Oral Care in Pregnancy

(photo by Krystal Walker @wonderfully_walker)

Pregnancy changes a woman’s body in so many ways, sometimes making it more challenging to prioritize yourself and even your own health. Oral health is often one of those sacrifices made during the 40 weeks of growing a baby whether it be related to exhaustion, hormonal changes, morning sickness or nausea, or a combination of the many other common pregnancy symptoms. Oral health during pregnancy is more important than ever for a woman because of how pregnancy can affect the oral cavity. 

While there are many truths related to pregnancy and oral health, there are also some myths. 

Let’s debunk those misconceptions first. 

MYTH: Mother’s lose a tooth with each pregnancy. 

MYTH: The growing baby takes calcium from the mother’s teeth during pregnancy.

MYTH: A mother’s oral health does not affect the baby. 

So, what is actually true about oral health and pregnancy?

TRUTH: Pregnant women are more susceptible to developing dental cavities during their pregnancy.

TRUTH: Women are likely to experience more bleeding from their gums during pregnancy.

TRUTH: It is safe and recommended to visit the dentist during pregnancy. 

Did you know that nearly 60 to 75% of pregnant women have some form of gingivitis? 1 Did you also know that 1 in 4 women of childbearing age have untreated cavities? 2 Lastly, did you know that only 22-34% of US women seek dental care during their pregnancy? 

There are a number of pregnancy-related oral health symptoms, with some having the potential to affect a mother’s baby. Therefore, it is important that women are educated and informed to help them make the best decisions for their own oral health. But what are those common pregnancy-related oral health symptoms and how may some of them potentially affect their baby?

Known oral complications during pregnancy:

• Pregnancy gingivitis

Pregnancy gingivitis is the most common oral complication during pregnancy. 90% of pregnant patients will have some form of gingivitis, either localized or generalized. Typically pregnancy gingivitis is noticeable by the second month of pregnancy, or 8 weeks. Pregnant women are also more susceptible to infections, including oral pathology, because of the influx of hormones and their immunocompromised state. This means the biochemical and hormonal changes occurring during pregnancy enhance the risk for gingivitis (inflammation of the gums) and periodontal disease (gingivitis that has progressed to bone loss around the teeth). Existing research has associated periodontal disease as an increased risk for preterm birth, a low birth weight baby, or even pre-eclampsia. Because these changes or new occurrences may be asymptomatic, good oral hygiene and routine dental visits are even more important during pregnancy. 

Pregnant mothers can help reduce the risk of gingivitis during pregnancy by having a meticulous oral hygiene routine that consists of regular brushing (twice a day for 2 minutes), nightly flossing, using a mouthrinse geared towards gum health, and visiting their dentist at least every 6 months. It is important to remember that preexisting gingivitis will become exacerbated during pregnancy because of the influx of hormones. Typically symptoms of gingivitis resolve after birth assuming good oral hygiene practices are in place. 

• Pregnancy granuloma, or pregnancy tumor, or pyogenic granuloma

Pregnancy tumors are a benign, gingival lesion that appears clinically as soft, red-purple, tender, swollen mass that bleeds very easily and can range in size from several millimeters to centimeters. Oftentimes, these lesions are influenced by high hormone levels, hence pregnancy. These lesions are often in conjunction with a local irritant such as dental calculus (or tartar), plaque accumulation, or even a dental restoration. Pregnancy tumors may resolve within months following pregnancy, but may need to be excised. Pregnancy tumors occur in up to 5% of pregnancies and are most common between the top front gum tissue in between two teeth and are most commonly seen following the first trimester when the influx of hormones is so significant.

If you are experiencing one of these tumors, be aware they typically do not affect the supporting bone around its location. However, good oral hygiene including brushing and flossing is even more critical to keep them from becoming larger and uncomfortable. 

• Xerostomia (dry mouth)

Women may develop mouth breathing due to the respiratory changes that occur during pregnancy causing it to become more difficult to breathe out of the nose. In turn, dry mouth (xerostomia) and gingival inflammation may be the result. According to a 2015 study, 60-70% of women experience shortness of breath during pregnancy. 4

If you are pregnant and experiencing dry mouth, it is important to supplement with healthy alternatives, such as sugar free gum, water or sugar-free flavored water, and sugar-free lozenges to help reduce the risk for developing cavities.

• Tooth erosion and dental caries

Due to the many gastrointestinal changes that occur during pregnancy, nausea and vomiting are common first trimester symptoms that can lead to tooth erosion. Many women experience acid reflux as another pregnancy symptom that may also lead to tooth erosion. 

Nutrition and eating habits change during pregnancy meaning depending on what you are snacking on can lead to an oral environment that is more acidic and prone to decay. Because of the many cravings and aversions associated with pregnancy, try choosing snacks that are lower in sugars and carbohydrates. It is also important to brush using a low abrasive and fluoridated toothpaste and a gentle toothbrush (soft bristles). Remember, brushing and rinsing with fluoridated dental products are safe during pregnancy. If you are experiencing vomiting, avoid brushing immediately after getting sick and use a sodium bicarbonate rinse instead to neutralize the acidic oral environment (1 teaspoon baking soda with 1 cup water). 

• Ptyalism (increase in saliva)

An increase in saliva during pregnancy is often associated with nausea. If you are noticing an increase in salivary production, you may want to consider reducing the consumption of complex carbohydrates, which will also help reduce the risk of developing unwanted dental cavities. 

Mothers with good oral health have less risk for heart disease, diabetes, and reduced risk of tooth loss. Mothers with positive dental attitudes will have healthy mouths which in turn lead to positive outcomes for children and less risk for early childhood caries. Research has shown that receiving dental care is safe during pregnancy, but it is important that your dental provider is aware of your pregnancy during your visit. Be sure to disclose this information during your health history update to ensure you and your baby are receiving the safest and most appropriate dental care that is tailored to fit you and your baby’s needs. 

Sources:

1. American Dental Association Council on Access, Prevention, and Interprofessional Relations, 2006. 
2. Lindquist B, Emilson CG. Colonization of Streptococcus mutans and Streptococcus sobrinus genotypes and caries development in children to mothers harboring both species. Caries Res. 2004;38(2):95-103.
3. Gaffield ML, Gilbert BJ, Malvitz DM, Romaguera R. Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system. J Am Dent Assoc. 2001 Jul;132(7):1009-16. doi: 10.14219/jada.archive.2001.0306. PMID: 11480627.
4. Goland S, Perelman S, Asalih N, Shimoni S, Walfish O, Hallak M, Hagay Z, George J, Shotan A, Blondheim DS. Shortness of Breath During Pregnancy: Could a Cardiac Factor Be Involved? Clin Cardiol. 2015 Oct;38(10):598-603. 

About the Author 

Kristen Cockrell is a Registered Dental Hygienist with a passion for pediatric dentistry and oral health education. Kristen has been a practicing clinical hygienist for the past nine years and has a focus on providing oral health preventive services and education to the pediatric population. She is passionate about expanding access to dental care to medically complex and underserved patients while raising oral health awareness. She also has a particular interest in providing care to patients with special needs. Kristen has recently obtained a master’s degree in dental hygiene education at the University of North Carolina at Chapel Hill. Outside of work, Kristen loves traveling and spending time with her husband, one-year-old son, and golden doodle pup.