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The Importance of Oral Care in Pregnancy

DISCLOSURE: Noelle Copeland RDH is the oral care specialist and dental consultant to the Brilliant and Baby Buddy oral care lines through Compac Industries. See terms below.

Oral health during pregnancy is important, just like systemic health is important, in fact, oral health and systemic health are intricately connected and can directly affect one another. Brushing and flossing are the cornerstones of any oral health routine and sometimes additional interventions are needed to optimize a person’s home care efforts, especially if they are pregnant or thinking about becoming pregnant.

Visit your Dentist early in your Pregnancy!

Who do you call after you see that positive pregnancy test result? For most women, they are quick to schedule a visit to their doctor, midwife, or other trusted medical provider to confirm the pregnancy and talk about the expectations and healthy steps for the next 9 months. As far as oral health is concerned, those providers don’t typically discuss oral health when consulting on healthy pregnancy habits, but they should. Especially in the very beginning when you’re still relatively comfortable walking around and laying down, morning sickness hasn’t quite kicked in yet, and you have not developed any taste or smell aversions! This is the best time to see a dental professional to discuss your specific oral health and address any issues you may have.

If your medical provider does discuss oral health and advises you to visit your dentist, that’s wonderful, but if not, now you know to schedule that on your own. If you are overdue for a dental check-up, schedule an appointment as soon as possible. Contrary to popular belief, it is safe and recommended to have dental Xrays, dental treatment, and dental cleanings while you are pregnant, as directed by your doctor, especially if there are any underlying issues that need to be resolved. If you have unaddressed infections in your teeth or gums, that infection can affect the health and development of your baby.

The Advantages of learning about Early Oral Care for your Baby

Another great advantage to seeing your dental professional during your pregnancy is the chance to learn about early infant oral care. Early infant oral care is essential to laying a healthy foundation for your baby’s oral health and this routine is easy to start within the first month of life.

Most Early Oral Care programs involve:

  • Wiping baby’s gums and tongue with a sterile cleansing cloth 1-3 times a day after feedings.
  • At 3 months of age introduce a silicone toothbrush. (a finger toothbrush works great at this age)
  • When teething starts, switch to a silicone teether/toothbrush combo that the baby can use independently.
  • Visit the dentist within 6 months of the 1st baby tooth erupting or by baby’s 1st Birthday, whichever comes first.
  • As soon as the first tooth arrives, start brushing the baby teeth with a bristle toothbrush and continue to use silicone toothbrushes on the gums.
Morning sickness and protecting your teeth

“Morning sickness” is a deceiving term because it can last all day and for some women can be so severe that it requires hospitalization, that’s when it gets a new name, hyperemesis gravidarum. There is a significant difference between morning sickness and hyperemesis gravidarum as far as severity and frequency go. Hyperemesis gravidarum is extreme nausea, dizziness, vomiting, dehydration, and weight loss, to the point that some women cannot even stomach a small sip of water without becoming violently ill. This is considered a pregnancy complication and requires close monitoring to protect the mother and the baby. On the other hand “morning sickness” is often considered a right of passage into motherhood. It’s that early physical signal that “Yep, I’m pregnant and now my body feels totally different”.

Although different in severity both can leave lasting effects on the teeth. Anytime you regurgitate, either fully or by means of refluxing, stomach acid enters the mouth and coats the teeth and tissues. This acid strips away a special coating on the teeth called the acquired tooth pellicle. The pellicle naturally protects the teeth and when it is gone, it leaves teeth vulnerable. It takes thirty minutes for your saliva to rebuild this protective pellicle. In the meantime, your teeth and tissues are at risk, especially to abrasion and erosion. So what exactly does that mean? For starters, it means you can self inflict toothbrush abrasion by brushing your teeth after an episode. And if you’re having multiple episodes a day of reflux or regurgitation, and then brushing afterward to freshen up, you can literally start to brush away the enamel of your teeth. It also means that you can develop erosion pits and grooves and even cavities if the acid is allowed to just sit in your mouth and is not removed through swishing or rinsing. So what do you do?

How to avoid the lasting effects of “morning sickness “on your teeth
  • After an episode, DO NOT brush your teeth
  • Rinse your mouth well with plain water
  • Follow that up with a Ph stabilizing mouth rinse or gel with Xylitol.
  • Drink lots of water. If hospitalized, a patient with hyperemesis gravidarum will have IV fluids.

Xylitol has amazing benefits. You can get it plain in a mouth rinse, or you can use a child’s toothpaste that has it. Make sure that xylitol is the first or second ingredient and that added sugar is absent from the ingredient list. If using a paste/gel, just rub it into the teeth and spit out the excess, don’t brush it into the teeth. Another great alternative is to keep sugar free xylitol gum with you and chew that. Chewing stimulates your salivary glands to produce more saliva, which is exactly what you want to help speed up the pellicle reformation, plus the xylitol helps to re-balance oral Ph and protect the teeth and tissues.

What is Pregnancy Gingivitis?

Pregnancy gingivitis is very common during gestation. A woman can have a perfectly healthy mouth with little to no dental issues, and then she becomes pregnant and all of a sudden her gums are more tender, a bit swollen and bleeding in areas they did not before. Welcome to Pregnancy Gingivitis!

The prevalence and severity of gingival inflammation in pregnancy gingivitis 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.

