When Hamidah Shivji was pregnant with her daughter, a growing belly wasn’t the only change happening to her body. “My gums were more inflamed and tender feeling than normal, and I had more bleeding when I brushed my teeth,” says the Calgary mom. And because brushing provoked her gag reflex, making her persistent nausea worse, Shivji wasn’t able to keep her teeth as clean as she would have liked. So she scheduled more frequent cleanings with her dental hygienist.
“Dental health is an issue during pregnancy,” says Euan Swan, manager of dental programs for the Canadian Dental Association. “Women can have swings in their appetite that result in snacking on sugary foods, so they can be at higher risk of tooth decay. And with changing hormone levels, they can experience a mild inflammation of their gum tissue.”
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Shivji’s inflamed gums were due to a mild case of pregnancy gingivitis, a condition that affects at least 30 percent of pregnant women (and some experts believe it affects them all). Pregnancy gingivitis is characterized by gum swelling, bleeding and tenderness that’s caused by increased levels of the pregnancy hormones estrogen and progesterone, which make gum tissue more prone to irritation and inflammation.
It can be managed at home with regular brushing and flossing. Swan recommends brushing twice a day with a soft-bristle toothbrush or a powered brush, and flossing at least once a day. If there is persistent bleeding, it might be a good idea to schedule more frequent dental cleanings, he says. Pregnancy gingivitis usually resolves within a few months after childbirth, as it did for Shivji, as long as your gums were healthy prior to getting pregnant.
Another pregnancy side effect that can lead to oral health problems for women is morning sickness. Vomiting increases acid reflux into the mouth, which, if not rinsed away thoroughly, can lead to tooth erosion, says Swan. Pregnant women can drink fluoridated tap water to help keep tooth decay at bay. In rural areas or cities without fluoridated water, such as Calgary, moms-to-be can use a fluoride mouth rinse to reduce the bacteria in their mouth.
Cravings can also kick in and lead to food choices that increase the risk of tooth decay. “Watch the snacking on sugary foods or drinks,” says Swan. He emphasizes the importance of maintaining a good dental health routine during pregnancy.
Some pregnant women develop what are called “pyogenic granulomas” on the gum line between their teeth. “They’re essentially growths in the mouth that occur when inflammation of the gum tissue becomes so severe that the gum overgrows into little lesions or balls,” says Calgary periodontist Tara Habijanac. These shiny, red lumps may also be quite tender and sometimes bleed. Pyogenic granulomas can go down in size after childbirth, but may require a minor surgical operation to remove, says Habijanac. Women who experience persistent bleeding with brushing or flossing, or develop a lump or growth in their mouths, should make an appointment to see a dentist.
If gingivitis is left untreated, it may develop into periodontitis, or full-blown gum disease. Periodontitis occurs when gum inflammation and plaque build-up on teeth at the gum line becomes so advanced, it compromises bone support and gum tissue attachment around the teeth, which can lead to tooth loss.
Periodontitis is bad news for most people, but caries an extra risk for pregnant women. “Many studies show an increased incidence of preterm, low-birth-weight babies in pregnant women with severe periodontitis,” says Habijanac, noting it’s an association, as opposed to proven cause and effect (so just because a woman has periodontitis doesn’t mean she’ll go into labour before 37 weeks, or give birth to a baby weighing less than 2,500 grams). “The most recent study, from five years ago, suggests that if we treat the mom’s gum disease—before these babies are born—with periodontal therapy, then we can reduce this effect,” says Habijanac.
Are dental procedures safe during pregnancy?
Experts say that many pregnant women don’t experience any dental health hiccups when they’re expecting, but stress that a woman’s chances of getting through pregnancy with healthy teeth and gums increases if she visits a dentist prior to becoming pregnant, so regular dental check-ups and teeth cleanings are both safe and recommended. Dental X-rays should be avoided, but can be done safely if they’re needed for a diagnosis, says Swan.
If a pregnant woman develops a tooth abscess or needs an emergency root canal, it should be treated, but elective procedures, such as implants or soft tissue grafts, should be postponed until after delivery, says Habijanac. As well, Health Canada recommends that silver amalgam fillings not be removed in a pregnant woman because of the risk of her inhaling mercury vapour. For moms-to-be who need a filling, dentists should use a different material, such as composite resin.
As for tooth whitening, there’s not enough data to know for sure if it’s safe, so best to save it for before or after pregnancy. Also, the ingredient carbamide peroxide, breaks down into urea and hydrogen peroxide, the active bleaching agent. These ingredients commonly irritate already sensitive gums. Overall, the second trimester is considered the best time for any dental work because it’s after the critical first trimester when the fetus is most vulnerable, but before a woman becomes physically uncomfortable in the dentist’s chair during the pregnancy homestretch.