Pregnancy is a time of anticipation and change. There are many obvious changes throughout a woman’s body as well as some not so obvious that occur within the mouth or oral cavity. While temporary, pregnancy does affect how and when dental care is provided.

MYTHS

There is a long standing myth that a woman loses a tooth for every child she has. Of course this is not the case, but circumstances and changes in the mouth may make it appear so. The myth goes on to claim that the fetus draws calcium directly from the mother’s teeth.  It is a myth that calcium is lost from the mother’s teeth during pregnancy. The calcium your baby needs is provided by your diet, not by your teeth. If dietary calcium is inadequate, however, your body will provide this mineral from stores in your bones. An adequate intake of dairy products – the primary source of calcium – or the supplements your obstetrician may recommend will help ensure that you get all the calcium you need during your pregnancy. Increased cavities are the result of many factors such as an increase in snacking and poor oral hygiene.

INTRAORAL CHANGES

Starting about the second month of and continuing for the rest of the pregnancy, hormone changes affect the gums or gingiva. The gingiva is much more susceptible to irritation from plaque (soft) or calculus (hard) deposits on the teeth. An exaggerated inflammatory response can result in mild redness or gingivitis, to swelling of the gingiva between the teeth. These swellings are painless, but do bleed easily. Most pregnant women experience some form of inflamed gums even with good dental hygiene. Additionally, looseness of the teeth may be noticed, especially in the third trimester. These gingival changes usually reverse after the baby is born.

Cavities or decay, as noted above, can increase during or after pregnancy. Factors related to the pregnancy, not the pregnancy itself, can lead to this increase. The inflamed gums that many women experience can be tender so she may avoid brushing and flossing.  Plaque accumulates. As the fetus increases in size, the stomach capacity decreases and to compensate, frequent small meals and sugary snacks are common. With more plaque present and more available sugars, there is an increase in decay.

DENTAL CARE DURING PREGNANCY

Dental care during pregnancy is important. While many treatments are elective and usually postponed until after pregnancy, there is care that a pregnant woman needs and sometimes treatment cannot wait, but can be done with minimal risk. Consultation with a woman’s physician also helps minimize risks.

FIRST TRIMESTER

A dental exam and routine hygiene care (cleaning) is important so that the irritants (plaque and calculus) that lead to gingival inflammation and cavities, can be removed. Instructions in home care can help the pregnant woman maintain her oral health. The developing fetus is most susceptible to drugs, stresses, and cellular changes, and only emergency treatment and routine care should be performed at this time. Other dental treatment is usually postponed until after the pregnancy, and more pressing treatment is delayed until the second trimester, if possible.

SECOND TRIMESTER

Routine hygiene care again is advisable. Necessary dental treatment is relatively safe and comfortable for the woman at this stage. Your dentist will know not to use epinephrine. Unfortunately, all local anesthetics that dentists use cross the placenta. We know how much local anesthetic is safe for infants and children, but we don’t have a lot of information about safe amounts during pregnancy. As little as required to keep you comfortable during the procedure is probably the best rule to follow. Will you feel pressure? Yes. But if it’s painful, ask your dentist to numb the area more. It’s important that you are as comfortable as possible for two reasons:

  1. When you’re comfortable, the stress on the baby is reduced
  2. The more relaxed and comfortable you are, the better the anesthetic will work and the less discomfort you will have after the procedure.

X-rays are usually safe with a double shield at this stage. A written permission from the patients OB should be received for any prescriptions, x-rays, or administered drug (including local anesthetic).

THIRD TRIMESTER

If needed, due to inflammation or swelling of the gums, another hygiene appointment may be appropriate, but early in this trimester is the best time. Appointments are kept short as the woman is usually uncomfortable reclining in the dental chair.

FAQ ON PREGNANCY & DENTISTRY

Will pregnancy affect my oral health?

Expectant mothers (and women who take some oral contraceptives) experience elevated levels of the hormones estrogen and progesterone. This causes the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as “pregnancy gingivitis” 65 to 70% of all pregnant women developed gingivitis during this time! Symptoms include swollen, red gums and bleeding of the gums when you brush.

Pregnancy gingivitis usually starts around the second month of pregnancy and decreases during the ninth month. If you already have gingivitis, it will most likely get worse during pregnancy. Remember that the bacteria in plaque (not hormones) are what cause gingivitis. Brush twice a day and floss before you go to bed to help avoid plaque buildup. Gingivitis is most common during the second to eighth months of pregnancy.

What are “pregnancy tumors”?

