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Pregnancy, Oral Health and Your Baby

When you're pregnant, it seems everyone has advice for you. People tell you what to eat, how to prevent morning sickness, how to keep stretch marks at bay. It's likely, however, that no one has ever told you how important it is to take care of your teeth and gums.

In fact, some people still believe that the state of your mouth will decline during pregnancy and that there's nothing you can do about it. The saying goes something like, "You lose a tooth for every baby."

These beliefs are out of date. It's true that the hormonal changes of pregnancy can lead to "pregnancy gingivitis." This produces swelling, bleeding or tenderness in the gums.

But you aren't doomed to have dental problems when you're pregnant. Keeping your mouth healthy before and during your pregnancy will improve your chances of having a healthy pregnancy and a healthy baby. And if you have a healthy mouth, it's more likely that your baby will as well.

Periodontal disease and tooth decay (what dentists call "dental caries") are the two most common diseases of the mouth. They are both bacterial infections. Having either one, or both, can affect your pregnancy or the health of your baby.

Pregnant women with periodontal (gum) disease may be at a higher risk of problems such as early delivery or low birth weight babies. And the children of women with current tooth decay, or a lot of decay in the past, are more likely to get cavities before the age of 5.

Periodontal Disease and Pregnancy

About 12% of babies are born early (prematurely) in the United States. That's up from 10% in 1985. The number of premature births had been rising steadily for the last two decades, but declined slightly in 2007 and 2008.

Some women have a higher risk of giving birth early than others. They include:

  • Women with a history of premature birth
  • Women carrying more than one fetus (twins, triplets, etc.)
  • Women with certain abnormalities of the uterus or cervix.

But the answers aren't clear as to why many other infants are born too soon.

In 1996, a study found that women who gave birth before the 37th week of pregnancy tended to have advanced periodontal (gum) disease. The same was true of women who had babies weighing less than 2,500 grams. That's about 5.5 pounds.

Women with severe periodontal disease were found to have seven times the risk of giving birth early as women who had healthy gums. They also had seven times the risk of having a baby with a low birth weight.

The researchers calculated that advanced periodontal disease could be linked to about 18% of premature births in the United States.

Since then, several other studies have found that pregnant women with periodontal disease are more likely than other women to:

  • Give birth early (before 37 weeks of pregnancy)
  • Have babies with a low birth weight

The studies included women with both severe and mild periodontal disease. However, other research has not found a link between periodontal disease and these birth outcomes.

Is it possible that periodontal disease can lead to premature births? Research is still teasing out the answers. However, it appears that the body's attempt to fight the bacteria that cause periodontal disease may induce early labor.

Only a few studies have looked at what happens if pregnant women get treated for periodontal disease. A common treatment is scaling and root planing, which involves a thorough cleaning of the roots of the teeth. Some studies have found that this treatment can reduce the risk of preterm birth. Other studies have not shown such an effect.

The studies have shown that periodontal treatment given during the second trimester of pregnancy is safe for both the mother and the unborn baby. What may be most effective is treatment of periodontal disease before pregnancy.

Periodontal disease also may contribute to preeclampsia. This is a poorly understood condition that sharply increases blood pressure. Preeclampsia affects about 5% of pregnant women. It can be dangerous. The only cure is giving birth. This can put the baby at risk if delivery is premature. For the mother, complications can include stroke, kidney failure and hemorrhage.

So far, a few studies have linked preeclampsia with periodontal disease. More research is needed to discover whether there is a cause-effect relationship.

Dental Caries

Tooth decay is a bacterial infection. Infants aren't born with the bacteria that cause decay. Most acquire these bacteria from their mothers before their third birthday.

Common ways to transmit these bacteria are:

  • Kissing
  • Sharing utensils
  • Cleaning off a pacifier with your mouth
  • An infant putting his or her hand in your mouth

If you are pregnant and have cavities, you can reduce your child's risk of developing early tooth decay by improving your own oral health. This can greatly reduce the number of cavity-causing bacteria in your mouth and reduce the chance that you will spread them to your child.

Here are some important steps you can take:

  • See a dentist for treatment of all untreated cavities.
  • Brush and floss daily.
  • Use products, such as chewing gum and mints, that contain xylitol.

Mothers with active tooth decay will have more decay-causing bacteria. Therefore, their children are more likely to acquire them early in life. They are also more likely to get tooth decay.

Research has shown that pregnant women and new mothers who use products that contain xylitol can reduce the number of decay-causing bacteria in their mouths. You need to use the products every day for months for them to work. Xylitol-sweetened foods, candies and toothpaste can be found in health food stores and online stores.

Before You Become Pregnant

If you plan to get pregnant, visit your dentist for an exam. This way, you can receive any necessary treatment before you become pregnant.

A dental visit before pregnancy will reduce your risk of having a dental emergency during pregnancy. While you're in the office, you can schedule dental visits during your pregnancy.

Visiting the Dentist During Pregnancy

Many women steer clear of the dentist during pregnancy. They believe that certain aspects of treatment might harm the fetus. But dental care during pregnancy is an important part of keeping you, and your baby, healthy. Having a healthy mouth during pregnancy may reduce the risk of delivering a premature or low birth weight baby.

Hormonal changes that occur during pregnancy increase the chance of developing "pregnancy gingivitis" and periodontal disease. During pregnancy, the immune system is compromised. Therefore, it can't protect the body from the bacteria that cause gum disease. Cleaning the tooth surfaces often helps to relieve the symptoms of "pregnancy gingivitis" and improves overall oral health.

Sometimes periodontal treatment such as scaling and root planing is necessary during pregnancy. The American Academy of Periodontology recommends scheduling it early in the second trimester.

It is generally agreed that treatment during pregnancy is safe. However, dentists recommend scheduling non-urgent care for the second trimester or early in the third trimester of pregnancy.

The first trimester is not the preferred time for dental treatment. During this time, the fetus's organ systems are developing. Also, during the first trimester the fetus is more likely to be affected by the mother's exposure to medicines, chemicals, caffeine, alcohol and tobacco.

The third trimester presents other possible risks. In the last half of the third trimester, the uterus becomes sensitive to influences such as stress or an infection in the mother. These situations can lead to an increased risk of premature delivery.

In some women who are in their second and third trimesters of pregnancy, the growing uterus will put pressure on a large blood vessel called the inferior vena cava. This can cause a decrease in blood circulation. This problem has been reported in as many as 8% of all pregnancies. Women with this condition can have an increase in heart rate. They may feel light-headed.

A dentist who treats a woman with this condition should make sure that she can get in a comfortable position during the dental procedure. It's also a good idea to limit the length of the visit.

Regardless of the trimester, urgent dental treatment should not wait. Examples of urgent dental problems include a broken tooth, an infection or another problem that causes pain.

It is best to avoid using any medicines during pregnancy. In situations where they are absolutely necessary, common antibiotics and pain medicines can be used. They should be used in the smallest amounts possible to achieve results. Your dentist may consult with your obstetrician before prescribing antibiotics or pain medicine.

X-rays should be avoided during pregnancy. However, if they are needed to treat a dental emergency, your dentist will take steps to protect you and your baby. You will be covered with a lead apron. You will get only the minimum number of X-rays needed to help the dentist treat you.

If you are pregnant and have bleeding gums, swollen gums, gum pain or a toothache, visit your dentist so he or she can diagnose the problem. When you visit, be sure to tell your dentist that you are pregnant.

Local anesthetics and nitrous oxide sedation for required procedures may be used during pregnancy.

©2002-2013 Aetna, Inc. All rights reserved.

3/6/13

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