I have frequent questions about dental care during pregnancy. There are several changes that occur during pregnancy that can have an effect on the mouth and those changes can also cause us to modify our normal course of treatment.
There is a common concern that pregnancy causes the calcium to be lost in the mother’s teeth. This is only a myth. The teeth do not repair and remodel like bone does and are not directly effected by changes in hormones. If a woman has healthy teeth before the pregnancy and maintains good hygiene there is no reason to believe that there should be any calcium lost due to pregnancy and the teeth will remain healthy.
Morning sickness could be a dental concern in that it can have an effect on the enamel. The gastric acid from re-flux or morning sickness softens the enamel that it contacts. As a result the enamel is easier to wear off of the tooth with a process as simple as brushing the teeth. If there is active decay present the addition of an acidic environment from morning sickness would only worsen the decay’s progression. A dentist can provide some alternatives like rinsing with water and baking soda after an episode that will neutralize the acids left in the mouth. There are also products that are designed to help remineralize the teeth after being exposed to high levels of acid.
A more common problem in real life is the effects that the hormone changes during pregnancy have on the gum’s reaction to plaque. Plaque forms on the teeth is a matrix of bacteria, their byproducts, and food debris. If the plaque is not removed from the teeth in a timely manner the nearby gums respond by turning red and swelling. The gums become tender and are easy to bleed. This condition is called gingivitis which is a form of gum disease and can occur in any person who has an excess of plaque on the teeth. During pregnancy the hormones exaggerate the body’s response to plaque thereby worsening the gingivitis causing “pregnancy gingivitis”. This reaction will dissipate after the pregnancy without consequence if the oral hygiene can be maintained at a high level throughout the pregnancy.
If a woman has gingivitis or a more advanced periodontal disease before becoming pregnant, the hormones will cause the condition to worsen sometimes at an alarming rate. Sometimes the red and tender gums grow to an alarming amount forming “pregnancy tumors.” These are benign but extreme overgrowths of the gums that make eating and brushing uncomfortable. This condition would indicate the need for more aggressive dental treatment.
In addition to the reaction of the gums to the plaque, the baby may also be effected. If the gums become more inflamed and there is more bacteria on the teeth then there will be a higher likelihood that there will be bacteria that will enter the mother’s bloodstream. There is some research that suggests that that the body’s reaction to that bacterial insult could ultimately result in a premature birth.
The gingivitis can be prevented keeping the teeth clean. The teeth should be brushed with fluoride toothpaste at least twice a day and after each meal when possible. The teeth should also be flossed thoroughly each day. If brushing causes morning sickness, rinse with water or with anti-plaque and fluoride mouthwashes. Good nutrition – particularly plenty of vitamin C and B12 – help keep the oral cavity healthy and strong. More frequent cleanings from a hygienist or dentist will help control plaque and prevent gingivitis. Controlling plaque is also good at any age for any person and will help prevent gum disease and tooth decay.
If pregnancy is suspected or planned, a checkup with the dentist in the first trimester should be scheduled. Normally we would assess the current oral condition and determine if there needs to be any improvements in the oral hygiene routine. A visit in the second trimester for a cleaning is also recommended especially if there were oral hygiene concerns determined before or during the first trimester. Any necessary non-elective treatment can be done in the second trimester. A cleaning can also be done in the third trimester if necessary with attention paid to keeping the appointment brief.
Non-emergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through six month. Women with dental emergencies that create severe pain can be treated during any trimester, but the obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth.
Most dental problems relating to pregnancy can be overcome with good planning, good oral hygiene and careful treatment.
