How Pregnancy Affects Oral Health & Oral Health Affects Pregnancy
Every parent hopes that their baby will be born and grow up healthy and part of this is both parents’ oral health. Not only does a mother’s health affect the baby before and after birth, but the fetus affects the mother’s oral health. It’s important to understand the connection so that everyone can be as healthy as possible.
Pregnancy is a time of great physical changes that manifest themselves in very obvious ways. One that isn’t as obvious, and often not spoken about, is how the increased pregnancy hormone levels of progesterone and estrogen affect oral health manifested in four ways: increased risk of caries, gingivitis and possibly periodontitis, and pyogenic granuloma growths.
Dental Caries
It’s not uncommon for women to complain of morning sickness, especially in the first trimester. Around 70% of women will experience some degree of nausea and vomiting. Stomach acid weakens the surface of teeth and increases the risk of tooth decay and erosion of the teeth through demineralization of the enamel.
If you experience this, the best way to counteract tooth erosion is to immediately rinse your mouth to try and remove as much of the acid as possible. There are several methods to choose from:
Rinse with water if you are still queasy and this is all you can handle.
Rinse with a fluoride mouthwash, although you don’t want to do this too frequently in a day.
Mix 1 teaspoon of baking soda with 1 cup for a rinse to neutralize the acid and gargle.
Regardless of which rinse you choose, wait at least 30 minutes before brushing your teeth because the acid softens tooth enamel.
Having cravings or frequent snacking also increases the risk of developing caries. The nausea, vomiting, and hormones decreases saliva flow which creates an environment where caries develop more often.
Mothers who have many untreated caries or tooth loss are three times more likely to have children who also have caries. Children with poor oral health are nearly 3 times more likely to miss school because of dental pain than children whose mothers practice good oral hygiene. This is just another reason to ensure you do everything possible to give your child the best start in life by taking care of yourself.
Gingivitis
Regardless of how carefully you follow a good diet or take care of your teeth, hormonal changes make your gums more susceptible to inflammation and bleeding because increased blood progesterone and estrogen increases vascular permeability so your gums have an exaggerated reaction to the irritants in dental plaque, the earmarks of gingivitis. 60-75% of women will develop some level of gingivitis during their pregnancy, often in the first trimester. Because this reaction is caused by the increased hormone levels, the gingivitis usually disappears after childbirth. Gargling with warm, salty water relaxes gums and reduces gum sensitivity.
Even if your gums are more sensitive and may bleed when irritated, it’s important to keep brushing twice a day with a soft bristle toothbrush and floss once a day. If you have any issues, it’s always best to check with your dental professional.
Periodontitis
While pregnancy gingivitis is common and not usually dangerous, it can’t be ignored. Untreated gingivitis can progress to periodontitis, a bacterial infection that causes more severe gum inflammation and can affect the bone supporting the teeth. Not only do you risk losing teeth, but the bacterial infection that passes to your bloodstream can affect your baby both during pregnancy and after birth.
Severe cases of periodontitis can lead to pre-term delivery, and/or low or very-low birth weight for the baby, and mothers may develop pre-eclampsia or gestational diabetes mellitus. Women with chronic gum disease are 4-7 times more likely to deliver pre-term (37 weeks) and underweight babies than mothers with healthy gums. The more severe the gum disease, the earlier the delivery, as early as 32 weeks.
Pregnancy Tumor or Pyogenic Granuloma
A pregnancy tumor (also called pyogenic granuloma, granuloma gravidarum or lobular capillary hemangioma) is an extreme inflammatory reaction to plaque or food particles that develops, usually near the upper gum line between teeth. Approximately 10% of women will develop one. Most often, these women will also have pregnancy gingivitis.
Pyogenic granuloma are large, deep red lumps that may bleed. While they usually occur during the second to fourth month and reaches its highest level in the eighth month, it’s possible to develop one any time during a pregnancy.
If it interferes with eating, your dentist or a specialist may choose to remove it using a local anesthetic. Unfortunately, it will redevelop in 50% of the cases. It is non-cancerous, can’t spread, and usually disappears on its own after the baby’s birth.
Dental Care Before & During Pregnancy
Dental care should start even before you become pregnant since poor oral health during a pregnancy can result in poor outcomes for both mother and baby. Research has shown that unhealthy gums can even cause infertility. The presence of a common periodontal bacteria in saliva was three times more prevalent in women who had trouble becoming pregnant.
