Dental Care During Pregnancy
With all the changes brought on by pregnancy, you may not be thinking about routine things like getting your teeth cleaned. But new research suggests that it is more important than ever to keep that date with your dental hygienist -- gum disease, perhaps surprisingly, may affect your pregnancy.
To keep your gums in good shape during pregnancy, have your teeth cleaned professionally every six months, brush at least twice a day and floss daily. If you develop any symptoms of dental problems, it's essential to see your dentist right away -- no matter which trimester you're in.
How does pregnancy affect your mouth?
During pregnancy, blood flow throughout your body increases by about 30 to 50 percent. One result of increased blood flow to your gums is that bacteria living at the gumline get plenty of nutrition, and even if you were free of gum disease before pregnancy, you may now notice your gums are swollen, tender and even bleed when you brush. The elevated levels of estrogen and progesterone in your system also contribute to gum inflammation and sensitivity. This condition is called pregnancy gingivitis, and about 50 percent of all pregnant women will develop it.
Another dental problem related to pregnancy is that some women develop growths on their gums called or pregnancy tumors, also known as pyogenic granulomas. These are noncancerous growths caused by inflammation -- an immune response to an irritant, in this case plaque. They usually disappear after childbirth.
How can oral health affect your baby?
Recent studies show that gum disease or gingivitis -- marked by red, swollen, or bleeding gums -- may actually damage your baby's health. In one study, researchers found that women with severe gum disease are up to seven times more likely to deliver significantly prematurely -- before 32 weeks -- than women with healthy gums. Another study looked at women with gingivitis and more severe gum disease and found a threefold increase in the risk of delivering before 37 weeks.
Overall, the current studies of gum disease during pregnancy show a risk level for prematurity comparable to that of heavy drinking (more than 10 drinks a week) and somewhat higher than most estimates for smoking. Premature babies can have a wide range of health problems immediately after birth and often have more long-term complications than full-term babies (born after 37 weeks).
In addition to delivering early, women with pregnancy gingivitis may also have smaller babies, whether they're born early or not. One study found that women with pregnancy gingivitis were more than three times as likely to deliver a low-birthweight baby. This estimate is comparable to the risk posed by smoking during pregnancy.
How can gingivitis lead to premature birth?
The current theory is that when you have gingivitis, the bacteria found in plaque can make its way into your bloodstream. Your body responds to infections or trauma by producing chemicals called prostaglandins, which are also a signal for labor to start. Your immune system produces prostaglandins, which can cause uterine contractions and send you into early labor.
What should I do if I am diagnosed with gum disease?
Besides brushing twice a day and flossing daily, you should have your teeth professionally cleaned once during your pregnancy. At your visit, be sure to tell the dentist or hygienist that you're pregnant, or you suspect you might be.
If you are diagnosed with gum disease, consider asking your dentist or hygienist about a process called scaling and root planing, a form of deep cleaning that is recommended when plaque pockets are larger than 3 millimeters. After scraping or scaling the plaque at and below the gumline, the base of the tooth is planed, or smoothed, so that it's harder for plaque to grow again.
In one study, women with gum disease who had their teeth cleaned by this method had a six times lower rate of preterm birth (before 35 weeks, in this case) than women who received only a professional cleaning.
The second trimester is a good time to schedule a routine visit to your dental professional, but if you're experiencing problems at any time during your pregnancy, see him or her right away. In general, try to avoid major dental treatments while pregnant -- especially during the first trimester, which is the most crucial time in the baby's development. (A recent clinical trial indicates that essential dental treatment, such as filling a cavity, is safe in weeks 13-21 of pregnancy.) If you have a history of miscarriage or are otherwise concerned, consider talking to your dentist about postponing your nonemergency dental work -- but don't wait too long for your routine cleaning.
What about x-rays?
The American Dental Association recommends avoiding routine or elective x-rays during pregnancy. If you absolutely require x-rays, make sure the dentist or technician gives you a leaded collar to protect your thyroid, in addition to the regular leaded apron to protect your abdomen.
Oral Health Topics: Pregnancy. American Dental Association.
Clinical Trial Supports Safety of Providing Dental Care to Pregnant Patients, American Dental Association news release, 2010.
Gaffield, M.L., Gilbert, B.J., Malvitz, D.M., Romaguera, R. Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system. Journal of the American Dental Association. Jul;132(7):1009-16.
American Dental Association FAQs: Pregnancy http://www.ada.org/2730.aspx
American Academy of Periodontology. Baby Steps to a Healthy Pregnancy and On-Time Delivery. http://www.perio.org/consumer/pregnancy.htm
Jeffcoat, M.K., Geurs, N.C., Reddy, M.S., Cliver, S.P., Goldenberg, R.L., Hauth, J.C. Periodontal infection and preterm birth: results of a prospective study. Journal of the American Dental Association. Jul;132(7):875-80.
Lopez, N.J., Smith, P.C., and Gutierrez, Journal of Dental Research, 81(1): 58-63, Higher Risk of Preterm Birth and Low Birth Weight in Women with Periodontal Disease http://jdr.iadrjournals.org/cgi/content/full/81/1/58
Kesmodel, U., Olsen, S.F., Secher, N.J. Does alcohol increase the risk of preterm delivery? Epidemiology. Sep;11(5):512-8.
Women and Smoking: A Report of the Surgeon General, 2001 http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.7251#7603
March of Dimes: Preterm Birth http://www.marchofdimes.com/professionals/14332_1157.asp
Academy of General Dentistry. Pregnancy and Gingivitis. http://www.agd.org/consumer/topics/pregnancy/pregnancy_gingivitis.asp
Jeffcoat, M.K., Hauth, J.C., Geurs, N.C., Reddy, M.S., Cliver, S.P., Hodgkins, P.M., Goldenberg, R.L. Journal of Periodontology, (Vol. 74, No. 8) Periodontal Disease and Preterm Birth: Results of a Pilot Intervention Study.
American Dental Association: Treating Periodontal Disease: Scaling and Root Planing http://www.ada.org/prof/resources/pubs/jada/patient/patient_23.pdf
American Pregnancy Association: Pregnancy and Dental Work. http://www.americanpregnancy.org/pregnancyhealth/dentalwork.html
JAMA dental radiography study bolsters ADA recommendations http://www.ada.org/prof/resources/pubs/adanews/
JADA, An Update on Radiographic Practices: Information and Recommendations http://www.ada.org/prof/resources/pubs/jada/reports/report_radiography.pdf
American Academy of Periodontology. Periodontal (Gum) Disease. http://www.ada.org/public/resources/glossary.asp#d
American Dental Association. Glossary of Dental Terms. http://www.ada.org/public/resources/glossary.asp#d
Sanchez, A.R., Kupp, L.I., Sheridan, P.J., Sanchez, D.R. "Maternal chronic infection as a risk factor in preterm low birth weight infants: the link with periodontal infection," Journal of the International Academy of Periodontology, Jul;6(3):89-94
Badlissi, D., Guillemette, A., Fadin, A. "Prematurity and low birth weight: effects of active and passive smoking during pregnancy," Can J Public Health. Jul-Aug;92(4):272-5.
Wisborg, K., Henriksen, T.B., Hedegaard, M., Secher, N.J.Smoking during pregnancy and preterm birth. British Journal of Obstetrics and Gynaecology Aug;103(8):800-5.
Cleveland Clinic. Dental Care During Pregnancy. http://www.clevelandclinic.org/health/health-info/docs/3200/3235.asp