Many women make it nine months with no dental discomfort, pregnancy can make some conditions worse – or create new ones. Regular checkups and good dental health habits can help keep you and your baby healthy. Oral health care in pregnancy is often avoided and misunderstood by physicians, dentists, and patients. 

Getting a checkup during pregnancy is safe and important for your dental health. Not only can you take care of cleanings and procedures like cavity fillings before your baby is born, but your dentist can help you with any pregnancy-related dental symptoms you might be experiencing. 

Some prenatal oral conditions may have adverse consequences for the child. Periodontitis is associated with preterm birth and low birth weight, and high levels of cariogenic bacteria in mothers can lead to increased dental caries in the infant. Other oral lesions, such as gingivitis and pregnancy tumors, are benign and require only reassurance and monitoring. Every pregnant woman should be screened for oral risks, counseled on proper oral hygiene, and referred for dental treatment when necessary. 

Dental procedures such as diagnostic radiography, periodontal treatment, restorations, and extractions are safe and are best performed during the second trimester. Xylitol and chlorhexidine may be used as adjuvant therapy for high-risk mothers in the early postpartum period to reduce transmission of cariogenic bacteria to their infants. Appropriate dental care and prevention during pregnancy may reduce poor prenatal outcomes and decrease infant caries

Pregnancy Gingivitis

Your mouth can be affected by the hormonal changes you will experience during pregnancy. Gingivitis is inflammation of the superficial gum tissue. During pregnancy, gingivitis is aggravated by fluctuations in estrogen and progesterone levels in combination with changes in oral flora and a decreased immune response. Thorough oral hygiene measures, including tooth brushing and flossing, are recommended. Patients with severe gingivitis may require professional cleaning and need to use mouth rinses such as chlorhexidine (Peridex). Left untreated, gingivitis can lead to more serious forms of gum disease.

Increased Risk of Tooth Decay

Pregnant women may be more prone to cavities for a number of reasons. If you’re eating more carbohydrates than usual, this can cause decay. Morning sickness can increase the amount of acid your mouth is exposed to, which can eat away at the outer covering of your tooth (enamel). 

Brushing twice a day and flossing once can also fall by the wayside during pregnancy for many reasons, including morning sickness, a more sensitive gag reflex, tender gums and exhaustion. It’s especially important to keep up your routine, as poor habits during pregnancy have been associated with premature delivery, intrauterine growth restriction, gestational diabetes and preeclampsia.

Pregnancy Tumors

In some women, overgrowths of tissue called “pregnancy tumors” appear on the gums, most often during the second trimester. It is not cancer but rather just swelling that happens most often between teeth. They may be related to excess plaque. They bleed easily and have a red, raw-looking raspberry-like appearance. They usually disappear after your baby is born, but if you are concerned, talk to your dentist about removing them. Pregnancy oral tumor occurs in up to 5 percent of pregnancies. Lesions are typically erythematous, smooth, and lobulated; they are located primarily on the gingiva. The tongue, palate, or buccal mucosa may also be involved. Pregnancy tumors are most common after the first trimester, grow rapidly, and typically recede after delivery. Management is usually observational unless the tumors bleed, interfere with mastication, or do not resolve after delivery.

Loose tooth

Teeth can loosen during pregnancy, even in the absence of gum disease, because of increased levels of progesterone and estrogen affecting the periodontium (i.e., the ligaments and bone that support the teeth). For uncomplicated loose teeth not associated with periodontal disease (see below) physicians should reassure patients that the condition is temporary, and alone it will not cause tooth loss.

PERIODONTITIS

Periodontitis is a destructive inflammation of the periodontium affecting approximately 30 percent of women of childbearing age. The process involves bacterial infiltration of the periodontium. Toxins produced by the bacteria stimulate a chronic inflammatory response, and the periodontium is broken down and destroyed, creating Pockets that become infected. Eventually, the teeth loosen.

Elevated levels of these inflammatory markers have been found in the amniotic fluid of women with periodontitis and preterm birth compared with healthy control patients. Bacteria in the amniotic fluid and placenta of women with preterm labor and periodontitis.

It seems probable that this inflammatory cascade alone prematurely initiates labor. The mechanism is thought to be similar for low birth weight.

MEDICATIONS FOR DENTAL PROCEDURES

• Local anesthetics such as lidocaine (Xylocaine;
• FDA pregnancy category B) and prilocaine (Citanest;
•  FDA pregnancy category B)  mixed with epinephrine
•  (FDA pregnancy category C) are safe for procedures when dosed appropriately.30 Sedatives such as benzodiazepines (e.g., midazolam [Versed; 
• FDA pregnancy category D], lorazepam,triazolam
• [Halcion; FDA pregnancy category X]) should be avoided. Nitrous oxide is not ratedand its use in pregnancy is controversial.
• Contact to dentist for further details

References

• HUGH SILK, MD, University of Massachusetts Medical School and Family Medicine Residency Program, Worcester, Massachusetts
• ALAN B. DOUGLASS, MD, Family Medicine Residency Program, Middlesex Hospital, Middletown, Connecticut
• JOANNA M. DOUGLASS, BDS, DDS, University of Connecticut School of Dental Medicine, Farmington, Connecticut
• LAURA SILK, MD, Health Alliance, Leominster, Massachusetts