PREGNANCY

Dental care during pregnancy

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Proper nutrition is part of good dental hygiene and pregnant women in particular should be sure to eat a variety of healthy foods and get plenty of calcium, phosphorous, protein, vitamins.

In addition, eating a balanced diet during pregnancy will help promote dental health and overall health for you and your baby. A baby’s teeth begin to develop between months 3 to 6 of pregnancy, so be sure that you are getting enough calcium, vitamin D, C and A, phosphorous, and protein.

A myth persists that a pregnant woman will lose calcium from her teeth if she isn’t getting enough calcium in her diet during pregnancy. In fact, any calcium loss due to inadequate dietary calcium will occur in the bones, not the teeth. But if you include plenty of calcium-rich foods in your diet during pregnancy, your bones and teeth—and your baby’s bones and teeth—should be strong and healthy. That’s all the more reason to eat healthy while following a strict routine of good oral care.

Reasons why oral care is important during pregnancy

Oral care is especially important during pregnancy for several reasons:

  • Frequent eating

During pregnancy, women are likely to eat and drink more frequently throughout the day. And with the more frequent sugar intake comes an increased risk for cavities, so it’s especially important to stick with a sound tooth brushing and flossing routine.

  • Hormonal changes

Some women may be more likely to develop red, puffy gums during pregnancy because the additional amount of the hormone progesterone in the body causes a strong reaction to normal amounts of plaque. If your gums are especially sensitive, try a soft floss that slides easily and comfortably between teeth or a specialty interdental cleaning tool.

  • Radiation avoidance

Although some pregnant women may have a dental emergency that requires a dental x-ray, taking good care of your teeth during pregnancy reduces the odds that you will need dental x-rays, and you can avoid exposing your baby to radiation. But if you do need x-rays, don’t panic. Your dental professional will minimize your exposure by having you wear a leaded apron and leaded band around your neck to protect your thyroid.

When to tell the dentist you're pregnant

  • Don't skip the dentist during pregnancy

Following a consistent oral health care routine is especially important for pregnant women for several reasons.

Pregnancy changes the hormones in the body that put pregnant women at increased risk for periodontal disease, which is the most severe form of gum disease.  This is why pregnant women, or women who are considering pregnancy, should see a dentist for regular check-ups to catch any potential oral care problems before they become severe.

In fact, regular dental check-ups are recommended in order to help manage plaque build-ups and to identify and treat mild cases of tooth decay or gingivitis before they become severe.

  • Telling the dentist as soon as possible

As soon as you believe you’re pregnant, tell your dentist, because it may not be safe to have X-rays during pregnancy. You should also let your dentist know if you are trying to get pregnant; knowing this can help in planning x-rays or other treatments. Be sure to tell your dentist what medicines you’re taking and if your physician has given you any specific medical advice, as it may affect the treatment he or she recommends.

When possible, visit your dentist before pregnancy so you can take are of any pre-existing dental problems before you conceive.

  • Postponing dental care during your first trimester

The first trimester of your pregnancy (the first 13 weeks) is the time in which most of the baby's major organs develop. If you go to the dentist during your first trimester, tell your dentist that you're pregnant and have only a check-up and routine cleaning. If possible, postpone any major dental work until after the first trimester. However, if you have a dental emergency, don't wait! Infections in the mouth can be harmful to you and your baby. See your dentist immediately, and make sure that all dental professionals who examine you are aware you're pregnant.

  • Visiting the dentist during pregnancy

If you have postponed seeing your dentist during your first or second trimester, the third trimester is the time to have a dental check-up to ensure that your mouth is healthy. By visiting your dentist at this time, he or she will be able to advise you on what you can do to prevent oral health problems after your baby is born.

Step up your routine during pregnancy

Keeping your oral health on top of your mind

As you already know, your lifestyle and habits during pregnancy can affect your health as well as the health of your unborn baby. With all the things you need to be prepared for, your oral health may not exactly be top-of-mind. But maintaining the health of your teeth and gums is necessary to avoid the risk of developing pregnancy gingivitis and to establish good oral health long-term.

