Pregnancy, Oral Health and Your Baby

When you’re pregnant, it seems everyone has advice for you — on what to eat, how to prevent morning sickness, how to keep stretch marks at bay. It’s likely, however, that no one has ever told you how important it is to take care of your oral health.

In fact, some people still believe that the state of your gums and teeth will decline during pregnancy and that there’s nothing you can do about it. The saying goes something like, “You lose a tooth for every baby.”

These beliefs are out of date. It’s true that the hormonal changes of pregnancy cause many women to experience “pregnancy gingivitis” — swelling, bleeding or tenderness in the gums. But you aren’t doomed to have dental problems when you’re pregnant. Keeping your mouth healthy before and during your pregnancy will improve your chances of having a healthy pregnancy and a healthy baby.

Periodontal disease and tooth decay (what dentists call “dental caries”) are the two most common diseases of the mouth. Having either one, or both, can affect your pregnancy or the health of your baby.

Pregnant women with periodontal disease may be at a higher risk of problems such as premature delivery or low birth weight babies. And women with current tooth decay, or a history of extensive tooth decay, are at greater risk of having children who get cavities before the age of 5.

Periodontal Disease and Pregnancy
About 12% of babies are born prematurely in the United States; that’s up from 10% in 1985. Women most at risk for giving birth prematurely are those with a history of premature birth, those carrying multiple fetuses (twins, triplets, etc.), and those with certain abnormalities of the uterus or cervix. But the answers aren’t clear as to why many other infants are born too soon.

In 1996, a study found that women who gave birth before the 37th week of pregnancy tended to have advanced periodontal disease. The same was true of women who had babies weighing less than 2,500 grams (about 5.5 pounds). Women with severe periodontal disease were found to have seven times the risk of giving birth prematurely, or having a baby with a low birth weight, as women who had healthy gums.

The researchers calculated that advanced periodontal disease could be linked to about 18% of premature births in the United States.

Since then, several other studies have found that pregnant women with periodontal disease — either severe or mild — are more likely than other women to give birth early (before 37 weeks of pregnancy), to give birth to babies with a low birth weight, or both. However, other research has not found a link between periodontal disease and these birth outcomes.

Is it possible that periodontal disease can lead to premature births? Research is still teasing out the answers. However, it appears that the body’s attempt to fight the bacteria associated with periodontal disease may induce early labor.

Only a few studies have looked at what happens if pregnant women get treated for periodontal disease. A common treatment is scaling and root planing, which involves a thorough cleaning of the crowns and roots of the teeth. Some studies have found that this treatment can reduce the risk of preterm birth. Other studies have not shown such an effect.

However, the studies have shown that periodontal treatment given during the second trimester of pregnancy is safe for both the mother and the unborn baby.

Periodontal disease also may contribute to preeclampsia. This is a poorly understood and potentially dangerous condition that sharply increases blood pressure. Preeclampsia affects about 5% of pregnant women. The only cure is giving birth, which can put the baby at risk if delivery is premature. For the mother, complications can include stroke, kidney failure and hemorrhage.

So far, a few studies have linked preeclampsia with periodontal disease. More research is needed to discover whether there is a cause-effect relationship.

Dental Caries
Tooth decay is a bacterial infection. Infants aren’t born with the bacteria that cause decay. Most acquire these bacteria from their mothers before their third birthday.

Common ways to transmit these bacteria are kissing, sharing utensils, cleaning off a pacifier with your mouth, or an infant putting his or her hand in your mouth. Mothers with active tooth decay will have more decay-causing bacteria. Therefore, their children are more likely to acquire them early in life, and more likely to get tooth decay.

If you are pregnant and have cavities, you can reduce your child’s risk of developing early tooth decay by improving your own oral health. This can greatly reduce the number of cavity-causing bacteria in your mouth and reduce the chance that you will spread them to your child.

Here are some important steps you can take:

* See a dentist for treatment of all untreated cavities.
* Brush and floss daily.
* Use products, such as chewing gum and mints, that contain xylitol.

Research has shown that pregnant women and new mothers who use products that contain xylitol can reduce the number of decay-causing bacteria in their mouths. You need to use the products every day for months for them to work, but this is another way to reduce the risk of tooth decay in your young children.

Before You Become Pregnant
If you are planning to get pregnant, visit your dentist for an exam. This way, you can receive any necessary treatment before you become pregnant.

A dental visit before pregnancy will reduce your risk of having a dental emergency during pregnancy and give you a chance to schedule dental visits during your pregnancy.

Visiting the Dentist During Pregnancy
Many women steer clear of the dentist during pregnancy, believing that certain practices might be harmful to the fetus. But dental care during pregnancy is an important part of keeping you, and your baby, healthy. Having a healthy mouth during pregnancy may reduce the risk of delivering a premature or low birth weight baby.

Because of the hormonal changes that occur during pregnancy, the chance of developing “pregnancy gingivitis” and periodontal disease increases. This is because during pregnancy the immune system may work differently than usual and alter the way the body reacts to the bacteria that cause gum disease. Cleaning the tooth surfaces often helps to relieve the symptoms of “pregnancy gingivitis” and improves overall oral heath.

If scaling and root planing to treat periodontal disease is necessary during pregnancy, the American Academy of Periodontology recommends scheduling it early in the second trimester.

While no research has shown that treatment during pregnancy is dangerous, dentists recommend scheduling non-urgent care for the second trimester or early in the third trimester of pregnancy.

The second trimester is considered best because during the first trimester, the fetus’s organ systems are developing. Also, during the first trimester the fetus is more likely to be affected by things that the expectant mother is exposed to such as medications, chemicals, caffeine, alcohol and tobacco.

The third trimester presents other possible risks. In the last half of the third trimester, the uterus becomes sensitive to external influences, such as whether the expectant mother becomes stressed or develops an infection. These situations can lead to an increased risk of premature delivery.

In some women who are in their second and third trimester of pregnancy, the growing uterus will put pressure on a large blood vessel called the inferior vena cava. This can cause a decrease in blood circulation. This problem has been reported in as many as 8% of all pregnancies. Women with this condition can experience an increase in heart rate and a light-headed feeling.

A dentist who treats a woman with this condition should make sure that she can get in a comfortable position during the dental procedure. It’s also a good idea to limit the length of the visit.

Regardless of the trimester, urgent dental treatment should not wait. Examples of urgent dental problems include a broken tooth, an infection or another problem that causes pain.

It is best to avoid using any medications during pregnancy. In situations where they are absolutely necessary, common dental medications can be used. They should be used in the smallest amounts possible to achieve results.

X-rays should be avoided during pregnancy. However, if they are needed to treat a dental emergency your dentist will take steps to protect you and your baby. He or she will cover you with a lead apron and will take the minimum number of X-rays needed to provide diagnostic information.

If you are pregnant and have bleeding gums, swollen gums, gum pain or a toothache, visit your dentist so he or she can diagnose the problem. When you visit, be sure to tell your dentist that you are pregnant.

Local anesthetics and nitrous oxide sedation should be used with caution during pregnancy.

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