Some of us may take our dental health a little more lightly compared to other areas of our health, like watching our blood pressure or diabetes, etc. But in fact, dental hygiene in pregnancy plays a vital role not only for the pregnant mother but also the development of the baby. Also, pregnant mothers may be more prone to dental problems. As such, all the more we should take note of this topic in order to maintain proper oral hygiene and health.
Datin Dr Caryn Fung BDS (MAHE), AACD (USA), Dental Surgeon at Kuala Lumpur International Dental Center, chats with Motherhood Story to highlight the importance of dental care during pregnancy. Read on to find out how we can take good care of our oral health, what kind of procedures are safe, when it is advisable to visit our dentist, suitable medications, and some guidelines on the dos and don’ts.
Q1: Why is dental care so important during pregnancy?
Datin Dr Caryn Fung: During pregnancy, it is important for pregnant mothers to maintain good oral health care as they are predisposed to certain oral health conditions due to various reasons, such as fluctuation in hormone levels and poor oral hygiene may lead to gum disease causing gums to bleed easily or become inflamed.
When this is not taken care of, our gums and bone supporting our tooth may be affected which may eventually lead to tooth loss. Occasionally, you may find swelling in the gums (a condition known as ‘pyogenic granuloma’) which goes away after the baby is born.1
Pregnant mothers are at an increased risk of having tooth decay due to increased snacking from pregnancy cravings, increased acid build-up from frequent vomiting episodes and also poor maintenance of oral hygiene.
Erosion of surfaces of teeth may also be common among pregnant mothers because of increased exposure to gastric acid from frequent vomiting episodes due to morning sickness in early trimesters or gastric reflux during late pregnancy.1,2
Q2: What can pregnant mothers do to prevent dental problems from arising?
Datin Dr. Caryn Fung: It is imperative to emphasise on oral health maintenance for pregnant mothers which includes brushing twice a day with fluoridated toothpaste, limiting the intake of sugary food, flossing once daily and attending dental visits before and during pregnancy.
Studies have shown that improved oral health in mothers may reduce transmission of bacteria to infants and decreases children’s future risk of having tooth decay.2, 3
Rinsing with diluted baking soda solution (1 teaspoon of baking soda dissolved in a glass of water) may help to neutralise the acid and thus, preventing tooth erosion.1,2,3
Q3: What supplements can they take in order to ensure their baby will have healthy dental and maxillofacial growth?
Datin Dr Caryn Fung: Nutrients essential for tooth development and maintenance include proteins, vitamins A, C and D as well as calcium and fluoride. These nutrients contribute to the proper formation of different layers of teeth such as enamel and dentin, as well as strengthening the bone which supports our teeth.4
Fluoride is incorporated into the tooth structure which helps to protect the teeth from the formation of cavities.
These nutrients can be consumed by maintaining a balanced and healthy diet which includes a proportionate amount of carbohydrates, fruits and vegetables, fish, meat and eggs.
Consume an adequate amount of milk and dairy products such as cheese and plain yoghurt which are beneficial in strengthening the teeth and bone. Don’t forget to drink plenty of water that contains fluoride.
Q4: At which point of their pregnancy are mothers not advised to go through any dental procedures?
Datin Dr Caryn Fung: Dental checkups and teeth cleaning can be safely performed throughout pregnancy. However, it is preferable for pregnant mothers to undergo dental procedures during the second trimester of pregnancy (14th to 28th week) when the development of baby’s organs has been completed.3,5
During the third trimester, pregnant mothers may experience discomfort during dental treatment when the chairs are reclined. Hence, shorter dental appointments should be scheduled with appropriate positioning of the chair.
Emergency dental care can be provided at any point throughout the pregnancy if it is deemed necessary by the dentist.3,5
Q5: What procedures are not suitable for pregnant women?
Datin Dr Caryn Fung: Teeth cleaning, fillings, extractions and other elective dental treatment are safe to be carried out during the second trimester of pregnancy.
It is best to avoid routine radiographs unless they are needed. Radiographs are considered safe for pregnant patients at any stage of pregnancy with proper abdominal and thyroid shielding.1
Q6: Is dental local anaesthetic safe during pregnancy?
Datin Dr Caryn Fung: Yes, local anaesthetics such as lidocaine or prilocaine with or without epinephrine are safe to be used during pregnancy.2,3,5
Sedatives and nitrous oxide are not recommended to be used on pregnant mothers.3.5
Q7: What are the medications that pregnant mothers need to be cautious of if being prescribed before and after any dental procedures?
