Pregnancy and Dentistry - Would you like the Pink or Blue Napkin?

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By Dr. David Leader

Many expectant mothers do not receive dental care due to poor advice or misconceptions. Some appear at the dental office tired, upset, and in pain. Actually, dental care is an important part of prenatal care.

Although, elective procedures are usually delayed until after delivery, treatment of decay, prophylaxis (cleaning), root canal treatment and extractions are done routinely for pregnant women. Most women do not loose one tooth per child as the old wife’s tale states.

Patients should always tell their dentist if they have any changes in their health. If they know or suspect that they are pregnant, it is a good idea to have the phone number of their obstetrician available for the dentist. Dentists and physicians often discuss treatment options with each other to determine the best course of treatment for their patients.

Many people are concerned about exposing the unborn child to radiation during the exposure of dental x-rays (radiographs). The exposure that the unborn child receives is extremely small or zero. The amount of radiation used to expose dental x-ray film is small. The x-ray beam is focused on the area to be examined. There is a lead shield placed over the mother and her abdomen. The fetus is further protected, as always, by layers of the mother’s own body. Dentists only take radiographs that are necessary to treat a condition that is already obvious such as tooth decay that requires an extraction, root canal or filling.

Pregnant women should have regular checkups including prophylaxis. Women’s bodies react more to infection during pregnancy. They produce more of a chemical called prostaglandin that causes gums to become more swollen in the presence of plaque and tarter. This condition is called pregnancy gingivitis. Sometimes areas may become very swollen causing a pregnancy tumor. Frequent dental prophylaxis and good home care including brushing and flossing will help maintain or improve gingival health.

Higher levels of prostaglandin from gum disease have been shown to trigger early delivery and resulting lower birth weight babies. That is why women considering becoming pregnant should see a dentist for a periodontal (gum) exam. Once pregnant, it is important to maintain good oral health with prophylaxis every 3 months instead of the usual six. Women who are pregnant and have severe gum disease (mouth odor, bleeding gums, tarter, or loose teeth) should consult both their dentist and their obstetrician immediately.

Morning sickness affects many women. A common thing to do after a bout of morning sickness is to brush one’s teeth. Unfortunately, that is the worst thing to do. The surface of tooth enamel that has been exposed to stomach contents is weak. Repeated brushing of repeatedly weakened teeth often removes enough enamel to make teeth sensitive and more susceptible to decay. A better treatment is to rinse immediately with water that has a /pages/ teaspoon of baking soda dissolved in it. Then, use a fluoride rinse to strengthen the enamel. Wait at least a few hours before brushing with a soft bristled toothbrush.

Many medications must be avoided in pregnancy. Pain /pages/ relievers like aspirin, ibuprofen and others that are similar, prolong bleeding. The fetus may be affected by drugs that cross the placenta (the organ that interfaces between the mother’s uterus and the baby’s umbilical cord to provide oxygen and nutrition for the fetus). Many illegal, recreational drugs fall into this category, but also included are antibiotics like tetracycline, which will permanently stain the baby’s teeth. Dentists have a wide selection of safe medications to provide to their pregnant patients.

Late in pregnancy, it may be hard to sit through a dental appointment. Some women find that reclining in the dental chair makes them feel lightheaded. That is caused by the weight of the contents of the uterus resting on the inferior vena cava, one of the major blood vessels carrying blood to the heart from the lower half of the body. If you feel this happening to you, ask the dentist or hygienist to stop while you shift your body so that you are lying on your side. You will feel better quickly and the appointment may continue.

One of the most common risk factors for children that have dental problems is parents that have dental problems. Few of the causes of bad teeth running in families are genetic. Start your child off right by taking care of your own teeth. If you have any questions about dental care during your pregnancy ask your dentist or your hygienist.

Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.