Like we often say, pregnancy is accompanied by many changes in a pregnant woman’s body. The mouth and teeth are no different. Many mothers will have nausea, reflux and/or vomiting due to hormonal changes. This means that they will have more acidity in their mouth, which may damage the surface of their teeth, leading to an increased risk of cavities. Additionally, many women will have an increased appetite, will snack on things that may be sweeter. Together with an increased blood volume, this can promote pregnancy gingivitis and cavities.

There are many myths and realities circulating about dental care and pregnancy, and that is why I think it is essential to talk about it in this article. With the help of theoretical best practices guides and expert advice from a dentist, I hope to provide a scientific yet practical examination of oral hygiene during pregnancy.

First, it’s wrong to say that if a future mother doesn’t consume enough calcium during her pregnancy, her teeth will decalcify or fall out. If there is a deficiency, it’s the mother’s bones that will compensate for it. Which is not better. That is why it’s essential to eat foods with calcium every day. This helps forms the baby’s bones and teeth without having to rely on the mother’s structures to meet its needs.

There is also information circulating that talks about the danger of dental care during pregnancy and breastfeeding. In fact, there is no reason not to get dental care during pregnancy. However, your dentist may choose to use specific medications (local anesthesia, antibiotics) based on your situation. It’s a question of good judgement by your health professional dealing with your dental condition. A pregnant woman can get any dental treatment, even a root canal is necessary, and it’s an emergency. When the benefits are higher than the costs, it preferable to act.

There are no risks to fillings for a pregnant woman as long as:

• Routine x-rays are only used in emergency situations. The use of digital technologies and most dental offices makes x-rays even more safe for diagnostical purposes. Where possible, x-rays should not be used during the first trimester given the embryo’s rapid cell development and sensitivity to radiation. If the woman needs an emergency x-ray, a lead apron should cover her body to reduce the exposure to radiation.
• The filling used should not contain mercury because the metal will circulate in her body all the way to the baby. Even if low levels of exposure won’t harm the general population’s health (low dosage), Health Canada suggests using a composite (non-metallic filling) that doesn’t contain mercury. Additionally, Canadian environmental policies suggest reducing the use of mercury in all products to reduce overall exposure. In many countries around the world, products containing mercury are already banned. This includes Germany, Denmark and Sweden, to name just a few.

• Changing a filling during pregnancy is not necessary unless there is a specific problem identified.
• Local anesthesia used during a dental procedure is not a risk for the mother or baby. The dentist will make the appropriate choice of medication for both of you. The use of antibiotics may be necessary to treat an oral infection and is not dangerous for your pregnancy. Ideally, tooth repair should take place during the 2nd trimester. This is to avoid increased nausea (first trimester) and vagal response (laying on her back, drop in blood pressure during the last trimester). She may also have physical discomfort during the 3rd trimester, and stress should be avoided, which may trigger premature contractions.

Oral Hygiene During Pregnancy

Oral hygiene is essential throughout your pregnancy. Did you know that dental plaque is made up of bacteria that can be found in the blood, pass through the placenta and stimulate the release of prostaglandins, a hormone that provokes contractions? This is why daily mouth and teeth (and between the teeth) care is so important. It helps avoid dental plaque that can irritate your gums and prevent premature labour and a low birth-weight baby. 

Pregnancy gingivitis is a diagnosis made in more than 50% of future mothers between the 3rd and 9th month of gestation. The general population can be diagnosed with gingivitis. But pregnancy gingivitis is characterised by its particular and frequent occurrence during this period of life. Usually, everything goes back to normal after childbirth, but in severe cases, sores can cause permanent damage. Hormonal changes (estrogen and progesterone), more sensitive tissues, and increase blood volume mean that gums will be redder, brittler (bleed easily) and swollen. The presence of dental plaque (bacteria) causes gum inflammation, creating gingivitis. Eating sweeter foods and frequent snacking are aggravating factors. 

Here is some practical advice from our dental pro, Simon, which can improve your situation :

•   A balanced diet without a lot of sugar or carbohydrates, and take enough calcium, vitamins A, C and D, and proteins in circulation to strengthen your baby’s teeth and bones;
•   Brush your teeth after each meal with a soft toothbrush and use fluoride toothpaste;
•   Use dental floss every day to remove plaque between the teeth and on the gums;
•   Clean dental surfaces that aren’t visible;
•   If you are vomiting, rinse your mouth with water or gargle with a mix of water and baking soda to neutralise the acid in your mouth. Some fluoride mouthwashes can also help.
•   Plan a dental visit before 16 weeks of pregnancy for an oral evaluation, cleaning, and scaling to prevent future complications likely to occur during pregnancy. Then prepare a treatment plan for the 2nd trimester.
•   Contrary to popular belief, you do not need to take fluoride supplements during pregnancy as there are no added benefits. It should even be avoided. Regularly use fluoride toothpaste you can buy in a pharmacy.
•   Never use teeth whiteners during pregnancy and breastfeeding due to their contents, which should be avoided;
•   Delay orthodontic procedures or teeth implants unless already started.

After childbirth :

• A dental appointment should take place within 6 months after childbirth, especially if your dentist delayed treatments. This is to avoid complications, even if your insurance only covers an annual visit.
• In dental terms, breastfeeding will never be affected by treatments. The only thing that may occur is that the taste of a mother’s milk may change if a local anesthetic was used. Build up a milk reserve before the treatment and give it to the baby during the 24 hours following the dental procedure.