The connection between pregnancy and your oral health

The weeks and months of your pregnancy can be as hectic as they are joyful. With so much to organize and prepare, it can be difficult to keep up with everything. One thing that you shouldn’t let slip through the cracks is your own well-being — and that includes your oral health.

You may be surprised to learn that changes you undergo throughout your pregnancy can affect your oral health and vice versa. That’s why it’s important to know how the two are connected and the steps you can take to build and maintain good oral health throughout your pregnancy. And if you start before you get pregnant, all the better.

Consider these facts about oral health and pregnancy:

• Periodontal disease has been associated with preterm birth and low birth weight.¹

• Nearly 60% to 75% of pregnant women have gingivitis, an early stage of periodontal disease.² Changing hormone levels during pregnancy may aggravate this condition. Untreated, periodontal disease can lead to infection, tooth loss, and even cardiovascular disease.³

• Newborns are three times more likely to develop tooth decay if their mothers have high levels of untreated decay during and after pregnancy.⁴ The harmful bacteria that cause tooth decay can be transmitted to the baby.

How to take care of your oral health throughout your pregnancy

Oral health and family planning: Good oral hygiene and regular dental visits are important at any stage of your life, but especially when you’re planning to become or are already pregnant. Having your oral health in the best shape possible before you become pregnant can help avoid any risks associated with treating dental issues while you are pregnant and improve your chances of a healthier pregnancy. Here are some ways you can brush up on your oral health:

• Brushing your teeth 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 buildup below your gum line, which requires more attention.

• Flossing at least once a day helps remove plaque from between teeth where brushes don’t reach.

• Drinking water containing fluoride. If your dentist feels that you are not getting enough fluoride from your water sources, they may suggest fluoride supplements.

• Keeping all of your dental appointments as recommended. During pregnancy, your dentist may suggest more frequent visits.

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 minimize risks that may affect your pregnancy. If you’re experiencing dental pain or notice other abnormal issues in your mouth, see your dentist immediately. You and your dentist can discuss the issues and concerns and determine the best course of action.

Here are some general considerations for oral health care during your pregnancy:

• Throughout 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. You can check to see if additional cleanings are covered in your dental plan.

• If necessary, any procedures involving local anesthetic and radiographs are safe through your pregnancy.⁵ Make sure your dentist knows you’re expecting, and they’ll be sure to use pregnancy-safe methods.

• 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.

As a general rule, the second trimester is considered the best time for required, invasive dental procedures to be performed.⁶ This is because the first trimester is critical to organ development, so there is some concern that dental treatment can pose additional risks to your child. In addition, the third trimester is a time when sitting for extended periods in a dental chair may be uncomfortable or unsafe. If you need invasive dental treatment, you might encourage your dentist to discuss the situation with your physician to ensure everyone is comfortable with the proposed treatment plan.

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 after you have your baby if you choose to breastfeed.

X-rays during pregnancy: The use of dental X-ray images is generally safe during pregnancy.⁷ The radiation levels are low, and exposure is generally limited to the face and neck area.

Infections and dental emergencies: Severe, untreated dental infections may contribute to systemic inflammation, which has been associated with pregnancy complications, including early contractions.⁸ If you do experience a dental emergency, you and your dentist can consult with your obstetrician to discuss the risks and determine the best course of action.

Nutrition: Making sure you eat healthy foods that contain nutrients like calcium, protein, phosphorus, and vitamins A, C, and D can help with the development of your baby’s teeth — especially between the third and sixth month of pregnancy when a baby’s teeth start to develop.⁹ Increasing your calcium intake, in particular, can help prevent bone resorption, which can result in loss of bone density, including the jawbone.¹⁰ If your dentist or obstetrician does not feel you are getting enough of these nutrients, they may recommend supplements.

How pregnancy can affect your oral health — and what you can do about it

Loose teeth: Mild tooth mobility can occur due to hormonal changes.¹¹ This is usually temporary. However, persistent or worsening movement should be evaluated by a dentist.

Pregnancy gingivitis: Some pregnant women develop a condition known as pregnancy gingivitis.¹² 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.

Pregnancy epulis: Hormonal changes can cause a condition known as “pregnancy epulis,” in which red, round tumors appear on your gums.¹³ These growths can bleed easily and provide a pathway for bacteria to enter your bloodstream. These growths are benign (non-cancerous) and typically resolve after delivery.

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.¹⁴ 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.¹⁵ 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.

Some expecting mothers 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 help alleviate gagging include using a smaller toothbrush, brushing more slowly, closing your eyes, and concentrating on your breathing while you brush.

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. Sugary or acidic snacks and beverages, in particular, increase your risk of tooth decay.¹⁶ 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. Rinse your mouth with fluoride mouthwash or brush your teeth after you have satisfied your craving.

Blood disorders: Some women develop "acquired hemophilia" during and after pregnancy.¹⁷ These women 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.

Staying connected with your oral health during your pregnancy can help to ensure that both you and your baby have happy, healthy smiles. Make sure to talk to your dentist about any oral health-related questions.