Oral Health Care During Pregnancy

Caring for teeth and gums is an important part of your prenatal care

Did you know that caring for your own teeth in pregnancy, is just as important for you as it is for your baby’s prenatal tooth development?

Tooth buds for your baby’s primary or milk teeth start forming in the gums around the ninth week of pregnancy. Underneath these buds are the tiny beginnings of 32 adult teeth. Between month three and four, the teeth change shape. Dentin forms inside teeth and a protective layer of enamel covers the outside.

Pregnant women require 1000mg of calcium daily, to support the development and growth of the baby’s teeth and bones. If your diet does not contain enough calcium, your body will take it from your bones, but not from your teeth. This can increase your risk for osteoporosis later in life.

Dental Problems in Pregnancy

Pregnancy increases your risk for oral health problems, including gingivitis, a mild gum disease. When dental care is incorrect or neglected, gingivitis can develop into periodontitis. This is a severe gum infection which can lead to bone and tissue loss around the tooth, and eventually tooth loss. Studies have linked periodontitis and poor oral hygiene with growth restriction in utero (baby is born with a low birth weight) and premature birth. Research as to how and why is still continuing.

While pregnancy may cause tooth and gum problems for some moms-to-be, breaking a tooth is uncommon. However, if you do break a tooth or notice that your teeth feel loose in your gums, you should see your dentist as soon as possible. Loose teeth may be caused by high levels of the pregnancy hormones oestrogen and progesterone. This is usually temporary until after the birth, but if you are concerned, rather have your dentist check it out.

Causes of dental problems in pregnancy:

• An increase in the hormones progesterone and oestrogen
• Changes in eating habits, for example, a craving for sugary foods and drinks
• Common pregnancy complaints, like morning sickness (with vomiting) and heartburn, may affect teeth or lead to reduced oral health care. If you are unable to keep food down, you may not be getting the right balance of nutrients and in the correct amounts.

Common Problems and Solutions

Pregnancy gingivitis and cavities

Gingivitis may develop from the second month of pregnancy to month eight. Plaque, a sticky substance that builds up on teeth and contains bacteria, causes redness and swelling of the gingiva, the part of the gum near your teeth. Pregnancy hormones can make your gums more susceptible to irritation from plaque.

Pregnant women are also at a higher risk for cavities (holes in the surface of teeth) during pregnancy, not only from pregnancy hormones but also from changes in diet, for example, eating more sugary foods, often caused by cravings.

Signs:

• pain and bleeding when brushing
• swollen gums
• receding gums (you can see the root of your tooth)
• bad breath
• tooth ache or cavity seen on the tooth
• sensitivity to hot and cold and/or sugary foods

Tip: See your dentist for a check-up. Always tell the dentist that you are pregnant and any medication and supplements that you take daily. If you require minor dental work, like filling a cavity, this is safe from the second trimester. In some cases, gum disease may require antibiotic treatment. Dental x-rays are safe in pregnancy.

Weakened tooth enamel

Morning sickness which results in vomiting can have a negative impact on your teeth. Acids from the stomach are strong and can cause erosion of tooth enamel. In the same way, heartburn or acid reflux in the later months of pregnancy, can push gastric acids into your mouth, with the same effect on teeth.

Tip: Don’t brush your teeth immediately after vomiting. Stomach acids cover your teeth and brushing now may scratch the enamel. Rinse your mouth with water first, then mix one teaspoon of baking soda (keep a container in the bathroom) into one cup of water and swish it around your mouth. This neutralises the acid. Wait 30 minutes before you brush.

Gagging while brushing

This can happen at any time during pregnancy, but may be more common in the first trimester, especially if you are nauseous in the morning.

Tip: Don’t neglect your daily brushing routines, rather try various ways to find something that works for you. Change your toothpaste brand and flavour to something bland or try a brush with a smaller head. Brush slowly to avoid triggering the gag reflex. If you can’t make a full two minutes, stop after one minute to rinse your mouth before continuing.

Pregnancy tumours

Pyogenic granuloma are red lumps that form on the gums, usually between teeth, and they bleed easily. Although they are called ‘tumours’, they are not cancerous. They may be caused by plaque build-up on the teeth. They usually resolve after the pregnancy, but in some cases they may need to be removed by your dentist.                              

Tips For Taking Care Of Teeth

• Even if you don’t have obvious signs of dental health problems, make an appointment to see your dentist, especially if you have not had a check-up in the last six months.
• Practice good daily dental hygiene. Brush your teeth twice per day (for two minutes at a time) using a fluoride toothpaste and soft bristle brush. After brushing, use an alcohol-free, fluoridated mouthwash (contains fluoride) to strengthen your teeth.
• Floss once per day to remove trapped food particles between the teeth.
• Eat a balanced diet. Add calcium-rich foods like dairy products (milk, cheese, yoghurt etc.), calcium-fortified foods (cereals and soya milk products) and nuts to your diet. Also include fruits, vegetables and proteins in your diet to ensure that you are getting a range of nutrients.
• When you increase your calcium intake, you should also increase your intake of vitamin D, as it helps the body absorb calcium more effectively. To increase your vitamin D intake, get a little sun everyday (use sunscreen so you don’t burn). Foods to include in your diet are fatty fish (like pilchards), eggs and vitamin D-fortified foods (cereals and cooked porridges).
• To ensure that you are getting the vitamins and minerals your baby needs, take a prenatal multivitamin. Ask your healthcare provider to prescribe a product on the Scheme’s vitamin formulary list. GEMS will pay for your maternity vitamins as part of your benefits.
• Eating snacks that contain high levels of sugar  can lead to cavities, so limit the amount of these foods you eat and avoid sugary drinks.
• If you aren’t able to brush your teeth after a meal, chew a piece of sugar-free dental gum to increase saliva and neutralise acid.
• If you still smoke, consider quitting. Periodontal disease is more common in women who smoke.

A dental check-up during pregnancy is just as important as your prenatal visits with your healthcare provider. A regular cleaning will keep your teeth and gums healthy. Keep in mind, that if you’ve experienced any dental problems during your pregnancy, you should see your dentist after your baby’s birth.

Contact your midwife for support, advice and counselling.

Resources:  https://www.parents.com/; https://www.canada.ca/;https://www.babycenter.com/; https://www.cdc.gov/; https://www.colgate.com/; https://www.betterhealth.vic.gov.au/; https://www.marchofdimes.org/; https://www.mouthhealthy.org/; https://www.healthline.com/; https://www.webmd.com/; https://www.nhs.uk/; https://www.dentalhealth.org/; https://www.mayoclinic.org/