Pregnancy tumors (pyogenic granuloma) are inflammatory, benign growths that develop on the gums as part of an exaggerated response to the irritants that cause periodontal disease. These “tumors” are rare, usually painless and develop on your gums in response to plaque. Although they are not cancerous, they should be treated. Pregnancy tumors usually subside shortly after childbirth.

Is there a connection between my diet pregnancy and my oral health?

Eating a balanced diet is necessary to provide the correct amounts of nutrients to nourish both you and your child. What you eat during the nine months of pregnancy affects the development of your unborn child – including teeth. Your baby’s teeth begin to develop between the third and sixth month of pregnancy, so it is important that you receive sufficient amounts of nutrients – especially calcium, protein, phosphorous, and vitamins A, C, and D.

Could gingivitis affect my baby’s health?

New research suggests a link between pre-term, low birth weight babies and gingivitis. Excessive bacteria, which cause gingivitis, can enter the bloodstream through your mouth (gums). If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called “prostaglandins”, which are suspected to induce premature labor.

Should I receive dental treatment while I’m pregnant?

Good oral health care is vital during your pregnancy. Continue with your regular dental cleaning and check-ups to avoid oral infections that can affect the fetus, such as gingivitis and periodontal disease.

Dentists recommend that major dental treatments that aren’t urgent be postponed until after your child is born. The first trimester, the stage of pregnancy in which most of the baby’s organs are formed, is the most crucial to your baby’s development, so it is best to have procedures performed during the second trimester to minimize any potential risk.

Dental work is not recommended during the third trimester because the dental chair tends to be too uncomfortable for the mother. If you lie back, the chair may cut off circulation by placing pressure on the vein that returns blood to the heart from the lower part of the body.

If I do need treatment, what drugs are safe?

Be extremely cautious of all drugs during pregnancy. If you have gingivitis or periodontal disease, your dentist may want to treat you more often to achieve healthy gums and a healthy baby.

Although dental anesthetics such as Novocaine or lidocaine can enter the placenta, which filters out most drugs, the doses used in most dental procedures are considered safe.

If you need to have dental work done during your pregnancy, research has shown that some acceptable antibiotics include penicillin, amoxicillin, and clindamycin but avoid tetracycline, which can cause discoloration of your child’s temporary and permanent teeth.

Products containing paracetamol, such as Crocin, are approved, but you should be wary of other over-the-counter medications such as aspirin or ibuprofen. Avoid using narcotics for dental pain until after your child is born.

Prevention

You can prevent gingivitis by keeping your teeth clean, especially near your gum line and:

Brush your teeth at least twice a day and after meals when possible.

Floss Daily

If you suffer from morning sickness, repeatedly rinse our mouth with water and brush your teeth as often as possible to neutralize the acid caused by vomiting.

If brushing your teeth causes morning sickness, rinse your mouth with water, brush without toothpaste and follow with anti-plaque fluoride mouthwash.

DIET

Eat a well-balanced diet with plenty of vitamin C and B12. If you snack, stack healthy, and brush in between. See your dentist for help in controlling plaque and preventing gingivitis. Also schedule routine exams and cleaning to maintain good dental health. Remember, the healthier your mouth is, the healthier and happier your pregnancy and baby will be. Pregnancy is an exciting time and proper dental care can help keep everything going smoothly.

Link between Gum Disease and Early Births

In a study of 1,313 pregnant women, researchers at the University of Alabama found that women with severe periodontal disease, in their second trimester of pregnancy tended to give birth anywhere from 3 to 8 weeks before their due dates!

There are several things you can do to make your visit as comfortable as possible, and keep the amount of anesthetic that you’ll require to a minimum.

• You may want to take a mild pain medication prior to your appointment. If you’re not sure what medication is safe for you, discuss options with your health care provider.

• If you’re anxious about the procedure, talk to your dentist about whether laughing gas (nitrous oxide) would be appropriate to help keep you comfortable and relaxed. For many women laughing gas is safe and effective, as long as you are breathing at least 50% oxygen and the nitrous oxide isn’t used for more than 30 minutes.

• Have some protein 40-60 minutes before your appointment to minimize any hunger.

• While you’re in the dental chair, focus on your breathing and keep your legs next to each other, not crossed to keep your blood circulation flowing.

• Bring headphones and favorite, relaxing CDs or audiotapes.

• If you’ll need a lot of dental work, make several short appointments rather than fewer, longer appointments. Take a pillow to place under your right hip to keep you and the baby more comfortable.