Pregnancy Concerns

Pregnancy and Dental Health Concerns

If you are expecting, please let us know so we can ensure your optimum dental health during pregnancy. As oral healthcare professionals, our role is to educate. You can be assured that you will get the best dental care at Dental Health and Wellness Boston during your pregnancy. We will address any specific concerns and ease any fear or anxiety you may experience about receiving dental care.

The Oral Health of Mother and Baby

Current research on maternal and fetal physiology has proven that providing dental care during pregnancy is more beneficial than harmful. When compared to the risk of not providing care, prevention, diagnosis and treatment of oral diseases are far more beneficial and can be carried out during pregnancy with no additional fetal or maternal risk. “The American Academy of Peridontology, for example, urges health professionals to provide preventive services as early in pregnancy as possible and to provide treatment for acute infection or sources of sepsis irrespective to the stage of pregnancy. Timing is vital in the oral health of a pregnant women since it is possible that is may affect the oral health of their children. Assessment of oral health risks in infants and young children with appropriate intervention, along with anticipatory guidance for parents and other caregivers, has the potential to prevent the transmissibility and development of early childhood caries (ECC).

The oral health of a mother can affect the oral health of her baby. Anticipating oral health risks for a baby in utero can prevent the early dental caries (tooth decay, or, cavities) that develop early in a child’s life. During pregnancy, a mother must maintain routine dental healthcare, for herself and her child. The Perinatal Oral Health Consensus Statement from the American Congress of Obstetricians and Gynecologists states:
“Prevention, diagnosis and treatment of oral diseases, including needed dental radiographs and use of local anesthesia, are highly beneficial and can be undertaken during pregnancy with no additional fetal or maternal risk when compared to the risk of not providing care. Good oral health and control of oral disease protects a woman’s health and quality of life and has the potential to reduce the transmission of pathogenic bacteria from mothers to their children.”

How Changes to the Body Affect Dental Health

Physiological changes in the mouth of a pregnant woman put her at a higher risk for dental infection. This risk is also increased due to changes in the immune system during pregnancy. According to the California Dental Association, control of oral disease in pregnant women has the potential to reduce the transmission from new mothers to their infants. Hormonal fluctuations associated with pregnancy can exaggerate some dental disorders, and recent studies have shown a link between gum disease and premature births and babies with low birth-weight.

Common Oral Conditions During Pregnancy

It is a fact that physiologic changes occur in the mouth of a woman during pregnancy and it is important to understand that these changes place pregnant women at a higher risk for dental infection. Though gingivitis is the most common oral condition, other common oral conditions that affect dental health during pregnancy include the following:

Single, tumor-like growths of gingival enlargement may also appear during pregnancy. These growths often referred to as a “pregnancy tumor,” “epulis gravidarum,” or “pregnancy granuloma” are frequently associated with inflammatory gingivitis, or some other irritation. Poor oral hygiene is a cause of these growths. Plaque deposits, as well as calculus, are also present on the teeth adjacent to the lesion. To fix this problem, scaling and root planning are necessary, as well as intensive oral hygiene instruction. The growth generally fades postpartum; however in some cases the growth is removed due to discomfort, disturbing the alignment of the teeth or bleeding on mastication.

Teeth mobility is another problem that could occur during pregnancy and is often related to “the degree of gingival diseases disturbing the attachment apparatus, as well as to mineral changes in the lamina dura.” There is normally no permanent loss of clinical attachment; however in some individuals the progression of periodontitis can and does occur and can be permanent.

“Physiologic xerostomia (abnormal dryness of the mouth) is a common oral complaint.” Xerostomia is most commonly reported in accordance with the use of certain medications that produce dryness as a side effect, such as antispasmodics, antidepressants, antihistamines, anticonvulsants and others. Xerostomia can also occur during sleep. It is important to use increased oral hygiene, frequent fluoride exposure and to remove plaque from teeth before bedtime as treatment for this condition.

White Blood Cell Suppression: During pregnancy, the woman’s immune system changes, particularly in the suppression of some neutrophil (white blood cell) functions. Because of these changes the exacerbation of plaque-induced gingival inflammation can occur, for example. “Inhibition of neutrophils is particularly important in pregnancy-periodontal disease associations.”

Nausea and vomiting are very common during pregnancy; 70-85% of women experience these symptoms. Although nausea and vomiting during pregnancy (NVP) is predominantly associated with early pregnancy, it is possible that some women experience it past the first trimester. Hyperemesis gravidarum is a severe form of NVP that occurs in about 0.3-2.0% of pregnancies, and may lead to surface enamel loss primarily through acid-induced erosion.”

