Unique to You

In the hectic time leading up to your baby's birth, it can be difficult to keep up with everything important. Your oral health isn't something you can afford to overlook.

Changes you undergo throughout your pregnancy can impact your oral health. More importantly, poor oral health can impact your pregnancy. It is essential to learn about these connections and take the necessary steps to build and maintain good oral health, ideally before your pregnancy begins.

Consider these facts:

• Periodontal disease has been associated with preterm birth and low birth weight, although the extent to which poor oral health impacts these outcomes is not fully understood.¹
• Nearly 60% to 75% of pregnant women have gingivitis, an early stage of periodontal disease. Changing hormone levels during pregnancy may aggravate this condition.² Untreated, periodontal disease can lead to infection, unnecessary dental treatment, and missing teeth.
• Newborns are three times more likely to develop tooth decay if their mothers have high levels of untreated decay during and after pregnancy.³ The harmful bacteria that cause tooth decay can be transmitted to the baby.

Oral health and family planning: Good oral hygiene and regular dental visits are important at any stage of your life, but especially so if you are planning to become or are already pregnant. Having your oral health in the best shape possible before you are pregnant can help avoid any risks associated with treating dental issues while you are pregnant and improves your chances of a healthier pregnancy.

Inform your dentist: Alert your dentist or hygienist that you are pregnant or planning to become pregnant. Your dentist will work with you to develop the most appropriate treatment and maintenance strategy. Be sure to provide your dentist with your general physician and obstetrician's contact information. This is important in case they need to discuss your pregnancy and oral health status.

Dental treatment during pregnancy: While it's ideal to address any oral health problems before you become pregnant, issues can occur at any time. It's essential to have them evaluated as soon as possible to mitigate any risks that may affect your pregnancy. If you are experiencing dental pain or notice other abnormal issues in your mouth, see your dentist immediately. You and your dentist can discuss the issue and concerns and determine the best course of action. Here are some general considerations for oral healthcare during pregnancy:

• Through your pregnancy, your dentist will recommend how often you should have routine appointments. Periodic exams, routine cleanings, X-ray images, fluoride treatment, fillings, or orthodontic visits generally pose no concerns if planned and conducted appropriately during your pregnancy.
• If necessary, it's generally best to complete any procedures involving anesthetic and radiographs during the second trimester.
• More invasive procedures like periodontal disease treatments, tooth extractions, or root canals may need to be performed in cases of a dental emergency. This is because a failure to address the underlying problem may lead to pain or an increased chance of infection that can harm you or your baby.⁴

As a general rule, the second trimester is generally considered the best time for required, invasive dental procedures to be performed. This is because the first trimester is critical to organ development, so there is some elevated concern that dental treatment can present additional risks to your child. In addition, the third trimester is a time where sitting for extended periods in a dental chair may be uncomfortable or unsafe.⁵ If invasive dental treatment must be performed, you might encourage your dentist to discuss the situation with your physician to ensure everyone is comfortable with the proposed treatment plan.

Some professional medical organizations suggest women should consider delaying elective procedures such as tooth whitening or cosmetics until after your baby is born and you have fully recovered from your pregnancy. Keep in mind that certain medications may pass through breast milk to a nursing child, so the safety and timing of their use should be discussed with your health professional.⁶

X-rays during pregnancy: The use of dental X-ray images is safe during pregnancy. The radiation levels are extremely low, and exposure is generally limited to the face and neck, which will have little effect on a developing baby. Your dentist's normal safety protocols for X-ray images will protect against any adverse exposure to your baby. X-ray images can help detect dental issues whose treatment is more beneficial to you and your baby than any minimal radiation exposure. Many dental health professionals choose to double shield the abdomen of a pregnant patient with two lead aprons to reduce any scattered X-ray exposure even further.⁷

Tooth pain and dental emergencies: Severe tooth pain while you are pregnant, especially in the last trimester, can contribute to premature contractions. This should not keep you from getting the treatment you need. If you do experience a dental emergency and time permits, you and your dentist may want to consult with your obstetrician to discuss the risks and determine the best course of action.⁸

Maintain good oral hygiene: Expecting mothers often neglect their oral health, leading to dental issues that can affect both you and your baby. During pregnancy, it's important to be vigilant about your oral hygiene practices.

• Make sure you are brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If your gums bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day helps remove plaque from between teeth where brushes do not reach.
• Drink water containing fluoride. If your dentist feels that you are not getting enough fluoride from your water sources, they may suggest fluoride supplements.
• Keep all of your dental appointments as recommended. During pregnancy, your dentist may suggest more frequent visits.

Nutrition: Increasing your calcium intake during pregnancy will help strengthen the bones in your mouth. It will also help strengthen your baby's teeth which start to develop between the third and sixth months of development. Increased protein levels, phosphorus, and vitamins A, C, and D also help with the development of your baby's teeth. If your dentist or obstetrician does not feel you are getting enough of these nutrients, they may recommend supplements.⁹

Hormonal changes: Pregnancy brings about significant changes to your normal hormonal balance. These changes can affect your oral health.

