Pregnancy Dental Concerns
By Dr. Carole Horowitz

Pregnancy Dental Concerns

ASK THE EXPERTS  

Q: Are there any dental concerns I should be aware of while I'm pregnant?

A: Having a baby is a very exciting time! Having a disease-free mouth will contribute to a more comfortable pregnancy.  At this time, your oral health continues to be important to your overall health.

Seeing the dentist while pregnant is not only safe, but encouraged. As soon as a woman becomes aware that she is pregnant, she should visit her dentist for an oral exam and plan for dental care during her pregnancy. Also, frequent cleanings and exams will allow for the dentist to keep a close watch on any potential problems. 

RELATED: Find more ideas on the best ways to take care of yourself while pregnant.

Patients will often not feel any discomfort until a problem is in advanced stages. While dental procedures should be kept at a minimum, procedures should be undertaken in emergencies, to prevent pain, further caries (cavities), or worsening of gingival, gum disease, or infections.  The goal is to both minimize infections in the mouth and, therefore, extensive procedures that can have an impact on the developing fetus.

Even if you are only in the planning stages of having a child, it’s still wise to take care of any necessary dental treatment now to minimize problems later.  Preventive care and getting into good dental habits is important for the soon-to-be mother, and should be ongoing after the baby is born. Frequent dental visits and preventative home care is not only essential for the new mom, but for the whole family as well. 

The dentist plays an important role in guiding the expectant mother with prenatal care as well as providing up-to-date information about the relationship of oral health and pregnancy.  

As a result of increases in the hormones estrogen and progesterone, women may notice more gingival problems such as tenderness and sensitivity.  Many women experience “pregnancy gingivitis” marked by increased bleeding, redness and swelling of the gums.  This is in response to irritants in the mouth such as plaque or calculus (tarter).

Gums that are swollen are also a haven for trapped food.  Cravings for carbohydrates and sweets can lead to caries, so the mother should be informed of the importance of a proper diet. Minimizing sugary snacks (which combines with plaque) will lessen the chance of decay and further problems. If there is morning sickness, it is wise to swish or rinse with water after vomiting to rinse away stomach acids. Morning sickness can erode the enamel (the tooth’s protective layer) and make it easier for decay to develop.

Professional cleanings (prophylaxis) are safe and should be done often, along with an excellent home-care regimen.  If gum disease is left untreated, it can progress to bone loss with the more serious consequence of tooth loss. You also want to avoid oral infections, such as gum disease, because they've been linked to preterm birth.

During the first trimester, women can be treated for emergencies. However, it’s best, if possible, not to go ahead with elective dental treatment. This will help you avoid potential risks to fetal development. Also, the first trimester is a difficult time for some women to receive dental care due to feelings of nausea, vomiting, fatigue and sensitivities to smells/odors.

The second trimester is the best time for treatment, either elective and emergency.  At this time, the risk of side effects is lower as the development of the fetal organs is complete.  Women are generally more comfortable in this second trimester. It’s a good idea to keep legs uncrossed while sitting in the dental chair to maintain healthy circulation. A pillow and music could make the visit more comfortable and pleasant for the mother and baby.

During the third trimester, only emergency treatment should be done. Now, any elective dental work should wait until after the baby is born. This is to avoid the risk of premature labor. The third trimester also presents issues for some women, such as backaches, frequent need to use the bathroom, or discomfort sitting in the dental chair for long periods at a time.

Another question that arises regarding safety of dental treatment during pregnancy is whether the expectant mother can have X-rays, anesthesia, and/or medication.  Routine X-rays are not recommended, emergency X-rays can be done. The American College of Radiology says that no single X-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus. Two aprons for x-rays can be used for added protection. Local anesthesia in Category B (considered safe in pregnancy), such as Lidocaine, can be used. But because Lidocaine does cross the placenta, the amount administered should be minimal—only enough to make the expectant mother comfortable. The more comfortable she is, the less stress will be on her and the baby. No Nitrous oxide should be used. Antibiotics such as Penicillin, Amoxicillin, and Clindamycin (also considered Catergory B) may be prescribed if needed after a procedure.

The main thing to keep in mind is that “Prevention is Key.” It is essential to avoid oral infections. However, if there is an infection, then the consequences of not treating it outweigh risks of medications used during dental treatment.

Expecting parents need to be educated regarding oral care of the infant, and, later, dental care for young children. Did you know that a mother with active tooth decay can also spread the decay-causing-bacteria to her child through saliva? This perpetuates poor oral health.

RELATED: Get more advice on maintaining a healthy pregnancy.

Home care for infants begins with gum massage, removal of plaque, dietary management, and fluoride supplements in areas where water is not optimally fluoridated.

For helpful, up-to-date resources on oral care in pregnancy, visit ADA’s consumer site Mouth-Healthy.