Everything you need to know about your teeth and gums during pregnancy

Periodontal disease (gum disease) of a pregnant mother is one of the risk factors for preterm delivery and/or low birth weight of a newborn baby. For this reason it’s important for every expecting mother to take care of her oral health during pregnancy. Some of the oral conditions that occur during pregnancy can be very uncomfortable, and if not taken care of, can be the beginning of lots of oral health problems in the future.

A woman will ‘lose a tooth’ with each pregnancy

NOT TRUE

Without any additional oral care measures, you should be able to maintain your usual oral health even while pregnant. It only requires your normal routine that everybody should practice daily – brushing twice a day and flossing once a day. In addition to your daily routine, it is recommended to see your dental hygienist every 6 months unless otherwise advised. The only additional care that I recommend while pregnant is to have a professional dental cleaning every 3 months instead of the usual 6 monthly cleaning.

While pregnant, the baby takes the mom’s calcium, weakening her teeth and leading to decay and loose teeth.

NOT TRUE

A women often battles with decay after pregnancy because of diet and behavioral changes while pregnant. Pregnant women typically consume more sugar/carbohydrates and eat more frequently due to cravings, or to combat nausea. Decay is 100% preventable – even while pregnant! Once minerals such as calcium are deposited into the tooth structure, it is no longer available for extraction by the unborn baby.

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Pregnant women are at a higher risk for gingivitis (inflammation of the gums).

TRUE

Hormonal changes during pregnancy can cause an increased inflammatory response to bacterial plaque, causing the gums to bleed. During pregnancy, women are prone to “pregnancy gingivitis”, which, if left untreated, could develop into periodontitis (irreversible gum disease, including bone loss around the teeth). This is more likely to happen when you already have gingivitis when falling pregnant.

For this reason it is important to practice good oral hygiene before falling pregnant and to maintain good oral health during pregnancy. If the teeth and gums are healthy before falling pregnant, the effect of the hormonal changes will be mild.

Oral health during pregnancy : frequently asked questions

Can I have dental cleanings while pregnant?

You can have a professional dental cleaning at any time – even in the 1^st trimester. In fact, it is advisable to make sure you have optimum oral health before hormonal changes are taking place.

How can I prevent decay/tooth loss during pregnancy?

Brush twice a day. Floss once a day. Have a professional cleaning every 3 months. Limit the intake of sugar and carbohydrates.

Should I tell the dentist/hygienist that I am pregnant?

Yes, Large doses of radiation between weeks 2 and 18 might cause birth defects. A lead apron will be used when x-rays need to be taken, giving you protection from almost ALL scattered radiation exposure. A lead apron attenuates the scattered radiation between 95-98%. This means that at most, only 2-5% of radiation might get through the lead apron. If digital x-rays are used instead of traditional x-rays on film, there is even less exposure to radiation.

To put it in perspective: an average 7-hour flight by plane will expose a passenger to 0.02 mSv (millisieverts). This is equivalent to 16 intra-oral dental x-rays. During a year, exposure to ceramic tiles, granite kitchen counters and other indoor building materials in our homes easily amount to 0.1 mSv. This is the equivalent of 80 dental x-rays.

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Can I have fillings/root canal treatment or an extraction during my pregnancy?

If possible, have dental work performed between 14-20 weeks of your pregnancy. All invasive dental treatment that require local anesthesia and/or drilling that can wait, should rather be done after your pregnancy. This will prevent unnecessary stress on you and therefore on the baby. But if you have pain or infection, it should get seen to immediately.

Changes to your mouth and teeth during pregnancy

1. Dysguesia: change in taste sensation
   Hormones cause a change in your sense of taste during pregnancy. This often causes a metallic taste – without you even eating anything. It is typically more common in the 1^st trimester. There is not a lot that you can do to change it but here are a few pointers that might help:
   – Eat what you can and avoid what you don’t like
   – Banish the metallic taste with acids such as citrus juices or foods marinated in vinegar
   – Brush your tongue
   – Rinse with mild salt water
   – Change prenatal vitamins
2. Pregnancy gingivitis
   Most commonly the gums will become swollen, red, sensitive and bleed easily. It is important to understand that the hormonal changes will have less of an effect on the gums if they are healthy. But the hormonal changes make pregnant women more susceptible to gingivitis and it’s more common in the 2^nd trimester. If not treated, the supporting structure of the teeth (bone and ligaments) can be affected and it can be the start of periodontal disease (irreversible gum disease) with tooth loss as the end result.

   3. Pregnancy epulis
   Also called a pyogenic granuloma. This is a pregnancy tumor (non-cancerous inflammatory growth). It is an aggressive red, round gum swelling that may occur as a severe response to debris left on the teeth. They are more common in the 2^nd and 3^rd trimester. It may subside spontaneously following the birth of the baby.

However, if not, it may require removal by a dental surgeon. This is typically done after the birth of the baby, as it is prone to re-occurrence during pregnancy. It may bleed and crust over, making eating and speaking difficult.

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4. Enamel erosion
   Pregnancy hormones soften the ring of muscle that keeps food inside the stomach. Gastric reflux and/or vomiting associated with morning sickness can cover your teeth with strong stomach acids. Repeated reflux and vomiting can damage the enamel and increase the risk of decay.Avoid brushing your teeth for at least an hour after vomiting. You want to avoid brushing all that acid into the tooth enamel. Rather rinse your mouth thoroughly with plain tap water, following with a fluoride containing mouthwash. You can also use your tongue to spread a little fluoride toothpaste over your teeth. The fluoride will help to re-mineralise the enamel.

5. Gagging while brushing
   This is a common problem with pregnant women, especially when brushing the tongue or back teeth. Try using a toothbrush with a small head – a toddler’s brush works well. It might help to close your eyes and concentrate on your breathing or use a distraction like listening to music. Take your time and don’t rush. If the toothpaste is contributing to the gagging, try another brand or brush without any toothpaste.To try and combat decay, the use of fluoride is important. If you can’t brush with fluoride toothpaste, use a rinse that contains fluoride. Rinsing can be done during the day – it doesn’t have to be done all at once with brushing and flossing. The added benefit of rinsing during the day is that you might alleviate the altered taste sensation in your mouth.

6. Food cravings while pregnant
   Only a pregnant woman can understand this!!! But of course, if the cravings are for sugary snacks, it may increase your risk of tooth decay. If nothing healthy will do, rinse or brush after a sugar indulgence or try to dilute the sugar. Chewing sugar-free gum after sugary eats will also help to restore the mouth’s pH a lot quicker. In doing so, the risk for decay will diminish.Regarding risk of decay, it is better to keep snacking to a minimum. Frequent snacking will cause the ph of the mouth to drop lower with each mini meal and stay low. A low pH increase the risk of tooth decay.

7. Increase calcium intake and Vitamin D
   It is not possible to extract a mineral such as calcium from the erupted tooth enamel and dentin. The calcium can also not be removed from the tooth via the pulp (nerve of the tooth) to be absorbed by the unborn baby. The only way that minerals can be removed from the tooth is by acid forming bacteria. But, minerals like calcium contained within the alveolar bone (bone structure around the tooth) and other bones of the body, are available to be extracted by the unborn baby.When the mother’s diet does not contain sufficient calcium and phosphorus, the unborn baby utilises the reserves from her bones. Vitamin D helps the body to absorb calcium. Good sources of calcium include: milk, cheese, plain yoghurt and almonds. You can get Vitamin D through small amounts of sun exposure, fatty fish, eggs, margarine, bread and cereal. Alternatively, supplements can be taken to achieve the desired result.

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