There are some restorative procedures that can be risky during a pregnancy so having work that requires general anesthesia or intravenous sedation prior to pregnancy is much safer. If it becomes necessary to have this type of work done during pregnancy, make sure you and your dentist speak with your OB/GYN about safety measures. An anesthetic that should be avoided during pregnancy is nitrous oxide which is known to cause abortion and congenital anomalies.
Mercury, used in dental amalgam (silver fillings), is dangerous to a developing fetus and pregnant mother. If an old filling needs to be replaced, drilling during pregnancy could increase risks of miscarriage, preeclampsia, and low birth weight because the mercury can pass through the placenta to the baby. Mercury poisoning dangers to the baby include brain, kidney, or other organ damage, and can also after birth through nursing. If you do need to get a new filling during pregnancy, be sure that it is resin-based (tooth colored).
It's important to maintain your regularly scheduled dental appointments throughout your pregnancy and preventative, diagnostic and restorative dental treatments during these visits are perfectly safe. Local anesthetics like lidocaine, prilocaine, bupivacaine, and mepivacaine are safe. Most antibiotics including penicillin, erythromycin, and cephalosporins are safe. Tetracycline antibiotics discolor teeth and shouldn’t be used. Keep in mind that a baby’s teeth start to develop in the 5th or 6th week of pregnancy and their teeth will be affected also. The antibiotics vancomycin and streptomycin have adverse effects for the baby. Again, your and/or your dentist should always check with your OB/GYN for safe medications and proper dosage of antibiotics and pain killers. There are safe options available.
The dental x-rays or radiographs taken in your dental office are safe for you and the baby. Use of an iron apron covers your abdomen and thyroid/neck area is an extra safety precaution.
Both the American Dental Association and the American College of Obstetricians and Gynecologists agree that it is better and safer to have emergency treatments such as extractions, root canals, or restorations during your pregnancy rather than delaying treatment until after you give birth. It’s best if your doctors can work together to ensure that you have the safest and easiest outcomes. Just remember that untreated dental issues can lead to very poor outcomes for you and your baby.
Accessing Oral Care
The National Institutes of Health recommend more than usual dental visits: 2 in the first trimester, and then 1 in each of the second and third trimesters. Unfortunately, most women aren’t aware of these recommendations or even the changes that occur during pregnancy. Only 44% of women say that their doctor talked to them about oral health during their pregnancy visits. While 76% of women will develop a dental problem, only a bit over half will visit a dentist during the pregnancy There are a few reasons for this discrepancy.
Women are often not aware of the consequences of postponing oral health treatments. They are already scheduled for more doctors’ visits than normal, may not be feeling well, or just aren’t aware of the seriousness of the issue.
Many women can’t afford additional oral health costs. Women who have dental insurance are twice as likely to visit a dentist as those that don’t. Only 33% of dentists accept Medicaid making the problem worse.
Many dentists are unwilling to see pregnant women because they are concerned about additional liabilities. 77% of OB/GYNs have reported that their patients were refused dental services.
There are some resources available to both mothers and dental offices. In 2019 the CDC and the American Academy of Pediatrics started the Protect Tiny Teeth program that provides resources for both professionals offices and new parents.
Final Thoughts…
Pregnancy is just another example of how oral health and your overall health are intertwined, especially in this instance because your oral health also affects your baby’s health. While it may not be convenient, it’s important to prioritize our daily oral hygiene, keep your dentist appointments, and work with both your dentist and OB/GYN if problems arise. Most procedures are safe and luckily, some of the issues that arise are tied to pregnancy hormones and will resolve themselves after you give birth – but that is not an excuse for ignoring problems or seeing your dentist.
Sources & Resources
Dr. Kami Hoss, If Your Mouth Could Talk, BenBella Books, Inc., 2022
Dental Care Before, During, and After Pregnancy (webmd.com)
Dental health during pregnancy | March of Dimes
Oral care in pregnancy - PMC (nih.gov)
Oral Health in Pregnancy - Journal of Obstetric, Gynecologic & Neonatal Nursing (jognn.org)
Oral health and pregnancy - Canada.ca
Pregnancy and oral health | Protect my smile | Delta Dental
Pregnancy | American Dental Association (ada.org)
Pregnancy and Oral Health | Johns Hopkins Medicine
Pregnancy and Oral Health | Resources for Patients (ihs.gov)
Talking to Pregnant Women about Oral Health | Oral Health | CDC
Teeth and Mouth Rare Pregnancy Complications
