Pregnancy is a time of anticipation and change.

There are many obvious changes throughout a woman’s body and 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 make it appear so. The myth goes on to claim that the fetus draws calcium directly from the mother’s teeth and results in weakened teeth that decay and may be lost. In fact, the mother’s diet (and nutritional supplements) give the developing fetus all the calcium he or she needs to develop. 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 gingivae. The gingivae are far 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 gingivae 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 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 risk.

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. 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.

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.

LINK BETWEEN GUM DISEASE AND EARLY BIRTHS

In a study of 1313 pregnant women, research 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! It is advised that expectant mothers increase their level of oral hygiene and seek regular professional care during their pregnancies.

PREVENTION

Brush your teeth at least twice a day and after meals when possible. Floss daily. If you suffer from morning sickness, repeatedly rinse out mouth with water and brush your teeth as often as possible to neutralise 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. Eat a well-balanced diet with plenty of vitamin C and B12. See your dentist for help in controlling plaque and preventing gingivitis. Also schedule routine exams and cleaning to maintain good dental health.

Could gingivitis affect my baby’s health?

New research suggests a link between pre-term, low birth weight babies and gingivitis. Excessive bacteria, which causes gingivitis, can enter the blood stream through your mouth (gums). If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called ‘prostaglandin’, which are suspected to induce premature labour.

FAQ ON PREGNANCY AND 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 including 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 avoid plaque build-up. Gingivitis is most common during the second to eighth months of pregnancy.

What are “pregnancy tumours”?

Pregnancy tumours (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 ‘tumours’ are rare, usually painless and develop on your gums in response to plaque. Although they are not cancerous, they should be treated. Pregnancy tumours usually subside shortly after childbirth.

Should I receive dental treatment while I’m pregnant

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’’ organs are formed, is the most crucial to your baby’’ development, so it is best to have procedures performed during the second trimester to minimise any potential risk.

If I do need treatment, what drugs are 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 childs temporary and permanent teeth.

What if I’m hungry between meals?

During pregnancy, many women have the desire to eat between meals. While this is a normal urge, frequent snacking on carbohydrate-containing foods can be an invitation to tooth decay. The decay process begins with plaque, an invisible sticky layer of harmful bacteria that constantly forms on the teeth. The bacteria convert sugar and starch that remain in the mouth to acid that attacks tooth enamel. The longer sugars are retained in your mouth, the longer the acids attack. After repeated attacks, tooth decay can result.

Eat nutritious, well-balanced meals made up of foods from the five major food groups: bread cereals and other grains; fruits; vegetables; meat; fish; poultry and protein alternatives and more yoghurt and cheese. Thy to resist the urge to snack constantly. When you need a snack, choose foods that are nutritious for you and your baby such as raw fruits and vegetables and dairy products. Following your physician’s advice regarding diet is your wisest course.

What can I do to keep my mouth healthy during pregnancy?

To help prevent tooth decay and periodontal disease, brush your teeth thoroughly twice a day with fluoride toothpaste to remove plaque. Be sure to clean between your teeth daily with dental floss or interdental cleaners. Ask your dentist or hygienist to show you how to brush and floss correctly. When choosing oral care products, look for those that display the Australian Dental Associations Seal of Acceptance, your assurance that they have met the ADA standards of safety and effectiveness.

What if I’m pregnant and need a dental x-ray?

As a general rule we attempt to avoid x-rays and treatment requiring x-rays until after the baby is born. However, an x-ray may be needed for dental treatment or a dental emergency that can’t wait until after the baby is born. Untreated dental infections can pose a risk to the foetus, and dental treatment may be necessary to maintain the health of the mother and child. Radiation from dental x-rays is extremely low. However, every precaution is taken to minimise radiation exposure. A lead apron minimises exposure to the abdomen and should be used when any dental x-ray is taken. A leaded thyroid collar can protect the thyroid from radiation, and should be used whenever possible. The use of a leaded thyroid collar is strongly recommended for women of childbearing age, pregnant women and children. Dental radiographs are not contraindicated if one is trying to become pregnant or is breastfeeding.