Dental Care During Pregnancy


Introduction







Pregnancy is a beginning of new stage in a women's life that brings about various physiological changes along with the oral cavity along with other physiological change. The importance of dental hygiene during pregnancy is often not stressed enough and ignored most of the times. Gingival hyperplasia, gingivitis, pyogenic granulomas and various salivary alterations are some of the changes commonly witnessed among pregnant women.


Besides, the infections that start in the mouth can easily spread to other parts of the body as pregnancy hormones can make gums more sensitive to dental plaque which eventually puts your baby’s health at risk. This will further result into increased risk of premature birth and low birth weight , pre-eclampsia, gingival tissue ulcerations, pregnancy granuloma, gingivitis, pregnancy tumors (epulis gravidarum), loose teeth, mouth dryness, and dental erosion. So, a healthy mouth during pregnancy is important for both mother and baby.



Data from the Australian Institute of Health and Welfare show that:

  • Dental care in Australia is largely provided in the private sector, with public dental patients generally being health care card holders and socioeconomically disadvantaged (AIHW 2010)

  • Adults living outside major cities are more likely to have poorer dental health, such as more tooth loss and untreated decay and less likely to have visited the dentist in the previous 12 months than those in major cities (AIHW 2009)

  • Aboriginal and Torres Strait Islander adults seeking dental care in Australia in 2004–06 had a greater average number of decayed and missing teeth and a lower average number of filled teeth than non-Indigenous adults across most age groups (AIHW 2008).

  • In Australia, the dental utilization rate among pregnant women appears to be even lower, ranging from 30% to 36%.13,14 Various factors have been cited that deter women from seeking dental care during pregnancy, such as socio-economic and





Common Dental Health Problems During Pregnancy



a. Gum problems - The hormonal changes during pregnancy can make your gums more prone to plaque, which can cause inflammation and bleeding of the gums. This is referred to as “pregnancy gingivitis”. If this is left untreated, it can result in periodontal disease pregnancy tumours. Pregnancy tumors are also called pyogenic granuloma and are not cancer. They’re lumps that form on the gums, usually between teeth and usually go away on their own after giving birth.


b. Vomiting - Vomiting, especially during the first months of pregnancy and if the teeth are not brushed sufficiently, an acidic environment or gastric juices will form in the mouth. more . In such cases, it is advisable to rinse your mouth with a spoon of baking soda mixed in a cup of water after you experience morning sickness, this will prevent the acid from attacking your teeth.


c. Cravings for sugary foods - Food cravings are among the most common symptoms of pregnancy and usually, the cravings include sugary,salty or acidic foods that can be very harmful to your teeth.


d. Gagging while brushing teeth - Some pregnant women find that brushing their teeth, particularly the back teeth, can cause gagging. However, it’s important to brush all of your teeth to avoid tooth decay.

Some tips to help prevent gagging include:

  • Use a toothbrush with a small soft head, such as a brush made for toddlers.

  • Take your time. Go slowly when you brush.

  • It may help to close your eyes and concentrate on your breathing.

  • Try listening to music.

  • If the taste of the toothpaste causes you to gag, switch to another brand. Or brush your teeth with water and then use a mouthwash containing fluoride. Go back to brushing with toothpaste containing fluoride as soon as you can.

e. Cavities (also called tooth decay or caries). These are small, damaged areas in the surface of your teeth. Being pregnant makes you more likely to have cavities. You can pass the bacteria that causes cavities to your baby during pregnancy and after birth. This can cause problems for your baby’s teeth later in life.


f. During pregnancy, there is an increased production of hormones like estrogen, progesterone and others. And such changes in hormone levels are thought to cause shifts in oral bacteria and change reaction of the body to infection, which often leads to development of gum inflammation also known as gingivitis. It is an inflammation (redness and swelling) of the gums. If untreated, it can lead to more serious gum disease. Excessive plaque build up can cause gingivitis, which can then progress to more serious dental issues. If you have gingivitis prior to becoming pregnant, gingivitis can worsen after becoming pregnant.


