Dental Guide for Pregnant and Women of Childbearing Age

If you are pregnant, think you might be pregnancy, or are trying to get pregnant,  it is truly important to start taking good care of your teeth and your gums. Your oral health is an important part of your overall health, and good oral health habits will help prevent oral problems during pregnancy.  Pregnancy causes hormonal changes that make you more susceptible gum disease which in turn. Gum disease, in turn, can affect the health of your developing baby. That is why, now is a great time to take good care of yourself and get your baby’s life off to a healthy start.  In this article I will attempt to answer some of the most common questions about pregnancy and oral health.

Is it safe to get dental treatment during pregnancy?

American Pregnancy Association not only considers annual dental examinations and prophylactic cleanings during pregnancy safe, but recommends them.  Preventive dental work is essential to avoid oral infections such as gum disease which has been linked to preterm birth and low birth weight.

Your dental appointments should typically be made during the second trimester, after your baby’s vital organs have been formed. Although regular exams and cleanings are not harmful during the first trimesters, having your appointment during the second trimester can reduce any possible risks to your baby. Once you reach the third trimester, it may be difficult to lie in the dental chair for an extended period of time.  Be sure to tell your dentist and the dental team that you are pregnant so that they can take special precautions.

Sometimes during pregnancy you require more extensive dental work such as cavity fillings and crowns. It should be done to reduce the chance of infection which can affect the development of your baby. Again, if this dental work is done during pregnancy, the second trimester is ideal. The safest course of action is to postpone all unnecessary dental work until after the birth.

What should I do if I have dental infection during pregnancy?

 If you are experiencing a toothache, or if you notice blood or pus around your gum line, these might be signs of infection, which can be quite dangerous during pregnancy. Tooth or gum infections can spread throughout your body, increasing the risks of pregnancy complications, like miscarriage, premature birth, or low birth weight. To treat dental infections during pregnancy, sometimes more extensive emergency dental work such as a root canal or tooth extraction might be necessary.  Be sure to speak with your prenatal health care provider before you undergo any extensive dental treatments.
How about cosmetic dental treatment?

Elective treatments, such as teeth whitening, veneers, and other cosmetic procedures, should be postponed until after the birth. It is best to avoid exposing the developing baby to any risks, even if they are minimal.

Anything else I should know about dental visits during pregnancy?

When you see an oral health professional, make sure you let him know that you are pregnant. Also to make you dental visits less stressful for you and your baby:
-Bring headphones and listen to some favorite music
– Maintain healthy circulation by keeping your legs uncrossed while you sit in the dentistal chair
-Take a pillow with you to help keep you and the baby more comfortable

Is it true that calcium is lost from the mother’s teeth during pregnancy?

The calcium your baby needs is provided by your diet, not by your teeth. If dietary calcium is inadequate, however, your body will provide this mineral from stores in your bones. An adequate intake of foods rich in calcium, such as dairy products will help ensure that you get all the calcium you need during your pregnancy

If calcium is not lost from the teeth during pregnancy, then why did I get so many cavities after my previous pregnancy?
When you eat or drink foods containing sugars or starches, the bacteria in tooth plaque produce acids that attack tooth enamel (outer layer of the tooth). After many such attacks, the enamel can break down and a cavity forms. Increased caries incidence during pregnancy is brought about not as a result of calcium requirements for your growing baby but because of your diet changes (frequent snacks, chocolate, sweets and other cravings). Also, frequently oral hygiene worsens during pregnancy because you feel tired and nauseous. In addition, morning sickness with resulting vomiting increase acid attacks on teeth which speeds up formation of cavities.

There is a saying “Woman looses a tooth for each pregnancy.” Is it true?

   Increase in levels of pregnancy hormones (progesterone and estrogen) can lead to an exaggerated response to bacteria in dental plaque. This causes your gums to become swollen, red, and bleed easily. This exaggerated response to plaque is called “pregnancy gingivitis”.  “Pregnancy gingivitis” is especially common during the second and third trimesters of pregnancy.
 In a percentage of women this problem will lead to a more severe gum disease called periodontitis and tooth loss, unless professional care is taken. In most cases, this can easily be prevented by maintaining immaculate oral hygiene during pregnancy.

