Dental Health During Pregnancy

Overview:

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.

Why Is Oral Health Care Important 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.

What Oral Health Care Measures Should Be Taken Before Getting Pregnant?

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.

What Measures Should Be Taken During Pregnancy?

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:

1. 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.

  • Trauma.

  • Hormones.

  • Viruses.

  • 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.

What Diet Should Be Followed for Good Oral Health During Pregnancy?

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.

Which Dental Procedures Can Be Performed During Pregnancy?

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.

• Muscle twitching.

• Hypotension.

• Fluid retention.

• Turning towards the left side semi-sloping helps relieve venous circulation during emergency dental treatment.

Which Drugs Are Safe During Dental Treatment of Pregnant Women?

1. 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.

2. Antibiotics - Penicillin, Amoxicillin, and Cephalosporins are considered safe during pregnancy. Use of Tetracyclines is avoided. It may cause teeth staining in the fetus.

3. Anesthetics- Local anesthetics like Bupivacaine, Lidocaine, and Mepivacaine are considered safe in pregnancy.

4. 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.

Conclusion:

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.