When you're pregnant,
it seems everyone has advice for you — on 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 oral health.
In fact, some people still believe that the state of your gums and teeth
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These beliefs are out of date.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
cause many women to experience "pregnancy gingivitis" — 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.
Periodontal disease and tooth
decay (what dentists call "dental caries") are the two most
common diseases of the mouth. Having either one, or both, can affect your
pregnancy or the health of your baby.
Pregnant women with periodontal disease may be at a higher risk of problems
such as premature delivery or low birth weight babies. And women with current
tooth decay, or a history of extensive tooth decay, are at greater risk of
having children who get cavities before the age of 5.
Periodontal Disease and Pregnancy
About 12% of babies are born prematurely in the United States;
that's up from 10% in 1985. Women most at risk for giving birth prematurely
are those with a history of premature birth, those carrying multiple fetuses
(twins, triplets, etc.), and those 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 disease. The same was true of
women who had babies weighing less than 2,500 grams (about 5.5 pounds). Women
with severe periodontal disease were found to have seven times the risk of
giving birth prematurely, or having a baby with a low birth weight, as women
who had healthy gums.
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 — either severe or mild — are more likely than other women to give
birth early (before 37 weeks of pregnancy), to give birth to babies with a
low birth weight, or both. 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 associated with 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 crowns and 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.
However, the studies have shown that periodontal treatment given during the
second trimester of pregnancy is safe for both the mother and the unborn baby.
Periodontal disease also may contribute to preeclampsia. This is a poorly
understood and potentially dangerous condition that sharply increases blood
pressure. Preeclampsia affects about 5% of pregnant women. The only cure is
giving birth, which 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, or an infant putting his or her hand in your
mouth. Mothers with active tooth decay will have more decay-causing bacteria.
Therefore, their children are more likely to acquire them early in life, and
more likely to get tooth decay.
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.
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, but this
is another way to reduce the risk of tooth decay in your young children.
Before You Become Pregnant
If you are planning 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 and give you a chance to schedule dental visits
during your pregnancy.
Visiting the Dentist During Pregnancy
Many women steer clear of the dentist during pregnancy, believing that certain
practices might be harmful to 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.
Because of the hormonal
changes that occur during pregnancy, the chance of developing "pregnancy
gingivitis" and periodontal disease increases. This is because during
pregnancy the immune system may work differently than usual and alter the
way the body reacts to the bacteria that cause gum disease. Cleaning the
tooth surfaces often helps to relieve the symptoms of "pregnancy gingivitis" and
improves overall oral heath.
If scaling and root planing to treat periodontal disease is necessary during
pregnancy, the American Academy of Periodontology recommends scheduling it
early in the second trimester.
While no research has shown that treatment during pregnancy is dangerous,
dentists recommend scheduling non-urgent care for the second trimester or early
in the third trimester of pregnancy.
The second trimester is considered best because during the first trimester,
the fetus's organ systems are developing. Also, during the first trimester
the fetus is more likely to be affected by things that the expectant mother
is exposed to such as medications, 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 external influences, such
as whether the expectant mother becomes stressed or develops an infection.
These situations can lead to an increased risk of premature delivery.
In some women who are in their second and third trimester 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 experience an increase in heart rate and a light-headed feeling.
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 medications during pregnancy. In situations
where they are absolutely necessary, common dental medications can be used.
They should be used in the smallest amounts possible to achieve results.
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. He or she will cover you with a lead apron and will take the minimum
number of X-rays needed to provide diagnostic information.
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 should be used
with caution during pregnancy.