Signs and symptoms of gingivitis include:

  • Redness and swelling

  • Tenderness in the gums

  • Bleeding of the gums, even when you brush your teeth gently

  • Shiny gums

  • Loose teeth due to high levels of the hormones progesterone and estrogen during pregnancy can temporarily loosen the tissues and bones that keep your teeth in place.


g. Pregnancy tumors (also called pyogenic granuloma). These tumors are not cancer. They’re lumps that form on the gums, usually between teeth. Pregnancy tumors look red and raw, and they bleed easily. They can be caused by having too much plaque (a sticky film containing bacteria that forms on teeth). These tumors usually go away on their own after giving birth.



h. Eating more often during pregnancy is common, but frequent snacking and grazing puts teeth in constant contact with acid in food. This also leads to increased production of acid-loving bacteria, such as Streptococcus Mutans, which produce more acid to weaken enamel.






Factors Responsible For Deterioration Of Oral And Dental Health During Pregnancy.


During pregnancy every women often face uncomfortable health issues and are well treated on time. But when it comes to oral health the problems that every women may face while pregnant should not be overlooked as they could cause further issues later for you or your baby.


Lets walk through few factors responsible for deterioration of oral and dental health during pregnancy -


i. Neglecting oral health during the first months of pregnancy due to extreme interest in some foods, especially carbohydrates, and tooth brushing can be neglected after they eat these kinds of food.


ii. Pregnant women bleed more readily due to the effect of pregnancy hormones (estrogen, progesterone), and may consequently avoid brushing their teeth and this will eventually result into bacterial plaque inside mouth.


iii. Decrease in saliva flow decreases so high chances of formation of caries during this period.


iv. Mothers can neglect their own oral and dental health care while they are dealing with the health of the baby, which in turn causes a deterioration of oral health.


v. Occurrence of periodontal disease (also called periodontitis or gum disease) due to untreated gingivitis. This causes serious infection in the gums and problems with the bones that support the teeth.




General Signs And Symptoms Of Dental Problems During Pregnancy


  • Bad breath

  • Loose teeth

  • Mouth sores or lumps on the gums

  • New spaces between your teeth

  • Receding gums (when your gums pull away from your teeth so you can see roots of your teeth) or pus along your gumline (where your gums meet your teeth)

  • Gums that are red, swollen, tender or shiny; gums that bleed easily

  • Toothache or other pain

  • If you have pain or swelling, call your dentist right away. If you have an infection, you need quick treatment to help prevent problems for your baby.



Prevention


With respect to anybody’s oral health, prevention is always better than a cure when it comes to looking after your mouth especially when you are pregnant. However, you’re less likely to have dental problems during pregnancy if you look after your teeth and gums before you are pregnant. You can do this by:

  • Brushing your teeth at least twice a day with fluoride toothpaste.

  • Flossing between your teeth once a day.

  • Eating a healthy diet and limiting food and drinks high in added sugar.

  • Avoiding tobacco products and alcohol

  • Visiting your dentist every 6 to 12 months.


Furthermore, it is vital that pregnant women do not ignore any early signs of gum disease and get checked out by a dental professional straight away as changing hormonal levels during pregnancy will react differently on your body due to bacteria on your teeth (plaque). This can lead to swollen and bleeding gums and even to the more serious forms of gum disease such as periodontitis and pregnancy gingivitis.


Besides, treating gum disease is very essential and it involves treatment in which dental health professional performs a deep clean under the gums to remove all the bacteria. Moreover the only risk associated with this is slight soreness of the gums which you would face even if you were not pregnant.


However, one of the easiest changes you can make to look after your oral health, and overall health, is your diet by switching to fresh fruit and vegetables and eventually cutting

down sugar intake such as candy and cookies, and avoid drinks high in sugar like fruit juice or soda and drink plenty of water, especially between meals and snacks


Healthy foods helps give women and her growing baby important nutrients as baby’s teeth start developing between 3 and 6 months of pregnancy as nutrients like calcium, protein, phosphorus, and vitamins A, C and D, help baby’s teeth grow healthy.


Finally, its also essential to visit dentist regularly every 6 months (twice a year), even during pregnancy. At your checkup, keep your dentist well informed about your pregnancy. Your dentist will usually wait until you've had the baby. Also, you should always speak to your doctor before taking any new medication while pregnant to make sure it is safe to use. However, it is generally safe for you to use common painkillers such as paracetamol and antibiotics when you are pregnant. .





Amazing tips for a healthy mouth during pregnancy


  • Talk with your dentist as soon as you know you’re pregnant to help you plan for dental care throughout your pregnancy.

