Dental Work During Pregnancy

Taking care of your teeth and gums is ideal during pregnancy. When conception occurs, the body begins producing high levels of estrogen and progesterone (pregnancy hormones). These hormones, especially progesterone, can create dental problems for expectant mothers. For example, progesterone can cause your gums to swell and become spongy, allowing bacteria to grow easier between the teeth and gums (pregnancy gingivitis- see below). Some women experience noticeably swollen gums, while others do not have any oral health problems at all. In most cases, dental problems disappear after delivery of your baby.

Many women debate whether or not to receive dental care while they are pregnant in fear it may harm their baby. However, dentists recommend seeing your dentist on a regular basis while you are pregnant, because of issues that can arise from the hormone changes. If you are planning to get pregnant, you should take care of all major restorative procedures before conception. This way, you are starting your gestation cycle with a healthy mouth. Preventive dental work is critical when avoiding oral infections like periodontal disease (which has been linked to preterm birth).

Visiting the Dentist

The first thing you want to do is inform your dentist you are either pregnant or planning to become pregnant. This will allow him/her to prioritize the dental work you need done. While you are pregnant, there are several procedures and treatments that can be done, that do not harm your baby. The safest course of action is postponing all dental work until after childbirth, but some dental emergencies require treatment during pregnancy. Root canal therapy, dental fillings, crowns, and tooth extractions are typically procedures that can be done if needed while you are pregnant. However, your dentist may postpone certain dental procedures, especially if they involve the use or need of a large amount of local anesthesia.

There are several conflicting studies on the possible negative effects on the baby from the medication used for some dental procedures. Lidocaine (Category B) is typically the drug used for dental work, but it crosses the placenta once it’s administered. This is why the amount used, if needed, is minimal. Drugs labeled category B are an indicator that it is safe for pregnancy. Oftentimes dental work requires antibiotics like penicillin, amoxicillin and clindamycin to treat or prevent infections. All of these are category B drugs.

In most cases, elective procedures like teeth whitening are avoided altogether during pregnancy. Many people wonder about taking x-rays while they are pregnant. Most routine x-rays are postponed until after birth, but some dental x-rays are considered safe when a lead apron is used to cover the abdomen area. According to the American College of Radiology, not one diagnostic x-ray has been known to cause adverse effects in a developing baby.

Medical professionals believe that it’s best to avoid all risks during the first trimester since this is when fetal organ development occurs. If dental treatment is needed during the third trimester that is non-emergency related, it is typically postponed until after birth. Lying on your back for extended periods of time may be difficult during your third trimester and poses a risk of premature labor. The second trimester is the best time to receive dental work during pregnancy.

Pregnancy Gingivitis

Pregnancy gingivitis is a common form of gum disease among expectant mothers. It typically develops between the second and eighth month of gestation. Approximately half of all pregnant women develop pregnancy gingivitis due to fluctuating hormones. It can be uncomfortable and cause swollen, red, tender gums that bleed. It is recommended you visit your dentist regularly and use proper oral hygiene techniques, especially if you have been diagnosed with gingivitis. If left untreated or if pregnancy gingivitis gets out of control, it can develop into periodontal (gum) disease. Periodontal disease has been linked to premature labor and low birth weight babies. According to the American Dental Association, pregnant women with periodontal disease are seven times more likely to have a baby born too early and/or too small, and before 37 weeks pregnant. This is due to very high levels of prostaglandin found in severe cases of periodontal disease. Prostaglandin is a labor-inducing chemical found in oral bacteria.

Pregnant women who need treatment for periodontal disease receive treatments such as root planing and scaling. Both treatments are non-surgical and involve removing bacteria and other toxins located on the teeth (scaling), a tooth’s root or in a gingival pocket (root planing).

Pregnancy Tumors

Occasionally, pregnancy tumors develop in the form of a large lump with dark red pinpoint markings. They are found on the gum tissue, near the upper gum line (most cases). Although they are called ‘tumors,’ there is nothing cancerous about them. They do not spread and only occur in about 10% of women with pregnancy gingivitis. Pregnancy tumors can bleed and scab, which can affect your speech and eating habits. They occur at various times in pregnancy, but are most common during the second trimester. You may hear them by several names including pregnancy epulides, lobular capillary hemangioma, granuloma of pregnancy, and pyogenic granuloma.

In most cases, pregnancy tumors disappear after birth. If desired, dentists can remove them by performing a simple procedure and using a limited amount of local anesthesia. However, recurrence rates for removed tumors are 50%. You have the option of leaving the lump alone and eliminating the cause of it instead. For example, your dentist may remove built-up plaque if it’s the source. Many times, good oral hygiene can prevent pregnancy tumors from developing.

Dental Tips during Pregnancy

Here are some tips to help you maintain good oral health while you are pregnant:

• Brush and floss your teeth twice a day or after each meal with a fluoride toothpaste
• Use over-the-counter alcohol-free fluoride mouth rinse
• Rinse your mouth out with water or brush your teeth after episodes of morning sickness. If the toothpaste is causing the morning sickness, talk with your dentist about recommended brands
• Visit your dentist on a regular basis. Do not skip a dental appointment because you are pregnant. Hormonal changes can put you at an increased risk for disease
• Inform your doctor or midwife in the loop with your dental health and treatment
• Receive regular dental cleanings
• Postpone elective procedure until after birth
• While at the dentist, keep your legs uncrossed while sitting in the dentist’s chair to prevent poor circulation
• Eat a well-balanced diet
• Avoid sugary cravings if possible
• If you are nervous about seeing the dentist, bring a pillow or music with you to help you relax. If anesthesia is needed, it works faster and better when you are calm and comfortable
• Talk with your dentist about the risks and benefits involved with treatment you may need. Also talk with your dentist about symptoms to watch for
• Pay attention to changes that may occur to your teeth and gums