Datin Dr Caryn Fung: Painkillers such as Acetaminophen (Panadol) and antibiotics namely amoxicillin, metronidazole and cephalosporins are safe to be prescribed to pregnant mothers. For patients allergic to penicillin, erythromycin or clindamycin may be prescribed.3,5
Avoid taking non-steroidal inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, which have been associated with increased risk of causing heart defects on the foetus.5
Tetracyclines are to be avoided in pregnant mothers and in children up to 12 years of age, as they may cause permanent tooth discolouration and staining.5
Q8: Can dental problems cause miscarriages?
Datin Dr Caryn Fung: Multiple studies have shown that there are associations between severe gum disease (periodontitis) with pre-term birth, low birthweight babies, premature birth of low birthweight babies and development of pre-eclampsia (pregnancy complication characterised by high blood pressure in pregnant mothers).1,2 Bacteria and inflammatory agents may travel through the blood circulation to placental tissues as well as uterus and cervix which may induce preterm labour.2
Teeth cleaning and root surface treatment can be safely performed during pregnancy for the management of periodontitis.
Q9: What are some high-risk congenital dental disorders that pregnant women need to be aware of for their babies?
Datin Dr Caryn Fung: Congenital dental disorders occur while a baby is developing in utero, often during the first three months of pregnancy. Congenital defects may be inherited or caused by genetic mutations.
They may also be attributed to environmental factors such as alcohol consumption, smoking, medication use, infections or nutritional deficiencies. These may lead to some congenital dental anomalies such as absence of teeth, poorly developed tooth structures and clefts.
Cleft lip and palate are among the commonest birth defects affecting children in Malaysia. It occurs in about 1 in 700 live births.6 Cleft lip and palate occurs when there is incomplete formation of the lip and palate of the baby since birth.
This condition may affect the child’s feeding, speech, facial aesthetics and may lead to ear infections, hearing problems and other dental problems. The management of cleft lip and palate may require an early intervention depending on the child’s condition and involves a multidisciplinary approach consisting of oral surgeon, orthodontist, pedodontist, ENT surgeon and speech therapist, to name a few.
Q10: How would pregnant women prepare for any congenital disorder prenatally?
Datin Dr Caryn Fung: Cleft lip and palate are associated with familial history whereby if you or your partner’s family have cleft lip and palate, your child is more likely to be born with these birth defects. However, there are measures which pregnant mothers can take to reduce the baby’s chances of having these birth defects.
Pregnant mothers should avoid drinking alcohol and avoid smoking during pregnancy. Ensure that there is sufficient folic acid in their diet or supplements. Attend prenatal checkups to ensure that they are fit and healthy for pregnancy.
It is recommended to maintain a healthy weight range during pregnancy as obesity is associated with increased risk of cleft lip and palate development in babies.
Pregnant mothers should consult their physician on medications which are safe to be taken during pregnancy. Avoid taking anticonvulsant medications for seizures and sedatives such as benzodiazepines, which are associated with the development of cleft lip and palate.2 Ensure that your vaccinations are up-to-date especially for rubella and protect yourself from infections.6
References
1. Pregnancy [Internet]. Ada.org. 2021 [cited 10 August 2021]. Available from: https://www.ada.org/en/member-center/oral-health-topics/pregnancy
2. Oral Health Care During Pregnancy and Through the Lifespan [Internet]. Acog.org. 2021 [cited 10 August 2021]. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/08/oral-health-care-during-pregnancy-and-through-the-lifespan
3. Silk H, Douglass A, Douglass J, Silk L. Oral Health During Pregnancy [Internet]. Aafp.org. 2021 [cited 10 August 2021]. Available from: https://www.aafp.org/afp/2008/0415/p1139.html?_ga=2.62882348.1446642176.1592284086-619642441.1591286279#afp20080415p1139-b3
4. Diet During Tooth Development – PORTAL MyHEALTH [Internet]. PORTAL MyHEALTH. 2021 [cited 10 August 2021]. Available from: http://www.myhealth.gov.my/en/diet-during-tooth-development/
5. Kurien S, Sriram R, Rao V K P, Bodduru R. Management of Pregnant Patient in Dentistry. J Int Oral Health. 2013;5(1):88-97.
6. Cleft lip and palate [Internet]. nhs.uk. 2021 [cited 10 August 2021]. Available from: https://www.nhs.uk/conditions/cleft-lip-and-palate/
Source: Datin Dr Caryn Fung BDS (MAHE), AACD (USA), Dental Surgeon at Kuala Lumpur International Dental Center
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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