Oral health during pregnancy can greatly impact the mother and the fetus. While the physiological changes during pregnancy can certainly cause oral health issues, pre-existing oral health conditions can have an effect on the well-being of the mother and her unborn child.1
Dental practitioners can help their patients by educating them about the potential impact of pre-existing dental conditions, as well as diagnose and treat dental conditions that can develop with or during pregnancy.
Pre-Existing Disease
Several pre-existing conditions can negatively impact pregnancy. When examining oral health, studies support that pregnant women with pre-existing periodontal disease are at higher risk for compromised pregnancy outcomes including preterm birth, delivery of low-birth-weight babies, and development of pre-eclampsia.2
In fact, women with periodontitis have double the risk of pre-term birth.3 Complications of pre-term birth may include developmental delays, growth reduction, and hearing impairment.4 But why does periodontitis cause this to happen?
The gram-negative bacteria in the gingival biofilm leads to inflammatory markers in the bloodstream. These inflammatory markers cause an immune inflammatory response in the fetal-placental unit as well as suppression of local growth factors. This response can generate uterine contractions that may result in pre-term labor and/or babies with low birth weight.3,5
Oral Health Issues During Pregnancy
During pregnancy, the placenta produces higher levels of estrogen and progesterone. These hormonal changes may lead to increased gingivitis, gingival sensitivity to irritants, and pyogenic granulomas. This is partially due to progesterone increasing the vascular permeability.6
Pregnant and/or postpartum women also may neglect their own oral care to focus on the health and well-being of their baby.6 This leads to toxic plaque remaining on the teeth and gums long term. Not surprisingly, approximately 60% to 75% of pregnant women have gingivitis.1
In addition, the vomiting that may occur during pregnancy causes an acidic environment in the oral cavity. The acidity may lead to erosion and decay of the tooth structure.
Lastly, many women are hesitant to visit the dentist during pregnancy. This may be because there is a lack of perceived need, or they may mistakenly believe it is unsafe to visit the dentist during pregnancy.1
However, research supports that professional dental care during pregnancy is integral to improving oral health.6 Additionally, when appropriate pregnancy guidelines are followed, dental care is safe during pregnancy.1 If possible, a full oral examination is recommended prior to pregnancy to achieve optimum oral health and encourage proper oral care habits at home.6
Patient Communication
Dental professionals must effectively communicate the risks of pre-existing disease, such as periodontitis, to their patients who are pregnant or wish to become pregnant. Recommended conversation starters may include:
- The bacteria in your mouth impacts the rest of your body and can actually lead to pre-term labor. Let’s work together to treat your periodontal disease so you can have a healthier pregnancy and baby.
- I know you are planning to have children soon. Did you know that the bacteria that causes your periodontal disease can negatively impact your pregnancy? With proper treatment and home care, we can work together to manage your periodontal disease
For pregnancy gingivitis, dental professionals may say something like:
- During pregnancy, your hormones may cause your gums to be more susceptible to swelling and irritation. It’s really important that you keep plaque under control. Try by brushing with an oscillating-rotating toothbrush such as the Oral-B iO and an antimicrobial paste like Crest Gum Detoxify.
The patient and dental professional must work together to stop this cycle before it begins with diligent daily oral hygiene: brushing and interdental cleaning, getting regular oral health checkups, and properly treating periodontal disease early. Oral hygiene in pregnant women can be improved by amplifying their oral care routine at home with the proper oral care products.
The primary factor for gingivitis in pregnant women, toxic plaque, can likely be ameliorated by improved hygiene including the use of antimicrobial pastes such as Crest Gum Detoxify, antimicrobial rinse like Crest Pro-Health Multi-Protection Clean Mint, and optimal mechanical plaque control via an electric rechargeable toothbrush with a round head, like the Oral-B iO.
Moreover, pastes that include stannous fluoride such as Crest Gum Detoxify can prevent the erosion that may be caused by the acidic oral environment during pregnancy. Helping your patients to take good care of their mouth, teeth, and gums during pregnancy can help them to have a healthy pregnancy and a healthy baby.
References
- Hartnett E, Haber J, Krainovich-Miller B, Bella A, Vasilyeva A, Lange Kessler J. Oral Health in Pregnancy. J Obstet Gynecol Neonatal Nurs. 2016 Jul-Aug;45(4):565-73. doi: 10.1016/j.jogn.2016.04.005. Epub 2016 Jun 6. PMID: 27281467.
- Daalderop LD,Wieland BV, Tomsin K, Reyes L, Kramer BW, Vanterpool SF. Periodontal disease and pregnancy outcomes: Overview of systematic reviews. JDR Clinical & Translational Research 3:10-27.
- Manrique-Corredor EJ, Orozco-Beltran D, Lopez-Pineda A, Quesada JA, Gil-Guillen VF, Carratala-Munuera C. Maternal periodontitis and preterm birth: Systematic review and meta-analysis. Community Dent Oral Epidemiol 2019; 47:243-251.
- Ward RM, Beachy JC. Neonatal complications following preterm birth. BJOG. 2003 Apr;110 Suppl 20:8-16. doi: 10.1016/s1470-0328(03)00012-0. PMID: 12763105.
- Puertas A, Magan-Fernandez A, Blanc V, Revelles L, O’Valle F, Pozo E, León R, Mesa F. Association of periodontitis with preterm birth and low birth weight: a comprehensive review. J Matern Fetal Neonatal Med. 2018 Mar;31(5):597-602. doi: 10.1080/14767058.2017.1293023. Epub 2017 Feb 28. PMID: 28282773.
- Yenen Z, Ataçağ T. Oral care in pregnancy. J Turk Ger Gynecol Assoc. 2019;20(4):264-268. doi:10.4274/jtgga.galenos.2018.2018.0139
Ms. Jordan is a graduate of Westbrook College, UNE, dental hygiene, where she worked as adjunct clinical faculty for nearly 10 years and now serves on the advisory committee. She holds a master’s degree in organizational leadership and worked in private practice until 2001, when she became an employee of Procter & Gamble (Crest + Oral-B). She has held several positions for the company and currently holds the role of global professional & scientific relations. She has contributed to the Darby Walsh dental hygiene textbooks and has lectured locally to dental professionals, as well as students and faculty. She can be reached at jordan.ba.1@pg.com.
Dr. Gans graduated from the Ohio State University’s College of Dentistry in 2013 and completed a general practice residency at Saint Vincent Charity Hospital. She practiced dentistry in her hometown of Cleveland, Ohio, prior to joining Procter & Gamble in 2018. She is currently a P&G Professional and Scientific Relations Manager for Crest + Oral-B. Her goal is to teach dental professionals about the recent advances in paste and power brush technology to help improve oral health. In her free time, she enjoys spending time with her friends and family. She has five siblings including an identical twin who is also a dentist.
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