Know about your increased risk of gingivitis

During pregnancy, 50% to 70% of all women experience a condition called pregnancy gingivitis. This is why it's vital to pay more careful attention to your daily brushing and flossing routine to keep plaque under control. Here’s how:

  • Use a rechargeable electric toothbrush. Electric Toothbrushes remove more plaque than regular manual toothbrushes, and by investing in one, you can begin to take the steps to reduce the amount of plaque in your mouth and help prevent and reverse gingivitis.

  • Brush with an anti-gingivitis toothpaste. Be sure to read packaging carefully to make sure the toothpaste contains gingivitis-fighting ingredients.

  • Clean interdentally. Even if gingivitis causes your gums to swell and bleed, you still need to clean areas between the teeth. By doing so daily, you can eliminate more plaque than by brushing alone and help reduce your risk of developing pregnancy gingivitis.

  • Rinse with anti-gingivitis mouthwash. Rinsing with an alcohol-free, anti-gingivitis mouthwash is the final step to killing germs and improving your oral hygiene during pregnancy.

Learn about the medications you're taking

Some antibiotics and pain medications are okay to take during pregnancy and may be necessary. However, one group of antibiotics, tetracycline and related antibiotics may cause hypoplasia (underdevelopment) of tooth enamel and/or discoloration of the permanent teeth in children. Be sure to tell your doctor you’re pregnant if he or she prescribes this medication for you.

Be prepared for morning sickness

Morning sickness is nausea and vomiting that often occurs during pregnancy. It can happen at any time of the day. If you suffer from morning sickness, having your own emergency travel bag is a good plan. In a small, sturdy bag, pack the following:

  • Opaque plastic bags (Plastic grocery bags are a good choice)

  • Wet wipes, tissues or napkins to wipe your face and mouth

  • A small bottle of water to rinse your teeth and mouth

  • A travel-sized mouthwash, toothpaste and toothbrush to brush away stomach acids

  • Breath spray or mints

Flossing as part of your regular oral care routine

Consistent daily interdental cleaning should be part of your regular oral care routine in the best of circumstances, but the benefits of flossing are especially important if you are thinking of becoming pregnant or if you are pregnant. Pregnancy is one of several health conditions that make your teeth and gums more vulnerable to plaque buildup and infection.

You’re only pregnant for about 9 months, but it’s important to pay special attention to your oral health before, during and after pregnancy. Interdental cleaning, whether you use dental floss, a disposable flosser or a an interdental brush, should be part of your oral care routine, so find a product you like and use it daily.

Deal with changes in your mouth

During pregnancy, you may experience symptoms of dysgeusia (changing tastebuds or a bad taste in your mouth) or ptyalism (too much saliva).

To help cope with a bad taste in your mouth:

  • Brush often, and gargle with a mixture of baking soda and water (1/4 teaspoon of baking soda in one cup of water) to help neutralize pH levels

  • Add lemon to water, drink lemonade or suck on citrus drops

  • Use plastic dinnerware and utensils to help decrease metallic taste

To help cope with an increase in saliva, drink plenty of fluid to increase swallowing. Sucking on candies may also offer relief.

Please read in more details on each dental problem during pregnancy.

Avoid gingivitis during pregnancy

What pregnant women should know about

If you’re pregnant, your dentist needs to know about the first signs of gum disease symptoms. Pregnant women are at increased risk for periodontal disease because the increased levels of progesterone that come with pregnancy cause an exaggerated response to plaque bacteria. As a result, pregnant women are more likely to develop gingivitis even if they follow a consistent oral health care routine.

Gingivitis is most common during months two to eight of pregnancy. Tell your dentist when you are pregnant — he or she may recommend more frequent dental cleanings during the second trimester or early in the third trimester to help combat the effects of increased progesterone and help you avoid gingivitis.

Gingivitis during pregnancy

What is gingivitis?

