6/2024
Dental changes in pregnancy
Physiologic changes during pregnancy may result in noticeable changes in the oral cavity. These changes include pregnancy gingivitis, benign oral gingival lesions, tooth mobility, tooth erosion, dental cavities, and periodontitis. The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums. These changes to the gums and teeth during pregnancy should be monitored with reinforcement of good oral health habits to keep the gums and teeth healthy. Preventive dental cleanings and annual dental exams during pregnancy are not only safe but are recommended and can be done at anytime during pregnancy. In fact, some insurance carriers will pay for additional cleanings during pregnancy.
Here are some stats from the CDC:
- One in four people of childbearing age have untreated cavities.
- Children of individuals with high levels of untreated cavities or tooth loss are more than 3 times more likely to have cavities as a child.
- Children with poor oral health status are nearly 3 times more likely to miss school because of dental pain.
Factors affecting oral and dental health in pregnancy
During the first months of pregnancy extreme interest in some foods occurs, especially carbohydrates, and tooth brushing can be neglected after you eat these kinds of food. It is also common for pregnant individuals to graze or snack throughout the day putting teeth in constant contact with acid in food. This can lead to increased production of acid-loving bacteria, such as Streptococcus mutans, which produce more acid that can weaken tooth enamel. Also, pregnant individuals have more gum bleeding due to the effect of pregnancy hormones (estrogen, progesterone), and you may avoid brushing your teeth causing bacterial plaque to increase. Nausea and vomiting of pregnancy (NVP) causes stomach acid to coat your oral cavity which increases the acidic environment in the mouth. The nausea may also make you want to avoid brushing your teeth leading to neglect of your oral care. This increases your risk for cavities. Finally, saliva flow decreases causing an increase in cavity formation and can weaken tooth enamel—putting expectant moms at additional risk for cavities.
Poor pregnancy dental hygiene and preterm birth
Approximately 40% of pregnant individuals have some form of periodontal disease. Preventative dental work before and during pregnancy is essential to avoid oral infections such as gum disease, which has been linked to adverse pregnancy outcomes. A study conducted in 1996 showed an association between maternal periodontal disease and preterm birth. This is thought to occur because of an increased level of bacteria in the oral cavity when dental health is poor. This bacteria can enter the maternal bloodstream through the gums and travel to the uterus where prostaglandin production can cause uterine contractions leading to preterm labor. Other studies have supported this conclusion. Despite the lack of evidence for a causal relationship between periodontal disease and adverse pregnancy outcomes, the treatment of maternal periodontal disease during pregnancy is not associated with any adverse maternal or birth outcomes. In fact, prenatal periodontal therapy is associated with the improvement of maternal oral health.
Pregnancy gingivitis
Nearly 60 to 75% of pregnant individuals have gingivitis, an early stage of periodontal disease that occurs when the gums become red and swollen from inflammation that may be aggravated by changing hormones during pregnancy. Untreated gingivitis can progress to periodontitis, an inflammatory response in which a film of bacteria, known as plaque, adheres to teeth and releases bacterial toxins that create pockets of destructive infection in the gums and bones. The teeth may loosen, bone may be lost, and a bacteremia may result. Teeth with little bone support can become loose and may eventually have to be extracted. Gingivitis usually starts in about the second month of pregnancy and reaches the highest level at the eighth month.
Pregnancy and tooth decay
There is no scientific basis for the belief that fetal need for calcium required for intrauterine growth is obtained from the pregnant individual's teeth and that every pregnancy has tooth loss! Erosion of tooth enamel causing tooth decay is more common because of increased exposure to gastric acid from vomiting secondary to morning sickness, hyperemesis gravidarum, or gastric reflux during pregnancy. Pregnant people may also be at risk for cavities due to changes in behaviors, such as eating habits. These events can negatively affect oral hygiene.
One in 4 people of childbearing age have untreated cavities. Children of people who have high levels of untreated cavities or tooth loss are more than 3 times more likely to have cavities as a child. Children with poor oral health status are nearly 3 times more likely to miss school because of dental pain.
