Drilling Down the Fears of Dental Care During Pregnancy

by Michele Brown

Going to the dentist is probably not at the top of your favorite's list, but if you are pregnant, don't think for a minute you can neglect those pearly whites that line your mouth and serve you so well each time you eat or smile.

It's understandable that teeth and gums may seem unimportant compared to all those other physical, and mental, changes taking over the body and mind of a pregnant woman. Even during a normal pregnancy, one can feel “possessed” and feel too busy dealing with all those other concerns to worry about proper dental care. That’s why so many pregnant women neglect even routine brushing and flossing...and end up with bigger oral problems down the road.

My blog for this week will describe some of the oral changes that occur during pregnancy, the importance of maintaining good oral hygiene and the guidelines of proper dental care during the nine month gestation period. I can not stress enough the importance of reading this information right through to the last paragraph. I promise you, no one ever regretted taking good care of their teeth and I will give you some well-researched advice and how, and when, to do this successfully.

What Oral Changes Occur During Pregnancy?

The hormonal changes of pregnancy, food cravings and acid regurgitation that commonly occur may make a pregnant mother more prone to poor oral hygiene leading to increased risk of gingivitis and severe periodontal disease with resulting damage to gums and other structures and, ultimately, loss of teeth. Of the highest concern to the pregnant woman is that poor oral hygiene may adversely effect the pregnancy. Therefore, it is imperative that we give this important area serious attention.

High levels of estrogen and progesterone produced by the placenta may effect the gingiva (gums), causing inflammation of the structure that holds the teeth in place causing increased tooth mobility. There is an increase in oral vascularization and a decrease in immune response which may also increase susceptibility to oral infections. The gums will become swollen, inflamed, reddened and bleed readily on tooth brushing or flossing, especially with poor oral hygiene and when plaque is present. Gingivitis occurs in 60–75% of all pregnant women. In addition, hormonal changes may cause excessive saliva production called ptyalism, or less commonly, a dry mouth called xerostomia.

Specific Dental Complications of Pregnancy

• Tooth decay occurs at an increased rate in pregnancy due to acid reflux and excessive vomiting in the first trimester, in combination with bacteria and carbohydrate cravings.
• Pregnancy granuloma, also known as pregnancy tumor, appears like a painless gingival growth rarely more than 2 cm in diameter, often near the end of the first trimester. It is an inflammatory reaction to dental plaque. It appears on the gingiva of the anterior teeth and may also involve the tongue, lips, palate and oral mucosa. It bleeds readily and may be nodular or ulcerated. It is found in up to 10% of pregnant women. Excessive bleeding requiring transfusion from these tumors has been reported. The tumor is generally purplish-red or deep blue in color and may require surgical excision if it causes discomfort or bleeds readily. Most often, it regresses postpartum.
• Gingivitis caused by plaque results in swollen, inflamed gums that bleed readily. It occurs in 60–75% of pregnant women and may range from mild asymptomatic cases to more severe cases with pain and bleeding. Changes are progressive, occurring in the second month and continuing to the eighth month.
• Periodontal disease effects up to 40% of all pregnant women. It is nine times more likely to be found in women with gestational diabetes.
• Preterm delivery, low birth weight and preeclampsia have been linked to periodontal disease (more on this in the next article -- stay tuned!). However, more studies need to be done to determine if this is only an association or if it is a true cause and effect relationship.

Important recommendations to Optimize Dental Health

Emphasizing proper nutrition. The following food recommendations should be followed: