Pregnancy, although it is not always a very comfortable process, is not an illness, and the expectant mother is not per se sick. However, it is a special situation and has some special implications, some of which relate to dental care.
It is important to bear in mind that when a pregnant mother has dental treatment performed for her, there is also a second (at least!) and very small, developing, and highly sensitive person sitting in the chair with her. The developing embryo (and later, fetus) must be considered. In addition, the process of pregnancy causes temporary changes in how the mother’s body works, and some of these changes affect the health of her mouth.
Another aspect of pregnancy is the heightened interest most expectant mothers will have in their own bodies and the health of the soon-to-be addition to the family. This is an excellent time to provide useful information regarding preventive care for both the mother and for the child who will soon follow.
Although an expectant mother is not exceptionally susceptible to infectious diseases, the fetus is, and so it may be prudent, in dental practices with a lot of child patients, to treat the mother at a time when there are less children present, to reduce the possibility of exposure to common infectious childhood diseases.
Fact and Fiction
A number of myths regarding pregnancy and dental health need to be dispelled. The concepts that:
1) You lose a tooth for every baby.
2) The baby takes away calcium from the teeth and bones
are not supported by evidence. In fact, these beliefs can be detrimental if they cause you to believe that there is going to be some damage regardless of what you do and prevent you from taking some simple but effective measures to keep your mouth healthy during pregnancy.
Because of various hormonal changes during pregnancy (increase in estrogen metabolism and increased production of prostaglandins), there is an exaggerated inflammatory response. The result is that a relatively small quantity of dental plaque (the soft bacterial debris which builds up on teeth), which ordinarily might result in very mild inflammation of the gums, may cause a more severe inflammatory reaction. The gums may be very tender and swollen. This may lead to inadequate hygiene because brushing close to the gums becomes uncomfortable. In turn, this leads to more debris and more severe inflammation. The condition may become so severe that it leads to what has been called, inaccurately, a pregnancy tumor. This is a growth of inflammatory tissue in the gums, which is really not a tumor at all. This may be removed quite simply.
Some pregnant mothers may have difficulty in the first trimester, because of nausea, in brushing their teeth. It is most important to persevere and clean the teeth very thoroughly in order to get rid of the inflammation. If toothpaste is a problem because of nausea, simply brush without it, using a wet toothbrush, possibly with a bit of salt or baking soda. In addition, it is a good idea to have your teeth cleaned more often, say every 3 months, during pregnancy to help keep your gums healthy. Massaging the gums with a rubber point (Butler or Oral B) is very helpful and simple to use, and the dentist or hygienist should be asked to provide instruction in technique.
If the teeth are allowed to remain dirty, decay will result. This may be further aggravated by two other factors:
1) because of pressure in the abdomen, the stomach cannot hold as much food, and so there is a tendency to eat smaller, and more frequent, meals. This results in more frequent periods of acid attack on the teeth. If this is the case, the teeth should also be cleaned more often during the day.
2) Vomiting because of morning sickness, covers the teeth with acid which can cause decay. After vomiting, do not brush the teeth right away . Because of the concentrated stomach acid in the mouth, the brush will actually remove microscopic amounts of tooth structure. First, neutralize the acid by thoroughly rinsing the mouth with lots of water, and even better, add a bit of baking soda to the water. Use a fluoride rinse afterwards.
It is useful for many purposes to divide the term of pregnancy into three trimesters:
1st trimester- during this period the organs of the child form. This is the time when the risk of defects resulting from various insults (exposure to certain drugs, severe stress to the mother resulting in massive release by her of certain hormones, etc.)is most significant.
2nd and 3rd trimesters- by this time the parts of the body have more or less formed, and what goes on is mostly growth.
3rd trimester- A significant change occurring as the mother and child progress from the 2nd to 3rd trimester is the change in size and weight of both of them. The heavy mass in the abdomen of the mother, when she lies on her back, presses on the large veins through which blood returns from her legs. As a result, lying in this position causes accumulation of blood in the legs. This can cause a drop in blood pressure and swelling in the legs. In addition to this, there is a tendency to shortness of breath because of the extra space taken up in the abdomen.
Based on the above-mentioned phenomena, we can examine dental treatment during pregnancy in relationship to: prevention, types of treatment, radiation, drugs commonly used in treatment, and timing of treatment.
Oral hygiene (cleaning the teeth at home every day) is very important and can prevent most problems. Effective tooth brushing means using a good technique. Ask your dentist or hygienist for hands-on instruction.
Brushing alone does not clean the teeth thoroughly- some means of cleaning between the teeth is essential. This is the area which has the most debris. There are a variety of implements available- floss, special brushes which go between the teeth, rubber tips for massaging, etc. The appropriate choice is based on the conditions existing in your mouth and will not be the same for everyone. A dentist or hygienist can look at your teeth and recommend which items are useful for you. Basically, everyone needs to brush.