  • Get your teeth cleaned as dental cleanings are safe during pregnancy and help keep your teeth and gums healthy.

  • Brush at least twice a day with a fluoride toothpaste and clean between your teeth with floss every day.

  • Dental X-rays may be safe during pregnancy, but talk with your dentist about postponing them until your baby is born. Moreover if x-ray is a part of urgent treatment, your dentist will take extra steps to protect you and your baby.

  • Schedule treatments that require anesthesia, like fillings, crowns or root canals, in the second trimester as it will be safer for your baby as these treatments during third trimester is uncomfortable as its difficult for pregnant lady to lie on her back.

  • Postpone teeth whitening and other cosmetic treatments till your baby is born.

  • Protect your teeth from morning sickness by rinsing mouth with a teaspoon of baking soda mixed with water to keep stomach acids from attacking your teeth.

  • Choose healthy foods like vegetables, yogurt or cheese and try to resist the urge to snack too often as frequent snacking can lead to tooth decay caused by plaque, a sticky film that forms on teeth.

Pregnant women should be encouraged to follow three basic tips daily -

  • Brush their teeth at least twice a day

  • Floss daily

  • Use an antibacterial mouthwash

Bottom line - These above prevention tip will help to remove plaque from around the teeth and gums on a regular basis so that it is difficult for a bacterial infection to take hold. Additionally, regular check-ups throughout pregnancy are important to monitor the health of the teeth and gums.

Thus, it’s vitally important to stay on top of your oral health when you are pregnant to avoid any potential problems.



Frequently Asked Questions


1. Are dental X-rays safe during pregnancy?


Yes it is safe. It is a part of regular dental care and can show problems with your teeth, gums and the bones around your mouth.

Moreover it is safe during pregnancy. They use very small amounts of radiation, and your dentist covers you with a special apron and collar to protect women and your baby. But if your dentist wants to give you an x-ray, make sure he/she knows that you’re pregnant or trying to get pregnant.



2. How are dental problems treated during pregnancy?


If you have a dental problem that needs treatment, make sure your dentist knows that you’re pregnant but if its elective treatment then try to schedule it in the second trimester. Sometimes dentist recommends to postpone treatment till baby’s birth.


However, treatments that are safe during pregnancy include:

  • Medicine, like pain relievers and antibiotics to treat infections.

  • Local anesthesia as it lessens or prevents pain and used in a specific part of the body, like to numb your mouth for a dental filling or to have a tooth pulled.



3. Do I Need to Change My Daily Habits?


If you’re already brushing twice a day with a fluoride toothpaste and cleaning between your teeth once a day, keep up the good work! This habit during pregnancy is must to prevent premature delivery, intrauterine growth restriction, gestational diabetes and preeclampsia.



4. Why Are My Gums Bleeding?


Women develop pregnancy gingivitis, a mild form of gum disease between the second and eighth months of pregnancy. The main reason behind such gum disease is hormonal changes in the women which makes gums more easily irritated by plaque and can cause gums to be red, tender, sore and bleed. However, brushing teeth twice a day for two minutes will surely prevent gums bleeding.



5. Do You Lose a Tooth with Each Baby?


Losing a tooth is not a normal part of pregnancy, and if you do, you most likely already had an existing dental problem. However according to the Mayo Clinic, progesterone and estrogen can loosen the ligaments and bones that keep your teeth in place, even if you don’t have gum disease.



6. I'm Struggling with morning sickness. What Should I Do?


Unfortunately, morning sickness can hit any time of the day . And this sickness is associated with vomiting which covers teeth with strong stomach acids. These repeated reflux and vomiting can damage the surface of the tooth (the enamel) and increase the risk of decay.


Try below tips if you’re experiencing vomiting:

  • Avoid brushing your teeth immediately after vomiting as the teeth are covered in stomach acids, the actions of brushing may scratch the tooth enamel.

  • Rinse your mouth thoroughly with plain tap water.

  • Follow up with a mouthwash containing fluoride.

  • If you don't have a fluoridated mouthwash, put a blob of toothpaste containing fluoride on your finger and smear it over your teeth. Rinse thoroughly with water.

  • Wait for an hour after vomiting before you brush.



7. Can I whiten my teeth while pregnant?


Teeth whitening can be performed while you're pregnant, but your dentist may recommend waiting until after the birth for most non-emergency dental treatments.

