Have you ever heard the old myth that an unborn baby “takes the calcium from your teeth?” Or perhaps you’ve heard a beloved grandparent say that she “lost a tooth for each baby?” Misinformation abounds in terms of prenatal dental health, and while you may know that these myths are false, you may not know specifically what preventative steps to take before, during, and after your pregnancy. What treatments are considered safe? What are the real risks of dental disease to you and your baby? What changes can be expected?

Pregnancy creates complex changes throughout the body, many of which affect oral health. While calcium and tooth loss are not typical of a pregnancy, some of the changes may include:

Pregnancy gingivitis: Approximately 40% of pregnant women have some form of periodontal (gum and supportive bone) disease (3). An increased inflammatory response causes the gingivae to swell and bleed during this time. In other words, you may not have more plaque, but your response to it is more aggravated. This typically peaks during the third trimester. Rinsing with saltwater may help with the irritating symptoms of pregnancy gingivitis. Mix 1 teaspoon of salt with 1 cup of warm water for a soothing rinse.

Benign oral lesions: Also known as pyogenic granulomas, granuloma gravidarum, or epulis of pregnancy, these occur in about 5% of pregnancies. They are a highly vascular, sometimes raised lesion that usually occur in the attached gums in the front of the mouth. They are also caused by the increased inflammatory response, and usually regress after pregnancy with no need for excision or treatment, unless they are very painful or interfere with chewing or talking. Have your dental professional observe and diagnose the lesion if one occurs.

Tooth mobility: The same chemical signals sent by your body that loosen the ligaments to accommodate your growing baby loosen other ligaments as well. Ever wonder why your feet get bigger? Ligaments attach the small bones in your feet, too. Your teeth are supported by ligaments and bone, and mobility during pregnancy is normal, and should not result in tooth loss unless periodontal disease is also present.

Tooth erosion: Increased exposure to gastric acids (via heartburn or chronic vomiting) can erode tooth enamel. Antacids can keep the acids at bay, and rinsing often with a teaspoon of baking soda in a cup of water can neutralize the strong acids that may be present in the mouth.

Dental caries: Increased acidity in the mouth, more frequent snacking, and an increase in processed or sugary drinks and snacks, and a decrease in attention to oral hygiene can all cause an increase in dental decay and cavities.

The good news is that preventative and restorative dental care is safe during pregnancy, and is not associated with any negative outcomes to the mother or child. This means that treating gum disease, and maintaining oral health is the most prudent choice during pregnancy. Keeping the mother’s oral environment healthy keeps tissues stable and prevents problems, certainly, for her at a minimum, and potentially for the baby as well.

What treatments and medications are safe to use during pregnancy? Chlorhexidene rinses, fluoride treatments, and xylitol-containing products have no reported adverse effects on mothers or infants, and are considered safe for use. For restorative care and urgent treatment needs, there are antibiotics that are considered safe in the case of infection, as well as localized anesthetics (such as Lidocaine, Bupivacaine, and Mepivicaine - with or without epinephrine) that may be used during pregnancy (2). Dental radiographs (with a thyroid and abdominal barrier) are considered safe by the American College of Obstetricians and Gynecologist, and the American Dental Association. At Monroe Street Family Dental, we wait on routine radiographs until after the pregnancy, unless an urgent need is outlined, and the risk of undiagnosed problems supersedes the cautionary delay.

Brushing 2-3 times daily, and not skipping out on the flossing is crucial during pregnancy to keep plaque at bay, and to prevent gum disease and dental decay. Limit sugary and processed snacks, and limit the frequency of these snacks as well (frequency is the number one contributor to dental decay.)

At Monroe Street Family Dental, we understand that sometimes cravings can’t be denied, and that exhaustion sometimes can’t be avoided - while you do your best, we will be right there with you. MSFD recommends that pregnant women come in for an extra preventative visit, for a professional cleaning and an application of fluoride. We support you and want to help you to be happy and healthy - baby, too!

References and Resources:

(1) The “Healthy Smiles for Mom and Baby Advisory Board,” a division of the Children’s Health Alliance of Wisconsin. The Wisconsin Perinatal and Infant Oral Health plan is available at www.chawisconsin.org/hsmb. Retrieved June 2016, Advisory Board Statement received June 2016.

(2) Oral Health Care During Pregnancy Expert Workgroup, 2012. Oral Health Care During Pregnancy: A National Consensus Statement. Washington, DC: National Maternal & Child Oral Health Resource Center.

(3) Oral Health Care During Pregnancy and Through the Lifespan. Committee Opinion No. 569. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 122: 417-22.