• Loose teeth: Elevated levels of progesterone and estrogen can loosen the ligaments and bones that keep your teeth in place, even if you don't have existing gum disease. This effect usually subsides on its own after delivery, but talk to your dentist if you notice your teeth moving when they shouldn't.¹⁰
• Pregnancy gingivitis: Some pregnant women develop a condition known as pregnancy gingivitis. It is an early form of gum disease that causes red, tender, and sore gums (typically between the second and eighth months). Good daily oral hygiene will keep it under control, and it often subsides after giving birth.⁷
• Pregnancy epulis: Hormonal changes can cause a condition known as "pregnancy epulis," in which red, round tumors appear on your gums. These growths can bleed easily and provide a pathway for bacteria to enter your bloodstream.¹¹ The tumors usually resolve after delivery but in some cases require removal by a dentist after your baby is born.
• Morning sickness and acid reflux: Hormonal changes can cause unpleasant changes to your gastrointestinal system, including morning sickness, acid reflux, and gagging while brushing your teeth. The actions release strong stomach acids into your mouth, which can damage the surface of your teeth and increase your risk of tooth decay.
  • If you experience morning sickness or vomiting, don't brush your teeth immediately afterward. The brushing action may erode your tooth enamel while your teeth are still covered in stomach acid, which can lead to increased tooth sensitivity, loss of surface enamel, and even cavities. Instead, rinse your mouth with a teaspoon of baking soda dissolved in water, followed by a fluoride mouthwash. Try to wait 30-60 minutes before brushing.⁹
  • Some women find that brushing their teeth (especially back teeth) causes them to gag. While unpleasant, it's still important to brush all of your teeth to avoid decay. Some ideas to alleviate gagging include using a smaller toothbrush, brushing more slowly, closing your eyes, and concentrating on your breathing while you brush.¹⁰
  • Food cravings: Changes in hormone levels during pregnancy can often lead to changes in your eating habits. Some cravings can lead to choices that increase your risk of tooth decay.¹² If you crave certain foods or drinks while pregnant, do your best to avoid them or choose a healthier option. Sugary or acidic snacks and beverages, in particular, increase your risk of tooth decay. Choosing fresh fruit instead can ease your craving by providing your body with natural sugar and fiber, which helps to reduce unhealthy spikes in insulin. Also, try to avoid chips and other foods that are high in calories and have little or no nutritional value. Regardless of what you choose, rinse your mouth with a fluoride mouthwash or brush your teeth after you have satisfied your craving.
  • Blood disorders: Women are at increased risk for "acquired hemophilia" during and after pregnancy. They are also at higher risk of anemia and vitamin deficiencies that can cause increased bleeding. If your dentist suggests treatment while you are pregnant or soon after childbirth, you may wish to discuss the risks and precautions for increased bleeding before undergoing any procedures.
  • Acne medications: Women that are pregnant or nursing should talk to their dentist or physician about the use of acne medications as some have been linked to tooth discoloration in the developing permanent teeth of children.

  Lifestyle choices: Avoid alcohol, drug use, and tobacco use. Consider delaying elective procedures such as oral piercings until after delivery to reduce the risk of infections or complications that might require the use of medications to treat them.⁶

Medications: Make sure your dentist knows which over-the-counter or prescribed medications or supplements you are taking, including pain relievers. Some medications can lead to conditions such as dry mouth, which can affect the normal function of your salivary glands and lead to other dental issues.

If medication is necessary as part of any dental treatment you need, ask your dentist if they are safe to take given your stage of pregnancy or other medications you may be taking. Your dentist may also consult with your physician. Some things to consider include:

• Antibiotics: Many antibiotics used for dental treatment are completely safe to take while pregnant, but others are not.
• Anxiety medications: If you are avoiding dental appointments out of fear, anxiety, or are dealing with pain from an emergency or untreated condition, the impact from not addressing the issue can be worse for you and your baby.¹³Talk to your dentist about options to make you more comfortable and get the care you need.
• Pain medications: Opioid-based pain medications should be used only if necessary. Even if used as prescribed, they can increase your risk of premature birth or withdrawal symptoms in your baby.
• Sedation: If you need dental treatment that requires sedation, nitrous oxide should be avoided due to the potential for harming a developing baby.¹⁴

Gestational diabetes: Gestational diabetes is a state of glucose intolerance that occurs in the second half of pregnancy in about 4% of women who don't otherwise have diabetes. Gestational diabetes is caused by hormones in the placenta and results in insulin resistance or insulin deficiency. Gestational diabetes usually resolves after giving birth, but those who have had gestational diabetes are at an increased risk of developing Type 2 diabetes later in life.¹⁵

Postpartum eating disorders: New moms may be at risk for eating disorders. This can lead to a host of health problems that can impact both mother and baby. Regular dental visits can help prompt early identification and intervention.