However, teeth whitening and other cosmetic treatments should ideally be avoided during the third trimester. Ensure if you're using a home teeth whitening kit you check the concentration of hydrogen peroxide is no more than six percent as higher concentrations can potentially cause tissue damage unless applied by a professional.


8. Is dental anesthesia safe when you’re expecting?

As per the American Pregnancy Association it is important to strike a balance between making the mother comfortable and using as little anesthesia as possible. Moreover if you are comfortable, then your baby will be comfortable. And if you experience pain and stress, then your baby will as well. So tell your dentist so he or she can help you get comfortable.



9. Does a root canal affect pregnancy?


Root canal treatment can stop the pain by removing the infected tissue and restoring the tooth with a natural-looking crown. So, if you have a dental emergency, a root canal can be performed at any stage of pregnancy. However, the ideal time for dental surgery is during the second trimester.



10. How do I brush my teeth? How long should I brush?


You should brush your teeth for two minutes, twice a day with fluoride toothpaste. Choose a soft-bristled brush that fits your mouth and place the toothbrush at a 45-degree angle to the gums. Gently move the brush back and forth in short, tooth-wide strokes. Brush your tongue to remove bacteria and keep your breath fresh.





11. How can I keep my teeth and gums healthy while I’m pregnant?


Eat a wide variety of foods like vegetables, fruit, wholegrain cereals, pasta and bread, lean meats and chicken, fish, eggs, tofu, nuts and seeds, Milk, yoghurt and cheese.



12. Does the fetus take calcium from its mother’s teeth?


This is what many would refer to as “myth.” As mentioned before, during pregnancy many women experience hormonal gingivitis (inflammation and swelling of the gums), which causes the calcium loss in the teeth. The swollen gums collect bacteria which have acidic byproducts. This acid slowly burns the enamel and removes calcium in the process and ultimately can cause tooth decay. So the fetus is not drawing calcium from the teeth. The presence of acid is the cause.


13. How does what I eat affect my baby’s teeth?


Your baby’s teeth develop during the third and sixth months of pregnancy. Eating well before, during and after this period will help your baby’s teeth form correctly. So, it is important that you eat foods that include vitamins, A, C, and D, protein, calcium and phosphorous. Always talk to your health care practitioner about ways you could enrich your diet

14. How to cope up with food cravings during pregnancy?

Some women have unusual food cravings while pregnant. If you have cravings for sugary snacks, it’s best to avoid them as it may increase your risk of tooth decay. Try to snack on foods low in added sugar instead..


15. What is periodontal disease?


Periodontal disease is an infection in the mouth caused by bacteria. The bacteria use the sugar you eat to make acid. That acid can destroy the enamel (protective) coating on your teeth, which can cause tooth decay (cavities) or even tooth loss. Your dentist can treat periodontal disease even when you are pregnant.



16. Why are pregnant women more at risk for periodontal disease?


There are 2 major reasons women can have dental problems during pregnancy:

  • Pregnancy gingivitis—During pregnancy, changes in hormone levels allow bacteria to grow in the mouth and gums more easily.


  • Nausea and vomiting—Pregnant women may have nausea and vomiting or “morning sickness,” especially in the first trimester. The stomach acids from vomiting can also break down the enamel coating of the teeth.




Conclusion


Dental care doesn't stop just because you're pregnant. Regular dental care is a key component to good oral and general health. During pregnancy, oral and dental care requires special attention as it concerns both the mother and the fetus. Besides, improved oral health of the woman also decreases transmission of potentially cariogenic bacteria to infants and reduce children’s future risk of caries. i


Besides, you should also disregard myths about calcium leaching from your teeth to the baby, the loss of a tooth for every baby you have, and fluorides treatments being bad for your baby. None of these are true and your dentist should be an active part of your healthcare team in the lead-up, during and after your pregnancy.


It should also be kept in mind that neglecting oral and dental health during pregnancy does not only cause problems such as tooth decay and tooth loss, but may also lead to problems such as premature birth, low birth weight infant, and pre-eclampsia. In this period, mothers can protect their oral health by taking above necessary precautions and then they can prevent dental problems that may be irreversible.


Hence, taking good care of your mouth, teeth and gums during pregnancy can help you have a healthy pregnancy and a healthy baby.




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