Pregnancy and teeth: how to save? 5 questions for the dentist

What are the causes of the numerous problems with teeth and gums that expectant mothers suffer from? How can they maintain a healthy smile, and can they be treated by a dentist during pregnancy? We answer the most important questions about pregnancy and teeth.

Dentists at appointments often hear the same story from patients: “Doctor, my teeth started to fall out during (after) pregnancy.” Many women have the feeling that during intrauterine development the child “takes” calcium from the mother’s teeth, causing caries and gum disease.

In fact, this is a myth that has no scientific evidence. The calcium reserves necessary for the baby's development are not replenished by the mother's teeth. Why then do dental problems worsen during pregnancy?

What happens to teeth and gums during pregnancy?

Most often during this period, women complain of an exacerbation of diseases such as caries, gingivitis, and periodontitis. Each of them can lead to tooth loss if not treated promptly.

Toxicosis can also become a catalyst for carious processes. Nausea and vomiting, as well as changes in eating habits (large amounts of carbohydrates) cause disruption of the acid-base balance in the oral cavity, demineralization of teeth and the development of caries. If you do not sanitize the oral cavity before pregnancy, even minor carious lesions can turn into large lesions within nine months.

During pregnancy, hormonal levels (estrogen and progesterone levels) change and immunity decreases, which can lead to disruption of the gums' response to plaque formation. By leaving ordinary plaque unattended and untreated, you risk causing it to degenerate into tartar, which can damage the entire tooth.

Plaque also causes the development of gingivitis, an infection of the oral mucosa that causes swelling, redness, and bleeding of the gums. Due to altered hormonal levels, any inflammatory reaction in the body of the expectant mother is more violent, which is why the disease is otherwise called “hypertrophic gingivitis” or “gingivitis of pregnant women.” If it is not cured, it can develop into periodontitis, which means that gradual resorption or loss of bone tissue, suppuration of gum pockets and tooth mobility will be added to the listed symptoms.

However, it is still not worth linking a sharp deterioration in oral health with pregnancy. If you maintained proper oral hygiene before pregnancy, regularly attended preventive examinations and had professional cleanings every six months, then all of the problems listed above will most likely not affect you.

It’s another matter if you have never removed dental plaque and have not treated caries. Even if they practically didn’t bother you before pregnancy, during pregnancy the previously “acquired” problems will most likely worsen.

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Unfortunately, in our society there is a very widespread belief that pregnancy completely destroys teeth, and nothing can be done about it. Let's try to figure out why pregnant women are more likely than others to encounter problems in the oral cavity, and how to preserve their teeth during this period.

Features of dental care during pregnancy Surprisingly, oral care for pregnant women is not much different from that for ordinary patients. But it is important to understand what changes occur in the body of a pregnant woman, and what this can lead to in the absence of adequate care.

• First of all, these are serious hormonal changes. The hormones estrogen and progesterone, the amount of which varies significantly, have immunosuppressive properties (immune suppression), which increases the amount of plaque on the teeth and gums. The oral mucosa becomes easily vulnerable, bleeds at the slightest touch, and injury increases the risk of infection and inflammation. A change in the composition of the microflora towards more “aggressive” microorganisms is determined.
• The composition and quantity of saliva changes, which is directly related to the development of caries. The pH value of saliva shifts towards increasing acidity (from 6.7 to 6.2), and this reduces the protective function of saliva. The presence of hormones is also observed, which contribute to the growth of the number of microorganisms and, consequently, the formation of dental plaque.

There is a lack of calcium in the body of a pregnant woman, but to date there is not a single study that proves that it is washed out of dental tissues. True, in the presence of pathological processes in the oral cavity and the presence of somatic diseases, an increase in the need for calcium can have a significant negative effect on the body of the woman and the fetus. Observations show that increased tooth decay during pregnancy due to caries is associated with a significant deterioration in oral hygiene in most pregnant women. In the first trimester, when a woman’s malaise is most pronounced and often accompanied by toxicosis, a woman may even stop brushing her teeth or do it formally, constantly eating something during the day to relieve nausea. When the destruction of hard tissue reaches the neurovascular bundle inside the tooth, complications of caries such as pulpitis and periodontitis develop. Toxins that are produced during inflammation of the pulp or during the development of a focus of inflammation at the apex of the root are carried through the bloodstream throughout the body, which adversely affects the course of pregnancy and the development of the fetus. Another important point is that toothache is a psycho-traumatic factor, especially during pregnancy.