 Can I have dental anesthetic during pregnancy?

 Currently, there are conflicting studies about possible adverse effects on the developing baby from anesthetic used during dental work. Lidocaine is the most commonly used drug for dental work during pregnancy. U. S. Food and Drug Administration considers Lidocaine category B for pregnancy risk, which means that there is no evidence of human risk.  The amount of anesthesia administered should be as little as possible, but still enough to make you comfortable and reduce the amount of stress on you and the baby.

Can I have X-rays during pregnancy?

Routine x-rays should be postponed until after the birth.  Your baby’s organ development occurs during the first trimester, therefore it is best to avoid all potential risks such as dental X-rays, during this time. However, sometimes dental X-rays are necessary to perform some dental procedures, especially during emergencies such as infections which can pose a risk to your developing baby. 

Radiation from dental X-rays is extremely low and in the cases of dental emergencies the benefits of taking and X-ray significantly outweigh the radiation risks. According to the American College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus.  However, every precaution should be taken by your dentist to minimize radiation exposure. A leaded apron minimizes exposure to the abdomen and should be used when any dental radiograph is taken. A leaded thyroid collar can protect the thyroid gland from radiation, and should be used whenever possible. American Dental Association strongly recommends use of a leaded thyroid collar for all women of childbearing age, pregnant women and children.

Can I take any medications during pregnancy?

 Sometimes dental work requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled FDA pregnancy category B (No evidence of risk in humans) may be prescribed by your dentist.  Be sure to consult your prenatal care provider before taking these medications. Never take antibiotics without a prescription from your health care provider. If, for whatever reason, you have antibiotics leftover from a time when you were previously sick, do not take them unless your doctor tells you it is okay. The leftover antibiotics may not work for you current infection and can increase the chance that the bacteria will become resistant to antibiotics.

Is there any medication I can take for dental pain during pregnancy?

Though I recommend staying away from medications during pregnancy, sometimes you have to take medicine for dental or other pain. In this case, acetaminophen (Tylenol) will most likely be recommended by your healthcare provided. Acetaminophen is considered FDA pregnancy category B (No evidence of risk in humans). But remember that medications taken during pregnancy should be first cleared by your health care provider.

Aspirin and Ibuprofen ( Advil, Motrin) are not recommended during pregnancy.  U.S. Food and Drug Administration (FDA) considers Ibuprofen and Aspirin pregnancy category D in the third trimester. That means that there is significant evidence that taking it in the third trimester could harm your baby.
What are “pregnancy tumors”?
Occasionally overgrowths of gum tissue, called “pregnancy tumors,” appear on the gums during the second trimester. These localized growths or swellings are usually found between the teeth and are believed to be related to excess plaque. They bleed easily and are characterized by a red, raw-looking mulberry-like surface. They are often surgically removed after the baby is born. If you experience pregnancy tumors, see your dentist. To avoid “pregnancy tumors,” it is especially important to maintain good oral health during pregnancy. If you notice any changes in your mouth during pregnancy, see your dentist immediately.
What can I do to keep my mouth healthy during pregnancy?
•    Get you oral health under control before becoming pregnant
•    Brush your teeth at least twice daily with ADA accepted toothpaste. Switch toothpastes if you find that yours triggers nausea.
•    Clean between your teeth with floss once a day.
•    Avoid eating too many sugary foods.
•    Eat healthy foods, with lots of calcium and vitamin C. These nutrients help to maintain healthy gums and teeth.
•    Rinse your mouth out with warm water or an antibacterial mouthwash if you are suffering from vomiting and morning sickness.

Yaroslav Yarmolyuk DDS, MS, President of Orthodontic Experts
for “Bulgaria SEGA” newspaper