Pregnancy can lead to dental problems, including gum disease and increased risk of tooth decay. Research has found a link between gum disease in pregnant women and premature birth with low birth weight. Common issues affecting dental health during pregnancy include:

• Gum problems
• Gingivitis (gum inflammation) – this is more likely to occur during the second trimester. Symptoms include swelling of the gums and bleeding, particularly during brushing and flossing between teeth
• Gum overgrowth also known as pregnancy epulis, which may or may not resolve after the birth of the baby
• Vomiting
• Cravings for sugary foods
• Retching while brushing teeth
• Mobile teeth which usually firm up after the birth of the baby

During pregnancy, the gum problems that occur are not due to increased plaque, but an increased response to plaque as a result of increased hormone levels. However, with proper hygiene at home and professional help from a dentist, good oral health can be maintained during pregnancy.

Pre-pregnancy and dental health

Women are less likely to have dental problems during pregnancy if they already have good oral hygiene habits. Steps for good oral hygiene include:

• Brushing teeth at least twice daily with fluoridated toothpaste
• Flossing between teeth
• Following a healthy diet
• Visiting the dentist regularly

It is important for women planning to become pregnant to visit the dentist and have a check-up. It is more convenient to have elective procedures done before conception.

Dental health during pregnancy

Women should not avoid the dentist during pregnancy. Routine dental treatment is safe during pregnancy. Women should advise their dentist if they are pregnant when scheduling their dental appointment.

Common dental health issues during pregnancy

Vomiting

Pregnancy hormones soften the ring of muscle that keeps food inside the stomach. Gastric reflux (regurgitating food or drink) or the vomiting associated with morning sickness can coat your teeth with strong stomach acids. Repeated reflux and vomiting can damage tooth enamel and increase the risk of decay. Suggestions for pregnant women experiencing vomiting include:

• Don’t brush your teeth immediately after vomiting. While the teeth are covered in stomach acids, the vigorous action of the toothbrush may scratch the tooth enamel. Wait at least an hour after vomiting before brushing teeth
• Rinse your mouth with water (preferably fluoridated tap water) after vomiting, which will assist in removing acids
• Follow up with a fluoridated mouthwash
• A dab of fluoridated toothpaste smeared over the teeth can replace a fluoridated mouth rinse. Rinse thoroughly with water
• A dentist can provide further information and individualised advice.

Retching while brushing teeth

Some pregnant women find that brushing their teeth, particularly molars, provokes retching. Suggestions for pregnant women experiencing retching include:

• Use a brush with a small head, such as a brush made for toddlers
• Take your time. Slow down your brushing action
• It may help to close the eyes and concentrate on breathing
• Try other distractions, such as listening to music
• Alternatively, brush teeth with water and follow up with a fluoridated mouthwash. Go back to brushing with fluoridated toothpaste as soon as possible

Food cravings

Some women experience unusual food cravings (and food avoidance) while they are pregnant. A regular desire for sugary snacks may increase the risk of tooth decay. Pregnant women should snack on low-sugar foods instead. Suggestions for pregnant women experiencing sweet food cravings include:

• Try to choose healthier sweet options such as fresh fruits
• Rinse your mouth with water or milk or brush your teeth after eating sugary snacks. This will help to remove decay causing sugars from your teeth

Dental health after pregnancy

If gum problems occur during pregnancy, it is important for women to have their gums checked by a dentist after they have given birth. While most types of gum problems caused by pregnancy hormones resolve after birth, a small number of women may have developed a deeper level of gum disease that will need treatment to resolve. Women should practice good oral hygiene after their baby is born. Whilst with a newborn, it can be difficult to find time alone, mothers should ensure they:

• Brush teeth twice a day with fluoridated toothpaste
• Clean between teeth daily with floss or interdental brushes
• Drink fluoridated tap water
• Limit intake of high sugar foods
• Have regular dental check ups

*By Kate Jameson, Policy and Research Officer, Australian Dental Association.