Pregnancy and Oral Health

Pregnancy can lead to dental problems in some women.

Just like the rest of your body, your teeth, gums and mouth are affected by hormonal changes during pregnancy. Your increased hormones can cause a dry mouth, oral ‘pregnancy tumours’ (pyogenic granulomas), and can affect your body’s natural response to dental plaque (the layer of biofilm that builds up on your teeth daily) which can lead to, or exacerbate, gum disease. Morning sickness and sweet cravings can also contribute to an increased risk of tooth decay.

The health of you and your baby are intrinsically linked during pregnancy.

Your dental health has an impact on your overall health, which in turn has an influence on the health of your baby. If you neglect your oral health during pregnancy, and symptoms of hormonal changes, it can be harmful to your baby’s health1.

It’s therefore important that you maintain a good dental health routine throughout pregnancy (as well as before pregnancy, and after pregnancy). You should also be assured that oral health maintenance and dental care is both effective and safe throughout pregnancy2.

Maintaining your oral health

Visiting a dentist and dental hygienist regularly during pregnancy is highly recommended both for your own wellbeing and for that of your unborn child.

Hormonal changes will make your gums more susceptible to inflammation and infection, so regular check-ups and professional cleans are important, in conjunction with a good at-home routine which should include brushing at least twice per day and flossing once per day.

Your dental professionals can also assess for and advise you on other pregnancy-related conditions including tooth decay and dry mouth syndrome, so they can be managed effectively during your pregnancy.

Changes in your oral health

Increased hormones during pregnancy can make some women more susceptible to gum problems, and can also cause dry mouth symptoms. The gum problems that occur are not due to increased plaque, but are a result of your body’s increased response and sensitivity to the bacteria found in plaque due to the increased hormone levels.

Gum disease:

Some women develop ‘pregnancy gingivitis’ which causes gum inflammation. Symptoms include swollen, sensitive gums which may be prone to bleeding, especially during brushing and flossing. The gums may also turn a red colour (instead of pink).

It’s important that you don’t stop your normal at-home hygiene care (brushing and flossing) due to sensitivity and bleeding. If you are having difficulty with the symptoms, speak to your dental professional who can provide supportive treatment.

Whilst pregnancy gingivitis is usually temporary and should resolve itself after your baby is born, it’s important not to ignore the condition.

Untreated gingivitis can progress to periodontal disease, which is an advanced form of gum disease that also affects the bone and ligaments surrounding the teeth.

Some women may already be suffering from undiagnosed or untreated periodontal disease when they fall pregnant. Gum disease may not display any obvious symptoms until it has progressed to more advanced stages when the teeth start to become loose. It can therefore progress slowly without you being aware, or you may not realise the severity of the condition and seek early treatment.

Pregnancy may exacerbate the severity of existing periodontal disease3. Research has indicated that women suffering from periodontal disease may be at risk of adverse pregnancy outcomes including pre-term labour and low birth weight4.

Pregnancy tumours:

You may also develop what are known as ‘pregnancy tumours’ (pyogenic granulomas) which are red, lumpy lesions that appear along the gumline and between the teeth. They may bleed easily however are otherwise quite harmless, and they usually go away once your baby is born. However if they become difficult to manage your dental professional can provide treatment options.

Dry Mouth:

You might also be affected by dry mouth (xerostomia). Dry mouth syndrome reduces the amount of saliva you produce which can contribute to bad breath and, more seriously, tooth decay.

Saliva is your body’s natural defence mechanism to help prevent tooth decay. When you consume foods rich in fermentable carbohydrates (sugars or starches), bacteria in dental plaque feed on them and produce acids that ‘attack’ your tooth enamel (outer layer of your teeth). Saliva helps to neutralise these acids in a process called remineralisation, and also helps to cleanse the mouth of food particles that can contribute to acid production (from dental plaque) and odours (bad breath).

If you are suffering from the effects of dry mouth syndrome, your dental professional can provide treatments to lessen the symptoms.

Protecting your baby’s health

If gum disease becomes severe, the infection can affect your unborn baby’s development. Research has indicated that women suffering from periodontal disease can be at risk of adverse pregnancy outcomes including premature birth and delivering a low birth weight baby5. There may also be other long-term health risks for a child born prematurely or of low birth weight6.