However, gingival inflammation can also be caused by plaque and bacteria in the mouth, making the gingivitis more severe. In fact if you have gingivitis before getting pregnant, you are at risk that pregnancy will increase the severity of it.

Steps to take to reverse Pregnancy Gingivitis

The good news is that gingivitis can be completely reversed, you can treat it and limit or eliminate any permanent damage to the teeth or supporting structures in the mouth. How?

  • Brush 2-3 times a day, effectively, that means: At least 2 minutes of brushing, rinsing with an alcohol-free mouth rinse, and flossing every night, and even using 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)
  • Get professional cleaning and address any dental work that is safe and recommended.
  • Eat Clean. Limit processed sugars and carbs.
  • Use a saltwater rinse if gums are flaring up and tender
  • Use Xylitol. You can find xylitol in sugar free gums or mints, tooth gels, or rinses.
  • Be sure you use a soft toothbrush or extra soft-bristled toothbrush for when gums act up and teeth feel sensitive.

NOTE: **You should never use a medium or hard-bristled toothbrush on your teeth, for any reason, ever!!**

The Importance of avoiding Periodontal Disease

What is Periodontal Disease? Periodontal disease is an active infection in the mouth, affecting the teeth and the supporting structures they sit in, the bone 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 away the bone that teeth are securely fit into, the body does not regenerate that bone. This may be familiar to you if you have ever heard your dental professional talking to you about your bone levels. Bone levels are important, it’s what keeps your teeth in your mouth, so you don’t want actively shrinking bone levels.

Recognizing Gingivitis as an early warning signal! Gingivitis is the “cautionary signal” before periodontal disease sets in, so pay attention. If gingivitis goes unchecked and untreated, it will eventually lead to periodontal disease. This can take years to occur or be as short as a few months. This is one of the many reasons why dental professionals are so serious about treating gingivitis early and instilling regular maintenance and home care routines with their patients. You get one set of adult teeth and they need to last the rest of your life, and the structures that hold those teeth in your mouth need to stay disease-free.

Some of the Unwanted Effects of Periodontal Disease during Pregnancy! In pregnancy, active periodontal disease has been associated with adverse pregnancy outcomes, including preterm delivery, preeclampsia, and low birth weight. This prevalence is highest for women who have limited access to care and low socioeconomic status. The exact linking for these adverse outcomes is not fully understood yet. However, periodontal disease has also been observationally connected to other conditions like cardiovascular disease, diabetes, and Alzheimer’s disease.

The current consensus is that pathogenic oral bacteria travel throughout the body, via the bloodstream, and can negatively affect other parts of the body, including crossing the placenta during pregnancy.

These microorganisms cause inflammation in the oral environment, and can potentially cause inflammation in other parts of the body, leading to the potential for adverse pregnancy outcomes. Inflammatory markers scale higher in those with periodontal disease and are exasperated by any other condition that lowers the immune system or challenges it on a daily basis.

Although the science isn’t settled, it holds great weight to educate how oral health and systemic health are intricately connected, how systemic health and access to care are woven together, and how low socioeconomic status leads to poorer healthcare outcomes.

Why it is easy to overlook the early warning signs of oral diseases

Think about it like this. If you had an open wound on your hand or other appendages, you would more than likely not ignore it. Even if it didn’t hurt or bother you in any way. Visually, you might see inflammation, redness, exudate (puss), or bleeding as a sign that something is not right, so you consciously look for ways to address what’s going on. With oral diseases, you don’t always have a feeling or pain signal that something is wrong, let alone “infected” until it is quite progressed. If you don’t feel an infection and you can’t directly see it, as is often the case with oral diseases in the mouth, then it can easily get ignored. Once bacteria get deeply embedded into a tooth’s supporting bone structure, the infection can rapidly progress, especially during times where the body’s immune and circulatory systems are changing.

To Summarize – If you are pregnant or thinking about becoming pregnant:

Implement these six steps for Oral Care

  • Practice an excellent home care program.
    Brush 2-3 times a day, effectively, that means: At least 2 minutes of brushing, rinsing with an alcohol-free mouth rinse, and flossing every night, and even using interproximal cleaners for any spaces or areas that need a little extra attention.
  • Visit your Dentist and Dental hygienist.
    Address any recommended dental issues and get your teeth professionally cleaned. Learn about early infant oral care.
  • Don’t brush after an episode of vomiting/reflux.
    Rinse your mouth well with plain water. Follow that up with a Ph stabilizing mouth rinse or gel with Xylitol. Drink lots of water. If hospitalized, a patient with hyperemesis gravidarum will have IV fluids.
  • Eat Clean. Limit processed sugars and carbs.
  • Use a saltwater rinse if gums are flaring up and tender.
  • If you have it currently or get diagnosed with gingivitis or periodontal disease, get it treated as directed by your medical and dental professionals.

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7/22/2020.. This article is intended to provide an understanding of and knowledge about“oral health topics”as expressed through the perspective and experience of the author. It is not intended to be a substitute for professional advice or counsel, including the diagnosis or treatment of any condition. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition, an oral condition, illness or treatment of any listed or non listed situation above. By using this site, you signify your assent to our Terms and Conditions. If you do not agree to all of these Terms and Conditions, do not use this site!.


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