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 may make it appear so.  The myth goes on to claim that the fetus draws calcium directly from the mothers teeth and results in weakened teeth that decay and may be lost.  In fact the mothers 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 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.  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.

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.

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 labour.

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, are approved, but you should be wary of other over-the-counter medications such as aspirin. 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 gumline 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 vomitting.
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.

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!

It is advised that expectant mothers increase their level of oral hygiene and seek regular professional care during their pregnancies.