Oral Health

September 20, 2011

This entry focuses on oral health during pregnancy. The imbalance of female sex hormones during pregnancy has been implicated in changes in the oral cavity. Many of the changes can be minimized or prevented with good oral hygiene and regular oral health care.

PREGNANCY GINGIVITIS

Gingival (gum) changes become noticeable from the second month of gestation and reach a maximum level in the eighth month. Hormonal changes may cause the gingiva to become inflamed and edematous (swollen). “Pregnancy gingivitis” is characterized by a tendency to bleed easily.

PREGNANCY TUMORS

Single, tumor-like growths may develop on the tissue between the teeth. The “pregnancy tumors” may grow rapidly reaching 2 cm during the second trimester of gestation. Most of these lesions regress spontaneously several months after the termination of pregnancy.

TOOTH MOBILITY

Tooth mobility may be related to the degree of gingival disease and disturbance of the attachment apparatus (tissue attaching teeth to bone). Mineral changes in the bone may also contribute to tooth mobility. Tooth mobility due to hormonal changes during pregnancy usually reverses after delivery.

TOOTH DECAY

Pregnancy does not directly contribute to tooth decay. However, the frequent vomiting associated with morning sickness can cause acid erosion of the teeth. Snacking on starches and sugar-rich foods between meals increases acid production in the mouth. It can damage tooth enamel. The pregnant woman should try to limit sugary and starchy foods to mealtime.

ORAL HYGIENE CARE DURING PREGNANCY

The most important objectives in planning dental treatment are establishing a healthy oral cavity and optimum oral hygiene practices. Conscientious oral hygiene care during office visits as well as at home can help control bacterial plaque formation. Gingival conditions occur most frequently among pregnant women whose oral hygiene is inadequate and promotes plaque buildup. The hormonal and vascular changes that accompany pregnancy often exaggerate the inflammatory response to plaque. The dentist is charged with monitoring the pregnant patient’s oral hygiene to obtain good plaque control throughout pregnancy. Scaling, polishing, and root planing visits may be scheduled more frequently than for nonpregnant patients. Pregnant women should brush after each meal with a fluoride-containing toothpaste and floss thoroughly daily. Research has shown that women who have lowbirthweight infants as a consequence of either preterm labor or premature rupture of membranes tend to have more severe periodontal (gum) disease than mothers with normal-birthweight babies. However, it remains unknown whether there is a causal relationship.

THE ROLE OF DIET

Diet plays an important role in the developing dentition of the fetus. Vitamins, minerals, and proteins are transferred through the mother’s blood to the fetus. Vitamin C maintains the structure of bone and teeth. Proteins build teeth and bones. Calcium builds and strengthens healthy bones and teeth. If the mother is receiving an insufficient supply of calcium, it will be extracted from the mother’s bones to meet the fetus’s needs. The mother could experience skeletal problems later as a result.

DENTAL CARE

Elective dental care is not advised during the first trimester or last half of the third trimester. Organogenesis (development of the organs of the fetus) takes place during the first trimester and therefore, the fetus is very sensitive to environmental influences. During the last half of the third trimester, the uterus is very sensitive to external stimuli. Dental care during this time involves the risk of premature delivery. Moreover, thirdtrimester pregnant patients should not be subjected to prolonged chair time in a supine or semireclining position. The safest period during which a pregnant woman can obtain dental care is the second trimester. The focus should be on simple and short procedures. Any proposed emergency treatment should be discussed with the patient’s physician first.

RADIOGRAPHS

Whether or not pregnant women should be exposed to dental radiographs (x-rays) is a controversial area. Exposure to radiographs should be minimized. Radiographs should only be taken when absolutely necessary and high-speed film should be used to minimize exposure. As with any patients, the pregnant woman should wear a protective lead apron with a thyroid collar.

POSTPARTUM TRANSMISSION OF MUTANS STREPTOCOCCI

Research has shown that dental caries is an infectious and transmissible disease. Studies have shown that babies can acquire mutans streptococci, bacteria most strongly associated with dental caries, from their mothers. Mothers with untreated dental caries possess reservoirs of mutans streptococci.

SEE ALSO: Pregnancy

Suggested Reading

  • Berkowitz, R. (2003). Acquisition and transmission of mutans streptococci. California Dental Association Journal, 31, 135—138.
  • Offenbacher, S., & Beck, J. (1999). Periodontitis: A potential risk factor for spontaneous preterm birth. Compendium of Continuing Education in Dentistry, Fall, 32—39.
  • Rose, L., & Kaye, D. (1983). Internal medicine for dentistry. St. Louis, MO: C.V. Mosby.

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