tartar (brown, hard spots) on teeth
  • Bad breath
  • The earliest sign of gum disease is gingivitis when the gums appear red and puffy
  • Gingivitis happens when plaque is not removed from the teeth and gums daily
  • Pregnant women  are more likely to get gum disease
  • Periodontitis can result from untreated gingivitis.

Pregnant omen with severe gum disease may be at a higher risk of delivering pre-term, low birth weight babies than women with good oral health. Babies who are pre-term or low birth weight have a higher risk of developing complications, asthma, ear infections, birth abnormalities, behavioural difficulties, and are at a higher risk of infant death. A recent study showed that only about one third of pregnant women visit the dentist while they are pregnant.  Worse yet, only half of the women in the study who reported having a dental problem went to get care. 

 There is no evidence that routine dental examinations or treatment should not be performed during an uncomplicated pregnancy.  In fact, not going to the dentist may cause problems such as oral infections that can cause the need for emergency care or affect the fetus.  You should make sure you have regular check-ups and cleanings any time during pregnancy to keep your mouth as healthy as possible.

Emergency dental treatment to relieve pain, swelling, bleeding or infection should be sought as soon as possible, no matter what stage of pregnancy.  With today’s technology there is little radiation exposure to the fetus during dental x-rays when both a lead apron and a thyroid shield are used, so don’t worry if they are needed for emergency care.

Many women experience morning sickness during the first trimester, and may not be able to tolerate any procedures or instruments in their mouth. The first trimester is when the baby’s organs are developing, so it is best to avoid medication at this time if possible. The third trimester is also difficult for tolerating dental procedures, since lying back in the dental chair tends to be uncomfortable for the mother.  Lying on your back for extended periods can reduce circulation to the fetus by placing pressure on the vein that returns blood from the lower part of the body to the heart.

It is probably best to schedule any necessary procedures that are longer than 45 minutes such as multiple fillings or crowns during the second trimester or early in the third trimester.

Myth-

It is a myth that dental treatment during pregnancy is not safe. The benefits of providing dental care during pregnancy are significant and far outweigh minimal potential risks, particularly for a pregnant woman who has oral pain, an emergency oral condition, or infection. Prevention, diagnosis and treatment of oral disease, including dental x-rays and use of local anesthesia, are beneficial and are safe during pregnancy

Hormonal changes, mainly estrogen and progesterone, can cause many changes in the mouth. The same hormones that increase ligament laxity in other joints during pregnancy can also cause increased mobility of the teeth.  Severe mobility, however, may be a sign of severe periodontal disease and should be evaluated by a dentist as soon as possible.

Hormonal changes can also cause changes in saliva flow, either increasing or decreasing it.  Changes in the quantity and quality can also occur, making it less protective. Some types of bacteria that normally live in the mouth increase in numbers during pregnancy.  These bacteria can cause tooth decay or gum disease.

Changes During Pregnancy that Affect Oral Health-

Morning sickness can cause problems with oral health if the nausea makes it difficult for the pregnant woman to use a toothbrush or floss.  Some women are so sensitive that they have a difficult time tolerating anything placed in the mouth. If this causes a disruption of normal hygiene such as brushing or flossing, the bacteria that are normally present in the mouth are likely to cause pregnancy gingivitis or tooth decay.

The nausea that is often experienced during the first trimester is sometimes accompanied by vomiting.  During the
third trimester some women also develop severe heartburn or esophogeal reflux which propels stomach acid up into the mouth.  Stomach acids irritate the gingival tissue.  Stomach acids also soften the outer layers of tooth enamel allowing it to be removed easily.  If this happens repeatedly the enamel will become thinned.  This process is called dental erosion.

Treatment of acid exposure-

Tooth brushing should never be performed immediately after the mouth is exposed to stomach acid.  The brushing
action can remove the softened outer layer of enamel, causing it to thin. Rinsing with a solution of water that contains baking soda will neutralize the acid and allow the saliva to remineralize the tooth. If baking soda is not available, liquid antacids or plain water may be used. 

Saliva changes- 

One of the body’s primary defenses against tooth decay is saliva.  Saliva contains proteins and electrolytes that buffer and neutralize bacterial acids.  It also contains the minerals calcium and phosphorus, which help to re-mineralize (harden) teeth.

During pregnancy, saliva composition may show a decrease in buffering ability and calcium levels.   During pregnancy, saliva may develop a lower pH or become more acidic.  This change has been shown to be associated with increased levels of decay-causing bacteria. Decreased saliva flow can cause dry mouth or Xerostomia. Some women experience the opposite problem of excessive salivation, or Pryalism. Any of these changes in saliva may increase a woman’s susceptibility to tooth decay, so maintaining good oral hygiene habits becomes particularly important.

