Oral Health and Hygiene in Pregnancy
Pregnancy can leave you more susceptible to dental diseases, but
with proper home care and early detection of problems by your
dental professional, postnatal problems will be minimal or
non-existent -both for you as well as your baby.
If you're pregnant or are considering becoming pregnant, it's
important not to overlook oral health care. For some women, due
to hormonal changes, pregnancy can increase their risks to
dental disease. Dental disease apart from worsening the oral
health condition, affects the growth and development of the
In general, because of the unique hormonal changes women
experience, they can have an increased sensitivity to oral
health problems. Gingival sensitivity and bleeding from oral
debris and plaque, occasional discomfort during oral hygiene,
tooth decay from dietary changes, periodontitis and oral malodor
can all be influenced by hormonal changes in adolescence, during
pregnancy, and menopause. Moreover, women are often "too busy"
to give themselves good oral health care. Childcare, homemaking,
careers, educational goals etc. keep women "too busy." Often
women delay dental care because they feel they can't afford it.
Oral disease symptoms you may experience are:
This can be noticeable as early as 1-2 months into the pregnancy
and is associated with a disease reaction caused by an increase
in your hormone levels (estrogen) combined with the bacterial
plaque or tartar present in your mouth. This often results in a
condition called pregnancy gingivitis, which manifests as
swollen, fiery red gums, which bleed while brushing or on
slightest application of pressure. Often diffuse pain over the
gums and teeth and bad-breath are found associated with the
condition. If the gum disease is left untreated, it can advance
to a condition called destructive periodontitis, which causes
permanent loss of the bone that holds your teeth in your mouth
diminishing your chance of keeping your teeth through out your
Moreover, recent studies have proved that women afflicted with
periodontal disease, are likely to deliver their babies
prematurely. This was concluded after a meticulous study of more
than 2,000 pregnant women. It was also found that periodontal
problems in the mother lead to low birthweight in
babies. The women in the study had no other major risk factors
for preterm birth, including genitourinary infections, tobacco
use, and alcohol consumption. In the United States where the
study was conducted, about 25 percent of preterm births occur
without any known risk factors.
Pregnant women also are at risk of developing inflammatory,
non-cancerous growths, which are initiated when swollen gums
become irritated (Pregnancy tumor). The growths will generally
shrink on their own over a period of time, although a dentist
may decide to remove the growths if they cause chewing, brushing
or other oral hygiene procedures to become uncomfortable.
Tooth Sensitivity & / or pain
There are several conditions that can result in tooth
sensitivity and pain, but for proper diagnosis and treatment, it
is always recommended to consult your dentist. The main causes
A. Dental Erosion
Dental Erosion is the wearing away of tooth surface caused by
acids or chemicals. Those women affected by morning sickness
(normally 8-12th. week of pregnancy) are most at risk to this
condition. Stomach acids which come into the mouth as a result
of vomiting or gastric reflux over an extended period of time
can permanently dissolve the protective enamel from the surfaces
of the teeth
leaving the tooth sensitive- often to hot/cold or sweet. If
pressure or mechanical action is used, the acid tends to eat
through the surface more rapidly. Thus erosion gets accelerated
if a toothbrush is used immediately after vomiting.
B. Dental Recession
Dental recession is a permanent change in the gum height around
the tooth that results in the exposure of the root surface of
the tooth. The roots of your teeth are not covered by protective
enamel and therefore can be sensitive to hot/cold/ sweet as well
as being more susceptible to dental decay. The most common
causes of this condition are improper toothbrush selection
and/or a brushing technique employed that does not adequately
remove thebacterial plaque at the gum margins. Again, when
pregnant, you are more susceptible to gum problems due to the
hormonal changes within your body leaving you more susceptible
to gum recession.
C. Dental Decay
As we all know dental decay can cause sensitivity in teeth and
requires definitive treatment if the tooth is to remain in the
mouth. This is why it is important to have your dentist diagnose
exactly what is creating your sensitivity. There is no direct
link between pregnancy and an increase in dental decay, but the
decay rate does increase for some women during pregnancy.
There are several contributing factors , relevant factors here
During the early stages of pregnancy, some women find it
difficult to brush their teeth because the toothbrush or the
toothpaste makes them gag. This makes cleaning of teeth
difficult, which in turn increases tendency towards dental
2. Dietary changes
Pregnancy can result in increased appetite and cravings.
Frequent snacking particularly if your food choice is high in
sugar content may result in a dramatic increase in you decay
Dental management during pregnancy
*It is ideal to consult a dentist if you're planning to become
pregnant or suspect you're pregnant. Your dentist will examine
you and map out a dental plan for the rest of your pregnancy.
*The fourth to sixth months of pregnancy generally is the ideal
time for any necessary non-emergency procedures. It's best to
postpone non-emergency procedures during the first trimester to
avoid anything that could affect the developing baby. The last
trimester is often avoided because it can be uncomfortable for
the patient to sit for extended periods.
*Obstetricians should always be consulted during any emergency
that requires anesthesia or medication. In general, aspirin and
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) should be
avoided. Only X-rays that are needed for emergencies should be
taken during pregnancy and any elective procedure that can be
postponed should be delayed until after the baby's birth. If
X-rays are essential, leaded aprons may be provided by the
dental office to be worn by the pregnant mother, to prevent
radiation exposure to the developing baby.
* Taking good care of yourself during pregnancy helps improve
not only your own health but also the health of your baby.
Remember that your baby's teeth and jaws begin to form at 5-6
weeks of pregnancy. Dental problems lead to improper food
intake, which in turn affects the nourishment of the baby. Gum
diseases are proven to cause pre-term births as well as
low-birth weights. Untreated dental disease will also eventually
cause a permanent loss of teeth.
* Daily brushing with a low-abrasive, fluoridated toothpaste
(morning and night or ideally after every meal) using a
soft-bristled brush, flossing in areas where the brush is unable
to reach, a healthy diet, drinking plenty of water and regular
dental visits will keep your teeth and gums healthy during and
after pregnancy. Limit intake of sugars, starches and other food
items, which promote dental decay. Preventive topical fluoride
application procedures may also have to be carried out by your
dental surgeon in cases where predilection towards dental decay
is found. Defective tooth-brushing techniques should be
identified and corrected. Routinely have the bacterial plaque
and tartar professionally removed from the teeth by your
*In case of morning sickness, do not brush your teeth for at
least 30 minutes after vomiting. Rinse with plain (tap) warm
water after vomiting. Immediate brushing after vomiting will
cause erosion of tooth surfaces.
*To prevent gagging, use of a small-headed toothbrush might
help. Alteration of the brushing timings (rinse in the morning
with water and brush at lunch time or morning tea and at night)
may also help prevent gagging. You may avoid using toothpaste if
it is found beneficial as long as the gagging lasts.
*A balanced diet should be had by the mother, which ensures good
health for the mother as well as the developing baby. You may
fix up your diet after discussing with your doctor. Your doctor
may advise prenatal vitamins and mineral supplements also.
* It's a myth that calcium is lost from the mother's teeth and
"one tooth is lost with every pregnancy."
Dr. Prasanth Pillai K.S., BDS,MDS-OMFS.
DRYMOUTH / XEROSTOMIA
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