Dental conditions during pregnancy

Pregnancy can trigger a number of physical changes in oral health, including pregnancy gingivitis (inflammation of the gums) and pregnancy epulis (a growth on the gum).

Pregnancy gingivitis

Gingivitis, a form of periodontal (gum) disease, is common in pregnancy. The hormonal changes that occur at this time lead to increased blood flow to the gum tissue and increased inflammation of this tissue in response to the presence of plaque.

If you have pregnancy gingivitis, your gums will appear swollen and bleed easily. The severity of the gingivitis can be minimised by greater attention to oral hygiene. Brushing your teeth thoroughly twice a day with fluoride toothpaste will help reduce plaque, as will flossing after each meal.

Recently, a body of evidence has emerged linking more severe gum disease (periodontal disease) in pregnancy to an increased risk of premature birth. However this remains controversial. Meta-analyses (in which researchers combine results of several relevant studies) have not shown that treating gum disease (such as through scaling and root planing) during pregnancy reduces the risk of preterm delivery.

Pregnancy epulis

Occasionally, some pregnant women will develop a localised swelling on the gum, known as a pregnancy epulis or pregnancy granuloma. Typically this will occur in the second or third trimester, sometimes even appearing for the first time in the final month of the pregnancy.

A pregnancy epulis will often bleed easily, and can appear red and inflamed, however they are generally not painful. A pregnancy epulis is a benign (harmless) tumour and does not have the potential to become malignant (cancerous).

Some women who have an epulis will have it removed during pregnancy, usually because of bleeding, for cosmetic reasons, or because the diagnosis is uncertain. However, if left alone, the epulis will usually become smaller or disappear after childbirth.

Special considerations

Special considerations regarding oral health during pregnancy include:

Nutrition

You should eat a balanced diet including sufficient quantities of calcium, protein, phosphorus, and vitamins A, C, and D during pregnancy. This is important for your baby's dental health as well as your own.

Tooth decay

Hormonal changes during pregnancy and the acid from vomiting if morning sickness is present can all contribute to an increased risk of dental caries (tooth decay) during pregnancy.

Dental procedures

In general, any elective dental procedure should be postponed until after delivery, especially if it involves X-rays and anaesthesia.

However, a toothache should be considered a dental emergency. It is particularly important for your dentist to treat infections that can cause toothache, because these infections can potentially spread throughout the body and affect your pregnancy.

If you need to have a filling, it is important to note there is no evidence that amalgam (silver-coloured) fillings are linked to mercury toxicity. Nevertheless, if you are concerned about having amalgam fillings, there are viable alternatives.

It is safe to treat gum disease during pregnancy and this may reduce the risk of adverse pregnancy outcomes, such as preterm birth, as discussed above.

Antibiotics

Some antibiotics, including tetracyclines, are not suitable during pregnancy as they can cause discolouration of your baby's developing teeth.

Therefore it is important that your doctor or dentist is always aware if you are either pregnant or possibly pregnant. There are many antibiotic options available that have been proven to be safe in pregnancy.

Last Reviewed: 13 November 2012
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References

1. Prescribing medicines in pregnancy database. [Internet]; Content last reviewed 3 April 2012. Therapeutic Goods Administration. http://www.tga.gov.au/hp/medicines-pregnancy.htm (Accessed Dec 2012).
2. Baccaglini L. A meta-analysis of randomized controlled trials shows no evidence that periodontal treatment during pregnancy prevents adverse pregnancy outcomes. J Am Dent Assoc 2011; 142-1192-3.
3. Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc 2006; 137 Suppl 2; S75-135.
4. Mouth Healthy: Pregnancy [Internet] Consumer website of the American Dental Association 2012. http://www.mouthhealthy.org/en/pregnancy/ (Accessed Dec 2012).
5. Murry M. Dental health during pregnancy [Internet] Mayo Clinic; 2009 June 2. http://www.mayoclinic.com/health/dental-health-during-pregnancy/MY00719 (Accessed Dec 2012).
6. Oral Health during Pregnancy and Early Childhood. Evidence-based Guidelines for Health Professionals. February 2010. cda Foundation. http://www.cdafoundation.org/Portals/O/pdfs/poh_guidelines.pdf (Accessed Dec 2012).
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