Pregnancy and tooth mobility
Ligaments and bone that support the teeth may temporarily loosen during pregnancy due to hormonal changes, which results in increased tooth mobility. There is normally not any tooth loss in pregnancy unless other complications are present.
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Is having dental work in pregnancy safe?
Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions are safe during pregnancy. If dental work is done during pregnancy, the second trimester is ideal. Once you reach the third trimester, it may be very difficult to lie on your back for an extended period of time. Conditions that require immediate treatment, such as extractions, root canals, and restoration (amalgam or composite) of untreated caries, may be managed at any time during pregnancy. Delaying treatment may result in more complex problems.
If you will need to be on the dental chair for a pronged period of time, you may experience supine hypotension syndrome. This occurs when there is compression of the abdominal aorta and inferior vena cava by the pregnant uterus when you lay on your back. It is more common in the late second and third trimesters of pregnancy. In the dental chair you can elevate your right hip by 10-12cm or have a 5-15% tilt to your left side.
What about the medications?
During a dental procedure
Local anesthetics can be used in pregnancy including lidocaine, bupivacaine, and mepivacaine with or without epinephrine. The amount of local anesthesia administered should be as little as possible, but still enough to make you comfortable. If you are experiencing pain, request additional numbing. When you are comfortable, the amount of stress on you and the fetus is reduced. Also, the more comfortable you are, the easier it is for the anesthesia to work.
After a dental procedure
Analgesics or pain medications can also be used at the lowest effective dose for the shortest duration of time after a dental prodecure. This incudes tylenol, tylenol with codeine, hydrocodone, oxycodone, codeine ,meperidine, and morphine.
Antibiotics
Dental work often requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, cephalosporins, and clindamycin, may be prescribed after your procedure.
Medications to avoid
Valium, IV anesthesia, general anesthesia, inhalational anesthesia, cycline antibiotics, and ibuprofen.
Are dental x-rays safe?
Routine x-rays, typically taken during annual dental exams, can usually be postponed until after the birth. X-rays are necessary to perform many dental procedures, especially emergencies. According to theAmerican College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus. According to the ADA and ACOG, having dental X-rays during your pregnancy is considered safe with appropriate shielding. Some people may elect to avoid dental work during the first trimester knowing this is the most vulnerable time of development. However, there is no evidence suggesting harm to the fetus for those electing to visit the dentist during this time frame.
Tips to maintain good oral health in pregnancy
- Brush 2X a day for 2 minutes with a toothpaste that has fluoride--especially after meals and snacks.
- Rinse with saltwater (ie, 1 teaspoon of salt in 1 cup of warm water) to help with gum irritation.
- Clean between your teeth once a day with dental floss or another interdental cleaner.
- To help reduce the loss of enamel, do not not brush your teeth immediately after vomiting. Instead, rinse with a diluted solution of 1 cup water and 1 teaspoon of baking soda to neutralize the acid.
Other things to know
- Know your health coverage for dental services during pregnancy so that referrals to the appropriate dental provider can be made. Note that each state’s Medicaid coverage for oral health may vary.
- Pregnant individuals who have gingivitis and poor oral health before pregnancy are more prone to exacerbations during pregnancy and have more potential for tooth loss.
- The fetus DOES NOT take the calcium out of your teeth causing tooth loss!
- Maintaining good oral/dental health and before during pregnancy is just as important as maintaining your medical health for good pregnancy outcomes!
- Elective treatments, such as teeth whitening and other cosmetic procedures, should be postponed until after the birth. It is best to avoid this dental work while pregnant and avoid exposing the developing baby to any risks, even if they are minimal.
Resources
Oral Health Care During Pregnancy and Through the Lifespan, ACOG Committee OpinionNumber 569
Pregnancy-related dental problems: A review
Brushing for Two: How Your Oral Health Affects Baby