Pregnancy and Oral Health

“Studies have demonstrated that mothers of low-birth-weight infants tend to have more severe periodontal disease (gum disease) than mothers with normal birth-weight babies. Additional work is needed to determine whether periodontitis is a risk factor.” U.S. Surgeon General’s Report

1. Why are pregnant women prone to oral health problems?

• Changing levels of oestrogen in a woman’s body can cause dental problems.
• This is true of pregnancy, puberty, lactation, menstruation and menopause.

2. What oral problems are pregnant women likely to experience?

• Gingivitis
  Gums can become sore, swollen and sensitive, and may bleed during pregnancy:

• The higher the levels of progesterone and oestrogen, the greater the incidence of gingival inflammation.
• These gum problems usually start in the second month of pregnancy, and are at their worst in the eighth month, when the level of oestrogen and progesterone is highest.
• When hormone levels drop in the ninth month of pregnancy, gum problems start to diminish.
• Teeth are also more prone to decay because of hormonal changes.
• Bacterial levels increase in the gums with hormonal change and lead to more plaque being formed.
  Plaque causes gingivitis and decay.
• It appears that the immune system reacts differently to plaque during pregnancy.

• Heartburn and vomiting ( morning sickness)

• Heartburn and vomiting are some of the expected side effects of pregnancy. They can result in acids being brought up into the mouth. The acid damages the teeth by causing erosion of the enamel.
• Severe vomiting can cause serious erosion of teeth.

• Pregnancy Epulis
  A lump called a pregnancy epulis may appear on the gum. This is a growth consisting of irregular nodules that project from the gum:

• It is connected to the gum by a narrower stem, near the tooth.
• The color varies from pink to red, and is associated with chronic irritation.
• It can start during pregnancy and may slowly disappear.
• There are several different types of this growth.
• This is not dangerous and can easily be dealt with by the dentist.
• It is usually removed surgically.

• Granuloma or pregnancy tumour
  This is a nodular, fleshy swelling occurring in the gum, close to the tooth:

• It can be tender to the touch, but is usually not very painful.
• This tumour may occur during pregnancy, but it usually results from chronic irritation or injury.
• It is treated by surgery.

3. What precautions should be taken for teeth and gums during pregnancy?

• More frequent visits to your dentist are advisable.
• Try to reduce snacking on food with a high sugar content.

• Pregnant women are likely to snack more often than usual.
• This results in a more frequent intake of sugary snacks, which bacteria in plaque convert to acid.
• Plaque causes tooth decay and gum disease.

• A strict routine of oral hygiene should be observed at home.

• In addition to brushing and flossing, rinsing with salt water or a mouthwash is recommended.
• This should be done after each meal.
• The mouthwash should not be swallowed.

4. What special precautions will the dentist take with pregnant patients?

• Treatment for periodontal disease, fillings or medication may need to be postponed until after the pregnancy.
• General anaesthesia will be avoided.
• X-rays are not normally taken, especially during the first trimester (three months) of pregnancy.
  However, if the patient is in pain, all necessary treatment should be carried out, including essential x-rays.
• Infections, which could enter the mother’s blood stream and affect the developing foetus, must be treated.
  This applies particularly to the first trimester.
• Only medically approved pain relievers should be used, and then only when they are really necessary.
• Discuss any doubts and fears you may have with your doctor or dentist.

5. Can the foetus be protected if the mother has to have an x-ray?

• Most people are afraid that radiation from a dental x-ray is potentially harmful.
• There is, however, no proof that dental x-rays can affect the unborn child.

• The dentist will use a lead shield to protect the mother’s body from radiation, including the area of the womb.
• Modern x-ray film is very fast, and so the exposure time of each x-ray is very short.
• Digital x-ray technology reduces the exposure time to radiation.

6. Should amalgam fillings be avoided during pregnancy?

• There is an ongoing debate about whether or not amalgam fillings are toxic:

• Some people believe that the mercury in amalgam is a dangerous toxin, and a contributory cause of serious illness such as Altzheimers.
• Some dentists believe that mercury from amalgam filling could leak into the mother’s bloodstream and affect the unborn child.
• These fears about amalgam fillings are not proved.
• Everything possible should be done to protect a developing foetus, and no risks should be taken during pregnancy.
• It is best not to place or remove amalgam fillings during pregnancy.
• Alternative filling materials can be used.

7. Does gum disease cause premature births?

• Studies have shown that women with gum disease may deliver premature or low-birth-weight babies.

• However, there is nothing to suggest that the gum disease is the cause of the premature birth, or low birth weight.
• These problems often seem to occur in the same women.
• There is a possibility (but no evidence) that toxins released by gum disease may affect the weight of the baby, or cause the cervix to dilate prematurely, causing a premature birth.

8. Is it true that the foetus draws calcium from the mother’s teeth?

• This is a completely unfounded myth. It is, however, commonly believed.

• A pregnant mother must, however, include an adequate daily intake of calcium in her diet, or she and her baby may suffer a calcium deficiency.
• Milk, cheese and yoghurt should be sufficient, but the doctor may recommend a calcium supplement during pregnancy.

9. Can the pregnant mother’s diet affect the dental development of the baby?

• Yes, the mother’s diet during pregnancy affects the development of the baby, and this includes teeth and bones.

• Calcium, protein, phosphorus, vitamins A, C and D are very important for the healthy development of the foetus.
• A lack of vitamin D in breast milk can cause problems with the formation of tooth enamel of baby teeth.
• It is, however, accepted that a mother with a well-balanced diet, will not have to worry about her baby’s development. Your doctor will be ready to advise you about your diet.