“The principles of oral care do not change during pregnancy, but these procedures must be performed with special care, taking into account the processes occurring in the body.”

Rules for dental care during pregnancy and caries prevention

1. Thorough brushing of teeth 2 times a day with sweeping movements. Use a medium-hard brush unless otherwise recommended. Mandatory use of dental floss (floss) to clean the interdental spaces 1-2 times a day after brushing. Using fluoride paste at a concentration of 1000-1500ppm. To improve oral hygiene, you can use an irrigator.
2. 5-6 meals a day, including snacks. Between meals, only drinking water can be in the mouth. Reduce carbohydrate intake.
3. If you are concerned about vomiting when brushing your teeth, you can use mouth rinses.
4. During pregnancy, regular preventive examinations are necessary so that the doctor can see the problem at an early stage and help solve it.
5. Preliminary sanitation of the oral cavity at the stage of pregnancy planning.

12GKSP Dentist Kovshirko A.V.

Can a mother’s “dental” diseases affect the baby’s health?

Sick teeth and inflamed gums are a source of infection for the entire body. From the carious cavity, microbes can penetrate through the root canal into the blood and even provoke disturbances in the functioning of internal organs (heart, kidneys, etc.).

In addition, recent studies suggest that premature birth and the birth of low-weight children may be associated, among other things, with gum disease - an infection in the mother’s body can adversely affect the child’s health. Therefore, preventive dental examinations are extremely important for the health of both the child and the mother.

Common oral problems during pregnancy

Recent studies have shown that premature birth and low birth weight babies may also be associated with gum disease. In addition, an infection in the mother’s body can negatively affect the child’s health, so oral health should be monitored quite closely.

Mostly during pregnancy, expectant mothers encounter caries, gingivitis, and periodontitis. They require treatment and observation by a specialist. During pregnancy, it is better to change your toothbrush and give preference to medium-hard bristles, so as not to injure sensitive gums. Brushing your teeth during pregnancy should be just as thorough—twice a day and for at least two minutes.

During pregnancy, it is not recommended to perform procedures such as implantation and prosthetics, resort to surgical treatment, or remove tartar. All these procedures involve the use of anesthesia, which may carry additional risks for the baby’s development.

For urgent indications, dental care is provided in any trimester. Therefore, if the expectant mother feels pain or malaise, do not neglect medical help and should consult a dentist. He may recommend taking a photo or undergoing additional examination.

When to visit the dentist and what procedures are allowed?

The best option is to solve all dental problems and have professional cleaning done in advance, before planning a pregnancy, in order to minimize possible risks. But if you have started the situation, and dental treatment during pregnancy cannot be avoided, then you should remember the precautions.

Thus, in the first and third trimesters, you should limit yourself to only urgently necessary procedures, be sure to consult with your gynecologist about anesthesia or taking medications. Based on these recommendations, your dentist should determine the need for hygienic teeth cleaning and therapeutic treatment in the first trimester.

The safest time for dental treatment is the second trimester (14 to 26 weeks). At this stage, all manipulations can be carried out - taking precautions, of course. However, if possible, it is better to avoid introducing pharmaceutical drugs into a woman's body.

During pregnancy, it is highly recommended not to undergo procedures such as implantation and prosthetics, resort to surgical treatment, or remove tartar. This is due to the use of anesthesia.

Women are allowed to treat caries during pregnancy and periodontal diseases, inflammatory processes in the gums and teeth, tooth extraction (non-surgical), and installation of braces (if there is no tooth mobility).

Why might an expectant mother refuse to cleanse?

In addition to medical contraindications, there may be a number of personal reasons why it is recommended to avoid in-office teeth cleaning during pregnancy.

The first factor is purely psychological, but it is also the most important. If a woman is nervous when visiting a dental clinic, then there is no need to carry out cleaning unless indicated (only according to indications). It is impossible to worry the expectant mother, much less make her very nervous and experience discomfort. There are cases when you cannot do without the help of a doctor - with gingivitis, which pregnant women often suffer from, acute pain, caries, etc. Professional cleaning can usually be delayed for several months.

The second important factor is also largely related to the psychological state. If teeth are highly sensitive, even men and women who are not expecting a child are often advised to avoid ultrasonic cleaning. It can make teeth even more sensitive, which will lead to additional stress for the expectant mother.

Is it possible to have x-rays and anesthesia during pregnancy?