  • Gingivitis is an inflammation of the gums that is caused when plaque accumulates in the spaces between the gums and the teeth. The accumulation of bacteria can lead to the loss of bone around the teeth and can eventually lead to tooth decay and tooth loss. More than 50 percent of adults have some form of gingivitis.

During pregnancy, about half of all women (60 to 70 percent) experience a condition called pregnancy gingivitis. It is caused by an increase in hormone levels, which can exaggerate a woman's response to dental plaque in the mouth. This extra plaque may cause swelling, bleeding, redness and/or tenderness in the gums. Changes in the gums are most noticeable from the second month of pregnancy, reaching a maximum in the eighth month.  Gum sensitivity is an exaggerated response to plaque and is caused by an increased level of progesterone in your system. To control the amount of plaque in your mouth and to prevent gingivitis, brush your teeth regularly, at least twice a day for two minutes and floss your teeth every day. These actions help reduce the bacteria that can lead to pregnancy gingivitis.

Research on gingivitis during pregnancy and delivery

Research shows that hormonal changes during pregnancy make the mom-to-be more susceptible to gingivitis. But early signs of gum disease during pregnancy appear to be reversible. A study published in the Journal of Clinical Periodontology in July 2008 compared the gum health of 30 pregnant women and 24 non-pregnant women of similar ages. During the first and second trimesters of pregnancy, the pregnant women were more likely to show signs of receding gums and gums that bled easily compared with the non-pregnant women. But during the third trimester and at two postpartum dental examinations, these trends had reversed. These findings suggest that changes in clinical parameters during pregnancy are reversible, and pregnancy-induced gingivitis does not automatically predispose or proceed to periodontitis. But it is still important for pregnant women to be diligent about their oral care to help keep early symptoms of gingivitis under control.

Prevention of periodontitis is important to the health of the mother-to-be not only during pregnancy, but during delivery, too. Data from a second study published in the Journal of Periodontology in 2008 showed that women who had periodontitis during their pregnancies were significantly more likely to develop preeclampsia, a potentially life-threatening complication during delivery. This study supported results from several previous studies published in dental and obstetrics and gynecology journals that show a significant association between active gum disease during pregnancy and an increased risk of preeclampsia (a delivery complication associated with high blood pressure).

How to avoid gum disease

The best way to prevent gum disease during pregnancy is to develop a consistent oral health care routine before becoming pregnant, so you can establish your good oral health habits early.

  • Brush thoroughly at least twice a day, preferably in the morning and at night

  • Take your time; you should spend at least two minutes brushing your teeth

  • Be sure to use anti-plaque toothpaste to help protect your teeth from decay and gingivitis

  • Rinse thoroughly after brushing to get rid of bacteria in hard-to-reach places

  • Remember to floss daily to help avoid the build-up of bacteria

  • Eat a healthy, balanced diet

  • Avoid sugary snacks

  • Continue to visit your dentist regularly (once it is safe for the baby)

Step up your oral care

Maintaining the health of your teeth and gums is necessary to avoid the risk of developing pregnancy gingivitis and to get you on the path to better long-term oral health. By investing in a rechargeable electric toothbrush, you can begin to take the steps to reduce the amount of plaque in your mouth and prevent the onset of gum disease.

How stained teeth develop during pregnancy

Tetracycline is a potent antibiotic, and many women took this drug during pregnancy prior to 1980. It was especially widely used in the 1950s. Consequently, adults who were born before 1980 may be at risk for stubborn grey stains on their teeth.

If a woman takes tetracycline while she is pregnant, studies have shown that the drug calcifies in the baby’s developing teeth. The result is a dark grey or grey/brown stain that affects the entire tooth, or the stain may appear as horizontal stripes of various intensities of colour. In addition, children who take tetracycline during years of tooth formation may develop stains on their teeth.

