During pregnancy, women are prone to oral problems. This article guides oral health measures and treatments that are considered safe during pregnancy.
Pregnancy is a critical phase during women's life, characterized by complex physiological changes, which may adversely affect oral health. Preventive, diagnostic, and restorative dental treatment is considered safe during pregnancy.
Pregnancy causes hormonal changes in the woman's body that increase the risk of developing oral and dental problems. Optimal maternal oral hygiene will stop the transmission of caries-causing bacteria from mother to infants. Thus, both mother and baby can have a healthy oral environment.
On the other hand, oral health is the key to overall health and well-being. Oral health diseases, like periodontitis, are associated with conditions like cardiovascular diseases, diabetes, Alzheimer's disease, respiratory infections, and other disorders.
Healthcare professionals often fail to provide oral health care to pregnant women; sometimes, pregnant women do not seek or receive care, even with apparent signs of oral diseases. However, everyone must understand that oral health care is essential for a healthy pregnancy.
Women can take the following steps before a planned pregnancy:
A visit to the dental clinic for a general checkup.
Professional cleaning of teeth.
Examination of gums.
Treatment if required are cavity fillings, removal of an impacted tooth, or root canal treatments.
Physiologic changes that occur during pregnancy also result in changes in the oral cavity :
Pregnancy Gingivitis - High levels of progesterone hormone and increased blood flow to tissues can lead to pregnancy gingivitis. The symptoms are:
Sore and swollen gums that are more susceptible to bleeding even on brushing or flossing the teeth.
Benign Oral Gingival Lesions - It occurs mainly during the second trimester. Main causes:
Poor oral hygiene.
Malformed blood vessels (rare cases).
It is also known as pregnancy granuloma, pyogenic granuloma, or oral pregnancy tumor.
Tooth Mobility - Ligaments and bones that support the teeth may temporarily loosen during pregnancy, which results in increased tooth mobility. No tooth loss is seen unless some other complications are present.
Tooth Erosion - Erosion of tooth enamel may occur due to increased exposure to gastric acid from vomiting (morning sickness).
Dental Caries - It occurs due to increased acidity in the mouth (vomiting due to morning sickness), increased intake of sugary snacks (pregnancy cravings), and decreased attention to oral health maintenance.
Periodontitis - Untreated gingivitis during pregnancy may lead to periodontitis. In this inflammatory condition, a thin film of bacteria called 'plaque' adheres to the tooth surface and releases bacterial toxins leading to pocket formation, bone loss, tooth loss, loose teeth, or bacteremia.
It is essential to reassure pregnant women about these various changes occurring in their mouths and reinforce good oral health habits to keep the oral cavity healthy.
Baby's teeth start developing during the third to sixth month of pregnancy. Pregnant women must monitor their diet to support healthy teeth in their babies. Adequate intake of nutrients constitutes positive health effects. Some recommendations include:
Fruits, vegetables, cereals, milk, dairy products, meat, fish, and eggs are rich in A, C, D vitamins, calcium, and phosphorus. These have a positive impact on dental health due to the well-known effect of vitamins A and D on enamel formation.
Avoid sugar, dried candied fruits, and toffees.
Avoid nicotine as smoking negatively affects oral health. Excessive smoking may lead to conditions like periodontal inflammation, smooth tongue, or spontaneous bleeding.
Avoid alcohol consumption because overuse of alcohol is teratogenic in babies and can cause fetal alcohol syndrome, dental anomalies like small teeth, structural deterioration of the enamel, and delayed tooth eruption.
Some other habits that promote the good oral health of pregnant women are:
Tooth brushing and flossing twice daily. Because pregnant women have difficulty in brushing due to a strong gag reflex, they can use a smaller toothbrush or different toothpaste flavors to make brushing easier.
Gargle using mouthwash or warm saline water, which helps relax gum swelling and sensitivity.
Visit the dental clinic for the dental cleaning and regular checkups. Uncomplicated treatments during every trimester are considered safe. However, the second trimester is the safest.
Uncomplicated dental treatments can be performed after getting consent from the treating gynecologist.
The dentist can perform the following dental procedures:
1. The First Trimester - Pregnant women should avoid any effective dental treatment. Due to ongoing organogenesis, it is a sensitive stage, so unnecessary interventions can lead to abortion. However, necessary treatments like tooth extraction and root canal treatment can be performed in case of severe pain.
2. The Second Trimester - This is the best time to get any unavoidable dental treatments, such as tooth extraction, fillings, and root canal treatment.
3. The Third Trimester- Any dental treatment is not recommended unless it is an emergency. By this time, the baby is considerably grown inside the womb, thus making it very difficult for the pregnant woman to take the necessary position on the dental chair during the treatment.
During treatment, sitting for too long in the dental chair may result in inferior vena cava syndrome (supine hypotensive syndrome). The symptoms include:
Intense pain in the right-hand side.
Turning towards the left side semi-sloping helps relieve venous circulation during emergency dental treatment.
Dental X-rays - It should be avoided in high doses as it may cause microcephaly or mental retardation in newborns. But in case it is needed, the amount of radiation can be reduced using lead gowns, digital films, well-calibrated instruments, and a collimator, which will save the fetus from any damage.
Antibiotics - Penicillin, Amoxicillin, and Cephalosporins are considered safe during pregnancy. Use of Tetracyclines is avoided. It may cause teeth staining in the fetus.
Anesthetics- Local anesthetics like Bupivacaine, Lidocaine, and Mepivacaine are considered safe in pregnancy.
Painkillers - Dental pain may induce labor contractions due to stress. In combination with Codeine or Hydrocodone, Acetaminophen is commonly prescribed and is safe during pregnancy. A short course of these drugs is recommended to reduce the risk of opioid dependency. Non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended during pregnancy. Pregnant women should take any medications only after consulting doctors.