Increased bacteria- Many women experience nausea or hypoglycemia during pregnancy, which necessitates the consumption of between-meal snacks. Commonly promoted foods such as crackers may be high in starches (fermentable carbohydrates) that promote tooth decay.  This increased frequency of food consumption and increase in carbohydrate intake can promote tooth decay by increasing the acid production of decay-causing bacteria. 

Eating small frequent meals, as recommended during pregnancy, can cause an increase in bacteria growth, because they have a nearly continuous food supply. Gingival fluid is the fluid that is normally produced by the gums in the crevice between the gums and teeth.  This fluid contains antibodies and normally has a slightly protective effect.  However, in pregnancy, this fluid contains high levels of hormones.  Some types of bacteria can use these hormones for energy, and they can grow and multiply and cause problems with the gums. Saliva also contains higher levels of hormone that can trigger bacteria growth.

Pregnancy Granuloma- In about 5 to 10% of women, the increased response of the gums in the presence of pregnancy hormones can cause irritated gum tissue to grow into a lumpy mass known as a pregnancy granuloma (often misnamed a Pregnancy “Tumor”).  These usually start growing during the second trimester and are usually found between the teeth. They bleed easily and have a red, raw-looking rumpled surface. If they are small and do not cause any problems, your dentist will probably advise you to wait and see if they go away after the baby is born.  If they do not go away after delivery, they can be removed surgically.

Safe dental treatment-

Overall, the majority of drugs commonly used in dentistry are considered safe to use during pregnancy.  Commonly used antibiotics considered safe are penicillin, amoxicillin, cephalexins, erythromycins.

Pain and fever relief is important during pregnancy. 

Untreated fever can cause problems with the baby’s development, especially during the first trimester.  Severe pain can cause intense stress, leading to high levels of stress hormones and increased blood pressure, neither of which are good for your baby.  Acetaminophen (Tylenol) is usually recommended for pain. Your dentist will
probably want to contact your obstetrician if it is necessary to give you a stronger pain medication that contains narcotics, or a different antibiotic so make sure you bring the information on how to contact the physician who is providing your prenatal care with you to the dentist.

Aspirin or nonsteroidal anti-inflammatory drugs like Motrin or Advil can cause bleeding problems and other problems, and should be avoided. 

You should never take any drugs that are in the tetracycline family, as they can cause damage to the baby’s developing teeth.

It is very important to maintain good oral hygiene practices to prevent both dental decay and gum disease. 

Dental floss prevents both dental decay on contact surfaces and gum disease.  Ideally, flossing should be performed once per day, before brushing.  Brushing should be performed at least twice daily with fluoridated toothpaste.  Fluoride remineralizes (hardens) any areas of the tooth enamel that have been weakened by bacterial acids. There is no need to rinse the mouth after brushing.  In fact, NOT rinsing allows the fluoride to remain in contact with the tooth surfaces, where it is most effective.

American Dental Association approved antibacterial mouth rinses are very helpful for fighting gingivitis.  If you have gum disease, your dentist may want to prescribe a stronger mouth rinse that has chlorhexidine in it.

Xylitol is a natural sweetener that is found in fruits and vegetables such as plums, strawberries and raspberries. It is usually made from certain hardwoods such as the birch tree.

Xylitol:

•           Blocks bacteria from producing the acids that cause tooth decay

•           Decreases the levels of cavity-causing bacteria

•           Decreases plaque formation by bacteria on the teeth

•           Enhances remineralization (hardening) of weakened tooth structure

Keeping your regular dental exam schedule allows your dentist to detect and treat any problems that may develop during your pregnancy

Eat well-balanced meals-

a) B vitamins, especially folate (folic acid)

b) Vitamin C

c) Calcium

Snack smart

1) Avoid starchy or high carbohydrate snacks

2) Raw fruits and vegetables

3) Diary products

B vitamins are important for maintaining the health of oral tissues such as the lining of the mouth and tongue.  One B vitamin, Folic acid, appears to be important in the prevention of cleft lip and palate in the developing baby.  Cleft lip can form by the 8th week, and cleft palate by the 12th week.  The majority of studies have shown that an adequate intake of folate (folic acid) reduces the chances of having clefting problems, even in mothers who have a genetic predisposition for orofacial clefting.  Vitamin C helps a woman maintain healthy gums during pregnancy.

Calcium is important for both the health of the mother’s bones and teeth and the proper development of the baby’s bones and teeth. Substituting fruits and vegetables for starchy, high carbohydrate snacks will decrease your chances of tooth decay and increase your intake of vitamins and minerals.

Mothers are the most important influence on their children’s oral health. You are the key to a lifetime of good oral health for your child. The healthier your mouth, the healthier your child will be. And the better your oral care habits are, the better your child’s will be also.