In 2006, one study found that a protocol involving a combination of prescription fluoride toothpaste and a combination of whitening treatments in a dentist’s office followed by several weeks of nightly bleaching at home yielded favourable results. Check with your dentist if you have tooth stains from tetracycline and he or she can help you determine the best way to improve the appearance of the stains. Tooth bleaching solutions promote increased tooth sensitivity, so you may need to take additional precautions, such as using a soft-bristle toothbrush or soft floss to reduce discomfort and allow you to maintain your regular oral care routine. In addition, using toothpaste that is formulated for sensitive teeth may be helpful.

Dysgeusia - one of pregnancy problems

Are you pregnant and waking up feeling like you've been chewing on spare change overnight?

Some pregnant women experience a condition called dysgeusia, or changes in the tastebuds, during pregnancy. Fortunately, this condition resolves after pregnancy and is basically harmless, but it can be annoying for a pregnant woman who is trying to eat right and maintain good dental hygiene and prevent cavities.

Dysgeusia is distinct from the food cravings or food aversions that occur in pregnancy, when pregnant women seek out certain foods that they might not have liked in the past, or find that former favourite foods are unpalatable or taste strange. Most doctors and researchers believe that dysgeusia in pregnancy is linked to changing hormones and water retention, which affect all the cells in the body, including the taste buds. In addition, some researchers think that there is an evolutionary element at work, and that the metal taste prompts pregnant women to seek out certain nutrients that they need to replace, such as sodium and calcium.

Women can manage dysgeusia by chewing a sugarless gum or sucking on sugarless candies to mitigate the uncomfortable taste. And for those women who can tolerate spicier foods during pregnancy, the spiciness can offset the changes in taste.

What is ptyalism or hypersalivation?

"Ptyalism" is a strange-sounding word for excessive saliva. Ptyalism can occur in anyone, but it is very common for pregnant women to experience this condition, especially during the first trimester. Ptyalism is most likely to occur in pregnant women who are suffering from extreme nausea and morning sickness (called hyperemesis gravidarum).

The exact cause of ptyalism during pregnancy remains uncertain, but changing hormones probably play a role. Also, women who feel nauseous may make an effort to swallow less, which allows saliva to build up in the mouth. And the heartburn and nausea can prompt the salivary glands to produce more saliva to coat the esophagus and protect against the irritation of the mouth and throat that occurs with frequent vomiting.

There is no single cure for ptyalism. But some of these strategies might help you put up with the problem:

  • Brush your teeth. You should be following a regular oral care routine during pregnancy anyway to prevent gum disease, and brushing your teeth and using mouthwash several times a day can help keep excessive saliva at bay by making it easier for you to swallow.

  • Drink water. Taking frequent, small sips of water can help you swallow the excess saliva without aggravating your nausea.

  • Eat right. Try to eat smaller but more frequent meals and try to avoid excessively starchy foods, such as white breads.

  • Grab some gum. Chewing sugarless gum or sucking on hard sugarless candy can make it easier for you to swallow excess saliva.

Diabetes and pregnancy

Are you diabetic and planning a pregnancy? People with diabetes (either type 1 or type 2) are at greater risk to develop gum disease than someone who doesn’t have diabetes. The risk is greater because the higher blood sugar in people with diabetes provides a favorable environment for bacteria that can create plaque and lead to gingivitis. And someone with diabetes may be less able to resist an infection (including an oral infection) than someone who doesn’t have diabetes.

If you are pregnant and you have diabetes, you may be at higher risk for complications if you neglect your oral health. Results from a study comparing pregnant women with type 1 diabetes and non-diabetic pregnant women showed that the pregnant women with diabetes had significantly higher levels of plaque and gingival inflammation compared with the non-diabetic pregnant women.

Cravings

One reason to bolster your oral care routine during pregnancy: Cravings. The food cravings that come with pregnancy may mean that pregnant women who are already susceptible to plaque buildup are eating and drinking more frequently, increasing their risk of developing cavities.

If you find that your gums are more sensitive during pregnancy, especially if you’re brushing and flossing more frequently, try using soft floss to avoid irritating sensitive gums.