DISCLOSURE: Noelle Copeland RDH is the oral care specialist and dental consultant to the Brilliant and Baby Buddy oral care lines.
1. Pregnancy Gingivitis
- Pregnancy Gingivitis: Reversible, often exaggerated during pregnancy due to an increase in the hormone progesterone. More likely to occur during pregnancy if there’s an increase in plaque or bacteria in the mouth.
The prevalence and severity of gingival inflammation in pregnancy can be mild and not related to plaque accumulation, meaning the teeth are clean and the gums are just swollen because of the hormonal changes that are taking place. These changes increase blood flow to the gums and also change how the body responds to oral bacteria, causing sensitive, irritated, and swollen gums.
Pregnancy gingivitis is a common occurrence for many women during pregnancy. Hormones play a big factor in how our body responds to the bacteria and pathogens in the mouth. An expectant mom can change little to nothing about her oral care but suddenly experience sensitive and bleeding gums that she has not experienced before.
During pregnancy, an increase in the production of the hormone progesterone will cause the mother’s response to plaque and bacteria in her mouth to be exaggerated. However, gingival inflammation can also be caused by excessive plaque and bacteria in the mouth, making gingivitis more severe. In fact, if you have gingivitis before getting pregnant, you are at risk that pregnancy will increase the severity of it.
Pregnancy gingivitis and regular gingivitis experienced outside of pregnancy, are pretty much the same in the scope of treatment and prevention. The way to treat pregnancy gingivitis is with extra attention to everyday home care routines. Additionally, be sure to visit the dentist for a professional dental cleaning and evaluation.
2. Periodontal Disease
- Pregnancy Periodontal Disease: Not reversible. Was present and progressing before pregnancy occurred and then pregnancy accelerated it. Treatable professionally and health can be restored.
Periodontal disease is an active infection in the mouth, having a direct effect on the teeth and the supporting structures they sit in; the bone, ligaments, and gum tissues. Periodontal disease is NOT reversible. It can be treated and health can be restored, but the damage it does to the teeth, gums, and bone is permanent. Once the pathogenic bacteria starts to erode the bone that teeth are securely sitting in, the body does not regenerate that bone.
When pathogenic bacteria is left undisturbed in the mouth it causes an array of issues from mild to severe gingivitis, active periodontal disease, to decay and cavities. For pregnant women, that bacteria travels in the bloodstream throughout the body, with the ability to transmit and colonize the placenta. In fact, preterm low birth weight babies are a risk factor to mothers who have chronic periodontal disease that goes untreated before and during their pregnancy.
3. Treatment Options for Pregnancy symptoms
- Morning Sickness/Regurgitation/Reflux (Vomiting): Anytime you have repetitive vomiting, it can seriously affect the mouth’s tissues and tooth enamel, causing sensitivity. Stomach acid strips away the protective” tooth pellicle” and it takes about 30 minutes to an hour for the saliva to reform the pellicle This is why brushing the teeth is a big “NO NO” after vomiting! You can rapidly wear down the tooth enamel, causing significant tooth sensitivity and enamel damage by brushing right after vomiting. Treatment: The best way to fight the negative effects of morning sickness is to refrain from brushing the teeth right after. Rinse the mouth with plain water and if you can tolerate it, use a flavorless mouth gel that has Xylitol. Xylitol helps to protect the teeth after vomiting, by increasing saliva production, re-mineralizing the teeth, and by preventing bacteria build-up.
- Nausea/Queasy: When nausea and queasiness are experienced more regularly, like during pregnancy, or in other instances like, during cancer therapy, this can have a drastic effect on the diet and saliva production. Most of the time nausea is quelled with medications that can cause dry mouth or by prescribing a bland diet that typically includes crackers, electrolyte drinks with processed sugar, and carbonated beverages. This scenario can allow more plaque to accumulate in the mouth, and that can cause sensitive teeth and gums. Treatment: The best option for this situation is supportive therapy. First, be aware of what risk factors you have, and then be conscious of the choices you make. If you have a dry mouth, then use a saliva stimulator; Xylitol is my favorite recommendation. If you are on a bland diet that’s higher in refined carbs, then be sure you are drinking enough water and brushing/flossing twice a day.