During pregnancy, oral and dental care require special attention as it concerns the overall well-being of both the mother and the fetus. Neglecting oral health during this time causes problems like tooth decay or tooth loss and may lead to problems such as premature birth, low birth weight infant, and preeclampsia. Pregnancy is a beautiful phase in which the mother must protect her health and baby's health by taking the necessary precautions, maintaining good oral health, and preventing irreversible dental problems.
Myth and Reality
It is an old wives' tale that going to the dentist during pregnancy is risky for developing babies and moms-to-be. But, just the opposite is true – good dental hygiene is part of a healthy lifestyle for everyone.
It is very important to take good care of dental health and to maintain an oral hygiene routine during pregnancy. A pregnant woman must brush her teeth twice daily with fluoride toothpaste (approved by the dentist), floss daily between teeth daily, eat a balanced diet, and visit the dentist for a check-up and professional cleaning regularly.
During pregnancy, the body goes through various hormonal changes that can increase the chances of getting gum diseases and cavities. This can also affect the health of the developing baby.
Pregnancy is the time when the body undergoes numerous physiological changes. The hormonal changes can put pregnant women at a higher risk of developing dental problems. Due to poor oral health, pregnant women can experience adverse conditions like gingival tissue ulcers, pregnancy granuloma, gingivitis, pregnancy tumors, loose teeth, mouth dryness, dental erosions, premature delivery, and low birth weight baby, or pre-eclampsia.
Dental treatment can be done during any trimester of pregnancy if it is an emergency (infections or swelling), but it is best to perform dental treatment during the second trimester (from week 14 to week 20).
Pregnant women can prevent tooth decay and gingivitis by keeping their teeth and gums clean. Brushing with fluoridated toothpaste twice every day, flossing, and getting a professional dental cleaning can help maintain good oral hygiene and maintain healthy gums.
Due to hormonal fluctuations during pregnancy, the pregnant woman might feel that her breath smells bad. Progesterone and estrogen hormones can catalyze plaque formation on the tooth surface; the bacteria in plaque produce sulfur and cause bad breath.
Due to an increase in blood volume and hormone fluctuations during pregnancy, the body increases mucus production. This excess mucus may block the sinuses and drain down the throat, leading to postnasal drip. A little relief can be obtained by using steam (loosening the mucus), gargling with warm saline (salt water), or taking some throat lozenges.
The condition of having a weird taste in the mouth during pregnancy is known as dysgeusia. It primarily occurs due to pregnancy hormones. It can cause a sour or metallic taste in the mouth even without eating anything. Pregnant women can love or hate the same food at different times. Eating sugar-free gums, cold items, salty crackers, spicy food, or drinking citrus juice may help neutralize the taste.
Pregnancy brings a lot of changes to a woman’s body. Pregnant women feel a higher need for hydration; if sufficient amounts of water are not consumed by them, it may lead to dehydration, and a white coat appears on the tongue surface. The white coat on the tongue is a layer of bacteria and dead cells. Thus, drinking lots of water, maintaining good oral hygiene, and cleaning the tongue can help to get rid of the coated tongue.
It is absolutely safe to get dental fillings any time during pregnancy. It is better to schedule all dental procedures in the second trimester, so the risk of nausea is passed. Pregnant women must maintain good oral hygiene throughout pregnancy and postpone any cosmetic procedure until the baby’s birth.
It is possible to extract a tooth during pregnancy, but timing plays an important role. All procedures are recommended to be done in the second trimester. In the third trimester, extractions are not recommended unless it is an emergency. By this time, the baby has grown considerably big inside the womb, thus making it very difficult for the pregnant woman to take the necessary position on the dental chair during the treatment. Also, sitting for too long in the dental chair may result in inferior vena cava syndrome (supine hypotensive syndrome).
Yes, it is possible to remove the wisdom tooth during pregnancy if it is an absolute emergency. However, it is recommended to postpone this procedure until delivery, out of precaution if the wisdom teeth are not causing any complications.
The second trimester is considered to be the safest period for all sorts of dental treatments. By this time, the nausea is gone, and the pregnant woman is also comfortable sitting in the dental chair.
All dental procedures are considered safe during pregnancy, including the administration of local anesthetics with Epinephrine (Bupivacaine, Mepivacaine, or Lidocaine).
Dental X-rays should be avoided in high doses during pregnancy as they may cause microcephaly or mental retardation in newborns. But in case it is unavoidable, then the dose of radiation can be reduced using lead gowns, well-calibrated instruments, digital films, and a collimator to save the fetus from any radiation damage.
Yes, it is very important to tell the dentist about pregnancy, so the dentist can be cautious while performing the dental procedures, X-rays, and prescribing drugs safely during pregnancy.
Dental infection can cause severe pain and discomfort, which may directly or indirectly affect the unborn baby. A mother’s active tooth decay and infection can transmit caries-causing bacteria to the baby, which can cause dental problems to the baby's teeth in the future.
Painkillers like Acetaminophen can be taken after consulting the doctors to get some relief from pain. Also, sleeping with a slightly elevated head (with the help of a thick pillow) can help to decrease pressure, alleviate pain, improve circulation, and reduce swelling.
Recurrent oral infections during pregnancy can increase the production of pro-inflammatory mediators and thereby increase the risk factors for miscarriage. On the other hand, any dental procedure performed during pregnancy will not increase the risk of miscarriage. Thus, it is recommended not to delay any needed dental treatment during pregnancy.
Last reviewed at:
19 Dec 2022 - 5 min read
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