Pregnancy has always been a life changing moment for women and is associated with physiological changes affecting almost all the systems especially the endocrine and cardiovascular systems. It affects nearly every aspect of a woman’s life, including her oral health and may put her in a position which can require a dental treatment. Although pregnancy is not a contraindication to most of dental treatments, it certainly modifies treatment planning as protection of fetus is the primary concern when administration of ionizing radiation or drugs is considered.
What dental problems can you face during pregnancy?
Women may face many complications (systemic/oral) during pregnancy, which usually get over after childbirth but may continue for a long time if they are not treated or taken care of during pregnancy. Rise in hormones may lead to changes in attitude, mood and tolerance levels. Therefore, pregnant women should take extra care during this period to avoid any circumstances that could possibly have an effect on their fetus, especially in the first and last trimester.
- Pregnancy Gingivitis: Most common condition where gums become sore and are more susceptible to bleeding.
- Pregnancy tumor (Pregnancy granuloma or Pyogenic Granuloma ): A local growth seen on gums.
- Tooth Erosion: Wearing off of tooth enamel due to severe morning sickness and frequent vomiting.
- Dry mouth: Although few pregnant women may also complain of excessive salivation.
- Dental Decay: Due to changes in saliva composition and their buffering effect, dental caries becomes common during pregnancy.
What should you do if you can’t brush your teeth while pregnant?
Brushing teeth while pregnant is a challenge when morning sickness hits. Putting anything in your mouth can make you feel nauseous or even cause your stomach to churn. Your taste buds change and you might drool more than ever even when you stick your toothbrush in your mouth. Thoughts of giving up on brushing could be ruling your mind. It is important to remember that you are more prone to decayed teeth during pregnancy, so brush when you can and visit your dentist regularly.
There are strategies one can try to combat sickness due to brushing rather totally eliminating the idea. To name a few:
- Try brushing when you don’t feel like vomiting
- Changing toothpaste or use less/no toothpaste
- Use brush with a small head
- Start with the teeth inside
- Face downward when you brush
- Use toothpaste tablets/floss/mouthwash
What protocol should your dentist follow during your pregnancy?
Preventive cleaning of teeth and regular dental examination during pregnancy is absolutely safe and highly recommended. Hormonal upsurge during pregnancy causes the gums to swell, entrap food and bleed causing increased irritation in the gums. Preventive dental procedures during pregnancy are essential to avoid oral infections such as gum diseases, which have also been linked to preterm birth.
Your dental surgeon is encouraged to:
- Assess tooth decay risk and manage as needed.
- Perform comprehensive gingival and periodontal examination.
- Complete the oral prophylaxis (cleaning of teeth).
- Strategize to decrease maternal caries causing bacterial load.
- Effective plaque control (Use of fluoride tooth pastes/mouth washes, dental floss, sugar free gums).
- Endodontic treatments (such as Root Canal Treatment) may be necessary in case of an infected/painful tooth with or without swelling to overcome the risks of infection to the mother or the baby. In case such treatments are deferred, risk of abscess/ unrelenting pain during the phase of pregnancy can be much more stressful to potentially impact the mother and child adversely in this critical juncture.
- Surgical treatments are normally considered in the mid- trimester but preferably should be avoided.
- Supine position must be avoided and short appointments are preferred to minimize discomfort to the mother and the baby.
- Elective treatments, such as teeth whitening and other cosmetic procedures, should be postponed until after the birth.
Should you let the dentist take an X-ray of your tooth during pregnancy?
X-rays used for diagnostic purposes have always posed an apprehension in patients’ minds. Concerns exist for safety of X-rays in pregnant patients. According to the American College of Radiology, no single diagnostic procedure results in a radiation dose significant enough to threaten the well-being of the developing embryo and fetus.
In addition, dental x-rays are directed to the mouth not the abdomen/pelvic region therefore further minimizing exposure towards the fetus.
However, use of aprons and thyroid shields for pregnant patients and dosimeters and work practice controls for pregnant operators is recommended by American Dental Association (ADA).
- It is best to avoid all potential risks during first trimester and use all protective measures to minimize the exposure, in case radiographs are essential.
- MRI (Magnetic Resonance Imaging) is best avoided during the first trimester.
Is Local Anaesthesia safe during pregnancy?
Pregnancy in itself is no reason to defer routine dental care and necessary dental treatments. Procedures under local anesthesia are safe during the second trimester but unnecessary drugs should be avoided. Nonetheless, the anesthetics administered are safe however the quantity should be kept in mind. In case the administered initial dose is insufficient, patient can request additional anesthesia enabling them to feel relaxed. Incurred pain during treatment stirs the stress and it could be much more damaging to both the mother and fetus than any added quantity of the anesthetic dose. Many women are unaware of being pregnant in the early part of the first trimester and therefore it is preferable for women of childbearing age to avoid taking any drugs, unless absolutely essential.
As reaffirmed by American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women “Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding) is safe during pregnancy.” Thus, this article serves as a concise resource to help out pregnant patients in understanding the importance of routine dental care during an important phase of their life and guide them to make appropriate decisions about their oral health care and cut down the likelihood of transmission of bacteria to their developing fetus.
By Dr. Mugdha Gulati Motani,
BDS, Associate Dental Surgeon,
Former Trainee, CDER, AIIMS,
Certified Aesthetic Dental Surgeon
Specialist at Dantah