Floss is effective when there are not large spaces between the teeth. When such spaces exist, a variety of brushes that look like little bottle brushes are effective. These are available from (but not only from): Oral B, Paro, Butler. Oral B has an excellent website with lots of useful information (www.oralb.com) . Rubber tips for massaging are excellent, also if you are not pregnant and are very effective at reducing bleeding in the gums. One of the best is Butler’s Stimulator. Place the tip into the triangular space between two teeth and the gums, and press a few times (with the side, not with the sharp end) against the gum. Do this at least twice a day, and even more often if you have time.
Have a professional cleaning done every three months while you are pregnant.
If you are planning to get pregnant, seriously consider one of the first steps to be getting basic dental treatment looked after as an initial step beforehand, in order to minimize the need for urgent treatment during the pregnancy.
Being pregnant is a wonderful excuse and opportunity to improve many health habits, including eating well- in terms of dental health, this means avoiding foods with a high content of simple sugars, and limiting them to mealtimes.
Routine dental treatment- fillings, root canal treatment, simple extractions if urgent, cleaning of the teeth, crowns- can all be done during the second trimester. However, if crowns are required in an area of the mouth which is highly visible, it may be advisable not to do them during pregnancy, because the gum line, which is of aesthetic significance, is not stable, and the result may be unattractive.
In general, treatment (other than minimal preventive treatment such as cleaning the teeth) which is not urgent (i.e. can be delayed without causing any harm or resulting in unnecessary discomfort), should be delayed until a few months after delivery.
X-rays: may be taken if necessary, but should be kept to a minimum, and restricted to specific areas that must be seen in order to deal with treatment that must be done during pregnancy and cannot wait. The dosage of radiation received in the area of the ovaries is only about 1:50000 of the dose received in the area of the face when dental x-rays are taken, and that is without taking into account the shielding effect of a lead apron (which should always be used in any case). Other means of reducing the amount of radiation are the use of high speed film, a high-voltage x-ray machine, and appropriate filtering of the radiation. With all of these safeguards:
1) There is no reason that a few x-rays taken after the 1st trimester would cause any damage to the fetus.
2) Although the risk is much less after the 1st trimester, in case of emergency treatment urgently required during the first trimester, a few x-rays can be safely taken even during this period provided that the above-mentioned precautions are taken.
In general, dental x-rays during pregnancy should be kept to a bare minimum and restricted to specific problems which need to be dealt with urgently. In case of such treatment, they may be taken with confidence if appropriate precautions are taken.
Almost all drugs given to a pregnant mother cross the placenta and reach the fetus. Therefore, medications should be kept to a minimum. More specifically:
Local anaesthetics commonly used in dentistry are safe, particularly from the 2nd trimester. Some types also contain a small amount of adrenaline. If adequate anaesthesia can be obtained without the use of adrenaline or other blood-vessel constricting additives, it is preferable to use an anaesthetic without them, but good effective pain control takes precedence, because the amount of adrenaline in the anaesthetic is small compared to the amount that the mother herself will produce in response to theanxiety of pain should the anaesthetic be ineffective.
Antibiotics: -should be taken only if necessary, definitely not without recommendation of a doctor or dentist.
Tetracycline, chloramphenicol, and streptomycin should not be taken during pregnancy.
If antibiotic treatment is required, it should be taken because it is less of a risk to the fetus than a fever resulting from an untreated acute infection, which may result in premature delivery or spontaneous abortion.
Narcotic-based painkillers (e.g. codeine) – theoretically not a problem for very short term use. Long term exposure can cause addiction in the fetus. In general it is best to use an effective non-narcotic painkiller, e.g. acetaminophen, to avoid this risk at all.
Tranquilizers should not be taken. Some have been definitely associated with severe birth defects.
Nitrous oxide (“laughing gas”) during pregnancy may cause abortion or defects, and so should not be used.
Fluoride (other than fluoridated toothpaste or rinses which should not in any case be swallowed) supplements should not be taken by pregnant women. Even if the local water supply is not fluoridated, the fetus can (and should) wait until after delivery to begin receiving supplements, and then only according to the specific recommendations of a dentist. The appropriate dosage is based on the amount of fluoride present in the water supply and the age of the child.
Appropriate Timing of Dental Treatment During Pregnancy:
1) Get your mouth in shape before you get pregnant if you have the option!
2) Professional cleaning of teeth every three months during pregnancy.
3) 1st trimester: only cleaning and emergency treatment.
4) 2nd trimester: cleaning and other simple treatment.
5) 3rd trimester: cleaning and simple treatment. Treatment which requires longer appointments is more comfortably done in the 2nd trimester.
6) “4th trimester” - Breastfeeding: in addition to all the good non-dental reasons, breastfed children have fewer and less complicated orthodontic problems. The activity of the muscles used by a nursing baby play a key role in development of the jawbones. Highly recommended!