Changes in salivary composition in late pregnancy and during lactation may temporarily predispose to erosion as well as dental caries, however there are no convincing data to show that dental caries incidence increases during pregnancy or during the immediate postpartum period, though existing, untreated caries will likely progress.”

Gum Disease, Gingivitis and Pregnancy

Periodontal disease (gum disease) affects about 15% of women of childbearing age and up to 40% of pregnant women. The most common clinical periodontal condition in women during pregnancy is gingivitis due to the accumulation of dental plaque. This occurs in 60-75% of women generally between three and eight months of pregnancy, which reinforces the importance of periodontal preventive and treatment measures during pregnancy. Gingival changes usually occur in association with poor oral hygiene and local irritants, however the hormonal and vascular changes taking place in a pregnant woman often exaggerate the inflammatory response to these local irritants. Gingivitis results from the buildup of plaque, the sticky, harmful bacteria on teeth. Periodontal care should be provided during pregnancy because it is safe and effective in reducing periodontal disease and periodontal pathogens. It is important to maintain routine dental healthcare to prevent gum disease that may become aggravated during pregnancy.

Medical Conditions Related to Dental Care

Common pregnancy complications such as miscarriage, preterm birth, preeclampsia and gestational diabetes are sometimes believed to be associated with dental care, but this is not the case. According to studies:

Miscarriage is not related to first trimester of oral healthcare or dental procedures.
Although research is ongoing, the most current evidence shows that periodontal treatment has no effect on birth outcomes of preterm labor and low preterm birth weight. It is safe for the mother and the fetus.
Preeclampsia is not a contraindication to dental care.
Although oral health indicators have been linked to diabetes, gestational diabetes is not related to receiving dental healthcare during pregnancy. For more information about diabetes and dental health, please visit our Dentistry for Diabetics page.

Our Role as Your Boston Dentist During Pregnancy

As your oral health care professionals throughout our patients’ pregnancies, we believe that it is our role to educate. In doing so, we assure the pregnant woman that dental care is safe during pregnancy. We address any specific concerns and try to ease any fears about receiving dental care. We will inform the woman that prevention, diagnosis and treatment of oral diseases, including needed dental X-rays and use of local anesthesia, are highly beneficial and will not cause any additional fetal or maternal risk. We will plan definitive treatment for the dental health of mother and child based on customary oral health considerations, including:

Chief complaint and health history
History of tobacco, alcohol or other substance use
Clinical evaluation
Radiographs and other diagnostics when indicated”

We will also care for each patient individually, as we always go through the following process with our pregnant patients:

Develop and discussion of a comprehensive treatment plan that includes preventive, treatment and maintenance care throughout pregnancy.
Discuss the benefits, risks and alternatives to treatments.
Provide emergency/acute care at any time during pregnancy as indicated by the oral condition of the patient.
Perform a comprehensive periodontal examination, which includes a periodontal probing depth record.
Recommend that all women of childbearing age take a multivitamin supplement containing folic acid.
Support a woman’s decision to breastfeed and have ready access to patient education resources.
Reinforce tobacco and alcohol cessation and other medical recommendations at oral health office visits.
Place pregnant women in a semi-reclining position as tolerated, encourage frequent position changes, and/or place a small pillow under her hip to prevent postural hypotensive syndrome.
Utilize a rubber dam during restorative procedures and endodontic procedures.
Use safe amalgam and safe composite practices when placing restorative materials intraorally.
Consult with the pre-natal care provider when considering certain procedures
Provide necessary follow-up evaluation to determine if oral health care interventions have been effective.
Provide health education and anticipatory guidance about oral health practices for children to prevent early childhood caries.
Encourage patients to use the internet in order to learn more about oral health during pregnancy and early childhood.
Encourage and advise patients to continue to receive dental care during the postpartum period and thereafter.

We Will Educate You About Pregnancy and Dental Healthcare

Dr. Smith and her talented team of dental professionals will work with you during the course of your pregnancy to develop and discuss a comprehensive treatment plan. We will cover preventive care, treatment and maintenance care throughout your pregnancy and talk about the benefits, risks and alternatives to certain dental treatments. We will also give you anticipatory guidelines about the oral health of your new baby. Remember, maintaining routine dental care throughout your pregnancy is part of maintaining the overall health of you and your new child. We hope to see you soon.