- Gingivitis/Periodontal Disease: If you had gingivitis or periodontal disease before getting pregnant, then being pregnant can make the symptoms of those diseases worse. The change in hormones during pregnancy may make it easier for bacteria to grow, making gums more sensitive to the presence of plaque by exaggerating the body’s response to the toxins produced by bacteria. When gums or teeth are sensitive, oral care can become less effective and more painful. Treatments: Visit the dentist regularly before getting pregnant and during your pregnancy. Practice excellent oral care at home with a soft toothbrush for sensitive teeth. Treat any disease or infection immediately as instructed by your dentist and current obstetrician.
4. Diet and Nutrition
Your baby’s oral health and your pregnancy are intricately connected. Did you know that during the third and sixth months of pregnancy, children’s primary baby teeth begin forming and mineralizing? What you eat during pregnancy affects the growth of your unborn child in every way, including the development of baby teeth.
Calcium & Phosphorus are essential for strong teeth and bones and need to come from the mother’s diet in an adequate supply. If an expectant mother doesn’t get enough calcium in her diet to support the pregnancy, the body will pull it from the mother’s bones to give the baby what it needs. OUCH!
Phosphorus, another mineral that accounts for the hardness of teeth is found in many high protein sources such as meat and milk. Vitamin D helps the body absorb and retain calcium and phosphorus. However, very few foods contain Vitamin D naturally. Vitamin D is produced in the body when the skin is exposed to direct sunlight. An expectant mother should be taking prenatal vitamins to help supplement the vitamins, minerals, and nutrients she needs while pregnant.
5. Early Infant Oral Care
Baby teeth begin to appear in the mouth between 4-8 months of age for most children. Starting at 3 months of age, babies will begin to teethe in preparation for the baby teeth to break through the gums. Most children develop a full set of 20 baby teeth by the age of 3 years. But don’t wait until the first baby tooth comes in to start oral care, start oral care from the very beginning!
Early Oral Care
- Use a sterile cloth to gently wipe the baby’s gums, tongue, and inside cheeks after feedings; starting some time within the first month after birth.
- Introduce a silicone toothbrush to oral care time around 3 months of age.
- A great choice to start with is a finger toothbrush or a teether/brush combo.
- Execute this activity by rubbing and brushing over the baby’s gums and tongue.
- When you use silicone teethers, you can also chill and freeze many of them, which helps to provide pain relief if your baby is already teething.
- Once the first tooth erupts, use a bristle toothbrush to clean new teeth.
Oral Care at home
- Brush 2-3 times a day: At least 2 minutes of brushing, rinsing with an alcohol-free mouth rinse, and flossing every night. Use interproximal cleaners for any spaces or areas between the teeth that need a little extra attention.
- Don’t brush after an episode of vomiting/reflux. It takes thirty minutes for your saliva to rebuild the protective tooth pellicle that is stripped off your teeth after ANY oral acidic event, like vomiting or reflux. During this timeframe, your teeth and tissues are at risk, especially to abrasion and erosion from a toothbrush.
- Rinse your mouth with plain water after an acidic episode. Then follow that up with a Ph stabilizing mouth rinse or gel with Xylitol. Drink lots of water.
- Use Xylitol regularly. Xylitol helps prevent cavities by reducing the number of pathogenic bacteria in the mouth and their ability to “stick” to teeth, gums, and other oral tissues. Xylitol also helps to re-mineralize teeth by increasing saliva production and lowering oral acidity.
Oral health during pregnancy is important because it works to directly support systemic health. Brushing your teeth while pregnant, and supporting your oral health through regular and effective oral care routines is the best start to foundational oral care. Talk to your dentists about any challenges you may encounter or questions you may have about taking care of your mouth.
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Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.