Pregnancy can leave you more susceptible to dental diseases, but with proper home care and early detection of problems by your dental professional, postnatal problems will be minimal or non-existent -both for you as well as your baby. 

If you're pregnant or are considering becoming pregnant, it's important not to overlook oral health care. For some women, due to hormonal changes, pregnancy can increase their risks to dental disease. Dental disease apart from worsening the oral health condition, affects the growth and development of the growing baby. 

In general, because of the unique hormonal changes women experience, they can have an increased sensitivity to oral health problems. Gingival sensitivity and bleeding from oral debris and plaque, occasional discomfort during oral hygiene, tooth decay from dietary changes, periodontitis and oral malodor can all be influenced by hormonal changes in adolescence, during pregnancy, and menopause. Moreover, women are often "too busy" to give themselves good oral health care. Childcare, homemaking, careers, educational goals etc. keep women "too busy." Often women delay dental care because they feel they can't afford it. 

Oral disease symptoms you may experience are:

Bleeding Gums

This can be noticeable as early as 1-2 months into the pregnancy and is associated with a disease reaction caused by an increase in your hormone levels (estrogen) combined with the bacterial plaque or tartar present in your mouth. This often results in a condition called pregnancy gingivitis, which manifests as swollen, fiery red gums, which bleed while brushing or on slightest application of pressure. Often diffuse pain over the gums and teeth and bad-breath are found associated with the condition. If the gum disease is left untreated, it can advance to a condition called destructive periodontitis, which causes permanent loss of the bone that holds your teeth in your mouth diminishing your chance of keeping your teeth through out your lifetime.

Moreover, recent studies have proved that women afflicted with periodontal disease, are likely to deliver their babies prematurely. This was concluded after a meticulous study of more than 2,000 pregnant women. It was also found that periodontal problems in the mother lead to low birthweight in
babies. The women in the study had no other major risk factors for preterm birth, including genitourinary infections, tobacco use, and alcohol consumption. In the United States where the study was conducted, about 25 percent of preterm births occur without any known risk factors.

Pregnant women also are at risk of developing inflammatory, non-cancerous growths, which are initiated when swollen gums become irritated (Pregnancy tumor). The growths will generally shrink on their own over a period of time, although a dentist may decide to remove the growths if they cause chewing, brushing or other oral hygiene procedures to become uncomfortable.

Tooth Sensitivity & / or pain
There are several conditions that can result in tooth sensitivity and pain, but for proper diagnosis and treatment, it is always recommended to consult your dentist. The main causes are:

A. Dental Erosion
Dental Erosion is the wearing away of tooth surface caused by acids or chemicals. Those women affected by morning sickness (normally 8-12th. week of pregnancy) are most at risk to this condition. Stomach acids which come into the mouth as a result of vomiting or gastric reflux over an extended period of time can permanently dissolve the protective enamel from the surfaces of the teeth
leaving the tooth sensitive- often to hot/cold or sweet. If pressure or mechanical action is used, the acid tends to eat through the surface more rapidly. Thus erosion gets accelerated if a toothbrush is used immediately after vomiting.


B. Dental Recession
Dental recession is a permanent change in the gum height around the tooth that results in the exposure of the root surface of the tooth. The roots of your teeth are not covered by protective enamel and therefore can be sensitive to hot/cold/ sweet as well as being more susceptible to dental decay. The most common causes of this condition are improper toothbrush selection and/or a brushing technique employed that does not adequately remove thebacterial plaque at the gum margins. Again, when pregnant, you are more susceptible to gum problems due to the hormonal changes within your body leaving you more susceptible to gum recession.


C. Dental Decay 
As we all know dental decay can cause sensitivity in teeth and requires definitive treatment if the tooth is to remain in the mouth. This is why it is important to have your dentist diagnose exactly what is creating your sensitivity. There is no direct link between pregnancy and an increase in dental decay, but the decay rate does increase for some women during pregnancy.

There are several contributing factors , relevant factors here being -

1. Gagging
During the early stages of pregnancy, some women find it difficult to brush their teeth because the toothbrush or the toothpaste makes them gag. This makes cleaning of teeth difficult, which in turn increases tendency towards dental decay.
2. Dietary changes
Pregnancy can result in increased appetite and cravings. Frequent snacking particularly if your food choice is high in sugar content may result in a dramatic increase in you decay rate. 

Dental management during pregnancy
*It is ideal to consult a dentist if you're planning to become pregnant or suspect you're pregnant. Your dentist will examine you and map out a dental plan for the rest of your pregnancy. 

*The fourth to sixth months of pregnancy generally is the ideal time for any necessary non-emergency procedures. It's best to postpone non-emergency procedures during the first trimester to avoid anything that could affect the developing baby. The last trimester is often avoided because it can be uncomfortable for the patient to sit for extended periods.

*Obstetricians should always be consulted during any emergency that requires anesthesia or medication. In general, aspirin and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) should be avoided. Only X-rays that are needed for emergencies should be taken during pregnancy and any elective procedure that can be postponed should be delayed until after the baby's birth. If X-rays are essential, leaded aprons may be provided by the dental office to be worn by the pregnant mother, to prevent radiation exposure to the developing baby.

* Taking good care of yourself during pregnancy helps improve not only your own health but also the health of your baby. Remember that your baby's teeth and jaws begin to form at 5-6 weeks of pregnancy. Dental problems lead to improper food intake, which in turn affects the nourishment of the baby. Gum diseases are proven to cause pre-term births as well as low-birth weights. Untreated dental disease will also eventually cause a permanent loss of teeth.

* Daily brushing with a low-abrasive, fluoridated toothpaste (morning and night or ideally after every meal) using a soft-bristled brush, flossing in areas where the brush is unable to reach, a healthy diet, drinking plenty of water and regular dental visits will keep your teeth and gums healthy during and after pregnancy. Limit intake of sugars, starches and other food items, which promote dental decay. Preventive topical fluoride application procedures may also have to be carried out by your dental surgeon in cases where predilection towards dental decay is found. Defective tooth-brushing techniques should be identified and corrected. Routinely have the bacterial plaque and tartar professionally removed from the teeth by your dentist.

*In case of morning sickness, do not brush your teeth for at least 30 minutes after vomiting. Rinse with plain (tap) warm water after vomiting. Immediate brushing after vomiting will cause erosion of tooth surfaces.

*To prevent gagging, use of a small-headed toothbrush might help. Alteration of the brushing timings (rinse in the morning with water and brush at lunch time or morning tea and at night) may also help prevent gagging. You may avoid using toothpaste if it is found beneficial as long as the gagging lasts.

*A balanced diet should be had by the mother, which ensures good health for the mother as well as the developing baby. You may fix up your diet after discussing with your doctor. Your doctor may advise prenatal vitamins and mineral supplements also.

* It's a myth that calcium is lost from the mother's teeth and "one tooth is lost with every pregnancy."

 Dr. Prasanth Pillai K.S., BDS,MDS-OMFS.