The theory is that oral bacteria release toxins, which reach the placenta through the mother’s bloodstream, and interfere with the growth and development of the unborn baby. Oral infection also causes the mother to produce labour-triggering substances too quickly, potentially causing premature labour and birth7.

After the baby is born, decay-causing bacteria can be transferred from parents to the child, which can increase their likelihood of suffering from early childhood caries (tooth decay in the baby teeth)8. This can be transferred through behaviours such as kissing on the lips and sharing utensils such as spoons9. Therefore it is important that both parents continue maintain good dental hygiene even after the baby is born.

Be careful of morning sickness

Whilst morning sickness is beyond your control, it’s important that you know vomit is extremely acidic and can cause damage to your teeth known as enamel erosion. Enamel erosion is when the outer layer of your teeth is attacked and gradually dissolved by acid. This can weaken your teeth, making them more prone to sensitivity, and can eventually lead to cavities (holes) in the tooth surface.

To reduce the risk of damage to your teeth after vomiting, firstly refrain from brushing your teeth for at least one hour. The acid will have temporarily softened your tooth enamel and the action of brushing too soon can actually cause further damage and strip away the enamel.

What you can do instead of brushing your teeth straight away, to reduce the risk of enamel erosion, is:

  • Immediately rinse your mouth out with either water, an alcohol-free mouthwash, or a solution of ¼ teaspoon baking soda mixed into 1 cup warm water.
  • Chew sugar-free gum to stimulate saliva flow to help neutralise and wash away acid.
  • Eat acid-neutralising foods such as milk, cheese or yoghurt.
  • Smear a small amount of fluoridated toothpaste on your teeth to give you additional protection and improve the taste in your mouth.

Cravings

It’s common for pregnant women to suffer from some unusual or frequent cravings. If you are craving sweet foods, it’s important to be mindful that a regular desire for sugary foods may increase your risk of tooth decay.

To help prevent tooth decay, try to mix in some healthier, low sugar options such as berries with natural or Greek yoghurt.

You can also drink water after consuming sugary foods (swishing it around your mouth) to help remove some of the sugary particles left on your teeth, and chew sugar-free gum to stimulate saliva flow to help remineralise your teeth.

It is also better to have a larger portion of sweet foods in the one sitting, rather than snacking on smaller amounts of sweet food constantly throughout the day. This will limit your exposure to ‘acid attacks’ on your teeth.

Pre-pregnancy planning

You are less likely to suffer from pregnancy gingivitis and other dental problems during pregnancy if your teeth and mouth are in good oral condition before falling pregnant. This includes your regular at-home routine of brushing and flossing, and routine dental visits.

If you are planning on falling pregnant, and you have not been for a check-up in the last 6 months, it’s a good idea to visit your dentist and oral hygienist for a comprehensive clean and exam. This will start you off on the right track to keep a good oral hygiene routine throughout pregnancy and beyond.

 

References

  1. Australian Dental Association: Pregnancy – Separating fact from fiction (2016)
  2. Frontiers in Immunology: Role of Maternal Periodontitis in Preterm Birth (2017)
  3. Journal of Clinical and Diagnostic Research: Dental Considerations in Pregnancy – A Critical Review on the Oral Care (2013)
  4. American Academy of Periodontology: Expectant Mothers’ Periodontal Health Vital to Health of her Baby.
  5. Journal of Natural Science, Biology and Medicine: Periodontitis – A risk for delivery of premature labor and low-birth-weight infants (2010)
  6. Vaccine (Elsevier Sponsored Document): Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data (2017)
  7. Journal of Natural Science, Biology and Medicine: Periodontitis – A risk for delivery of premature labor and low-birth-weight infants (2010)
  8. Frontiers in Pediatrics: Early Childhood Caries – Prevalence, Risk Factors and Prevention (2017)
  9. BMC Oral Health: Oral health behaviors and bacterial transmission from mother to child: an explorative study (2015)

 
This information is intended to promote understanding of and knowledge about general oral health topics. It should not be taken as personal, professional advice; nor treatment or diagnosis. Always seek professional advice from an appropriately qualified medical practitioner.