Many experts, including those from the American Dental Association, note that if you can avoid X-rays during pregnancy, then it is better to play it safe and refuse this type of diagnosis. The same applies to anesthesia.

However, if x-rays and anesthesia are still necessary, you should resort to them in the second trimester, because in the first trimester, the formation of the baby’s vital organs occurs, and in the third, it is already physically difficult for a woman to perform any procedures. When choosing an anesthetic drug, your dentist should choose anesthetics with minimal amounts of epinephrine.

As for x-rays, the type of examination officially approved for pregnant women and nursing mothers is diagnostics using a dental computed tomograph. The radiation exposure in this case is minimal. In addition, the device gives the doctor the opportunity to accurately identify problems at the earliest stages of diseases, which helps to avoid diagnostic errors and complications.

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When can pregnant women have their teeth brushed?

As you know, during the first three months of pregnancy it is highly undesirable to carry out dental treatment, including dental cleaning procedures. At this time, the organs and systems of the fetus are laid and formed until the placenta is formed. The feeling of fear before visiting the dentist leads to the release of adrenaline by the female body, and this negatively affects the embryo.

The second half of the third trimester is also critical. The excitement experienced by a woman during this period or even minor external influences can tone the uterus, which threatens premature birth.

Ultrasonic teeth cleaning and other dental procedures in the second trimester are quite safe. It is during this period that a pregnant woman’s teeth and gums suffer greatly: from her body, the fetus takes the minerals it needs to form the skeletal system.

How to care for your teeth during pregnancy?

• Limit your consumption of carbohydrates and sweets - they provoke tooth decay.
• Replace sodas with water or low-fat milk and fruit juices with fruit.
• Brush your teeth with fluoride toothpaste and floss twice a day. Special pastes with sage, chamomile, and mint, which have an anti-inflammatory effect, are also effective.
• For frequent attacks of nausea and vomiting, chewing gum without sugar or with xylitol will help you, as well as rinsing your mouth with a soda solution after an attack (1 teaspoon of soda per glass of water). This will neutralize the negative effects of acids on enamel.

So, so that diseases of the teeth and gums do not overshadow the most important period in a woman’s life, you should prepare for it in advance - go to the dentist, get rid of caries and inflammatory gum diseases, and also regularly undergo professional hygienic cleaning.

Oral hygiene during pregnancy

The low level of knowledge of the rules of oral hygiene in young women prevents the timely elimination of foci of chronic inflammation, which leads to a high prevalence of complications during pregnancy. The following rules help preserve your dental health and the health of your unborn child:

• regular dental examinations at least three times during pregnancy (every trimester);
• professional hygiene;
• therapeutic sanitation of the oral cavity;
• correction of individual hygiene, including training in the correct technique of brushing teeth;
• selection of individual oral hygiene products [1].

Daily care rules:

1. It is recommended to brush your teeth with toothpaste and a toothbrush individually selected by your dentist.
2. Use dental floss to clean between teeth and along the gum line. This will remove plaque and reduce the risk of inflammation.
3. If it is not possible to brush your teeth due to toxicosis, use a mouth rinse, including after meals.
4. Brush your teeth properly 2 times a day for at least 2 minutes. Start from the upper jaw on the left, from the buccal surface of the teeth. Sweeping movements - from the gum to the cutting edge of the tooth.
5. Use a waterpik to effectively remove food debris.

Maintain your health by taking good oral care.

List of sources

1. Assessment of dental status and development of a complex of individual oral hygiene in pregnant women with diabetes mellitus. Dissertation for the academic degree of Candidate of Medical Sciences, A. A. Aleksandrov, Federal State Budgetary Educational Institution of Higher Education First St. Petersburg State Medical University named after. Academician I. P. Pavlova, 2022 // URL: https://vmeda.mil.ru/upload/site56/document_file/f2IsyYLUBd.pdf (access date: 08/07/2020).

2. The state of somatic and dental health in pregnant women, Ermukhanova G. T., Sharifkanova M. N., Oradova A. Sh., Ramankulova L. S., KazNMU, 2013 // URL: https://kaznmu.kz/ press/2013/05/28/somatic-and-dental condition/ (date of access: 08/07/2020).

3. Prescription of vitamins during pregnancy, Borisova E. O., General Medicine, 3.2010 // URL: https://cyberleninka.ru/article/n/naznachenie-vitaminov-vo-vremya-beremennosti/viewer (access date: 07.08 .2020).