Pregnancy and Oral Health

Pregnancy OHE Pregnancy is a time full of significant physical and emotional changes, and some of these changes can negatively impact oral health. Whilst this may not be a top priority to our patients at the time, it is important that we use every interaction throughout and after pregnancy to inform them of these changes and provide education on how to avoid long-term issues. This has become especially important to me following my own experience with pregnancy and recently welcoming my daughter. Even dental professionals are not immune from experiencing problems after such a huge life event!

This series will explore the changes that can occur during the first, second and third trimesters of pregnancy whilst also looking at the fourth trimester (the first 12 weeks after giving birth). It will also include some advice to support your patients during these stages.

First Trimester (1–12 weeks)

The first trimester begins on the first day of a missed period and lasts until the end of week 12.¹ The body is going through a huge amount of changes in these first 3 months but many people may not find out about their pregnancy until they are part way through this trimester. It is also common for patients not to disclose a pregnancy during a medical history check at this stage, as many will wait until after their 12-week scan. However, where patients do choose to disclose this information, we can provide some helpful oral health advice.

Fatigue and morning sickness is often one of the first signs of pregnancy. Sickness usually starts between weeks 4 and 7 and tends to settle by weeks 16 to 20. However, it can continue for longer and in severe cases may last the entire pregnancy.² Hormonal changes in the first trimester are thought to cause this sickness. Despite the name, morning sickness can occur at any time of day and it can make toothbrushing challenging, with some patients experiencing gagging or nausea whilst trying to brush their teeth. Frequent snacking is also recommended to reduce nausea, which can be triggered by hunger. Both of these can increase the risk of dental caries.

Periodontal disease that is not well controlled can negatively affect the unborn baby therefore it is really important that any existing periodontal conditions are regularly monitored by a dentist and/or hygienist.

The following advice can be given to reduce this risk:

Prioritise tooth brushing at night before bed and one other time of day.
Ensure any existing periodontal disease is under control. A dentist can support this.
If the taste of toothpaste triggers nausea, brushing with just water will still be beneficial as it will disrupt the plaque biofilm.
Use a fluoride toothpaste. A dentist may prescribe high-fluoride toothpaste if you are at particularly high risk.
Consider introducing a fluoride mouthwash to use at a separate time to brushing for an extra hit of fluoride.
Do not brush teeth within 30 minutes of being sick. The mouth is still acidic at this point. It is therefore better to rinse with water or mouthwash within this time period.
Try to consume tooth-friendly snacks such as vegetable sticks and low-fat cheese.

It is possible to have a severe form of pregnancy sickness known as hyperemesis gravidarum. This may require hospital treatment. It is unlikely that patients suffering from hyperemesis gravidarum will prioritise a dental visit. However, the above advice can be provided for any who do, as these patients will be at the additional risk of experiencing erosion from frequent vomiting.

Second Trimester (13–27 weeks)

The second trimester is often when most people feel at their best. Many will have announced their pregnancy at this stage, a small baby bump may begin to appear and hopefully the morning sickness and fatigue have improved or resolved. With this can also come an increased appetite and cravings for particular foods. These cravings can be for weird and wonderful foods. Often these are not very tooth-friendly! This can increase the risk of dental caries.

Patients may notice their gums are bleeding more easily during brushing. This is caused by an increase in oestrogen and progesterone during pregnancy.³ It is important that patients understand that this is common in pregnancy, and they should not avoid brushing or interdental cleaning as this can cause long-term periodontal problems in the future. In some cases, pregnancy can cause a lump to form on the gum known as a pregnancy epulis. This is harmless and does not require treatment but can look unsightly and can bleed on brushing.⁴ A dentist may choose to review this after pregnancy but otherwise there is no treatment required.

The following advice would be ideal to provide at this stage:

Whilst dental treatment is often postponed until after pregnancy, the second trimester is the ideal time to book and attend a dental check-up and a hygienist appointment if required. Not everyone is aware that NHS dental treatment is free during pregnancy and for 12 months after giving birth.⁵
Resume a good oral hygiene routine by brushing twice daily with a fluoride toothpaste and cleaning interdentally once daily.
Cravings don’t have to be ignored, but you can try to reduce the damage to your teeth by rinsing with a fluoride mouthwash after eating.
Continue brushing and interdental cleaning regardless of any bleeding.
If you experience a pregnancy epulis, you can obtain reassurance from dental professionals that this is related to hormones and should resolve after pregnancy.

Third Trimester (28–40 weeks)

The third trimester can be a challenging time for many mums-to-be. The baby grows rapidly during this time, which can cause indigestion, back pain, swelling of joints and fatigue. Patients are busy with maternity appointments and final preparations for their new arrival at this stage, so it is unlikely that a dental appointment will be prioritised. Lying flat in the dental chair is also not recommended. The growing baby can create a feeling that there is less room in the stomach for food. This may lead to a habit of eating little and often, which may increase the risk of dental caries.

The following advice can be given during the third trimester:

Now is a good time to stock up on oral hygiene aids such as toothbrushes, toothpaste and interdental cleaning aids before the baby arrives.
Try to maintain a healthy diet and keep sugary foods and drinks to meal times as much as possible.
Try to carry out a good oral hygiene routine before the evening tiredness starts to creep in.

Fourth Trimester (12 weeks following birth)

The fourth trimester often isn’t spoken about but I have found this to be the most challenging time when it comes to maintaining any kind of routine. Some days it can be difficult to find the time to have a shower, let alone perform a full oral hygiene routine twice a day. Newborn babies are not able to follow a routine for at least the first 12 weeks, so the days can feel like one big sleep-deprived blur. Let’s explore some of the specific challenges that may affect oral health during this time.

Babies wake several times during the night for the first few months. These sleepless nights take their toll on new parents and sometimes it is easy to favour a sugary snack over a healthy alternative during the day for a quick burst of energy. Waking up several times a night can be hungry work, so it also isn’t uncommon for a few snacks to be consumed. At this time, saliva levels in the mouth are low, which can increase the risk of caries. Breastfeeding mums will also be required to consume more calories whilst feeding their babies, which is likely to increase snacking behaviours. It is important that we show understanding of this challenging time and provide realistic advice rather than showing any judgement.

Looking after a newborn can be a big shock to the system, which places a lot of stress on new parents. This can lead to bruxism during the night and clenching during the day which may cause attrition.

The following advice can be given at this stage to support new parents with their oral health:

Prioritise brushing the teeth at night time and one other time of day. The teeth don’t necessarily need to be brushed first thing in the morning.
Practise mindful brushing and really concentrate on brushing all surfaces of all teeth. It can be tempting to scrub the teeth as quickly as possible when you have other things to prioritise.
Consider a nightguard if there are signs of bruxism. Where possible, it may be helpful to practise some relaxation techniques before bed such as meditation or yoga. This can also be done in the future when the baby is older.
Try to book a dentist appointment for a check-up.
Try to keep on top of your oral hygiene aids. Order some online if a trip to the shops isn’t possible in the early days.
Consider healthy alternatives to sugary foods and drinks. These will help energy levels in the long term as well as helping to reduce damage to the teeth.

Pregnancy and looking after a newborn baby is a huge life adjustment and with this comes the need to prioritise caring for the baby. This occasionally requires us to sacrifice caring for ourselves. Oral health should be seen as a form of self-care and hopefully with the advice outlined in this article we can support our pregnant patients through their journey into parenthood and, as a result of this support and education, minimise any oral health problems.

Written by Melanie Pomphrett RDH, MSc, PGCert

References

Tommy’s (2024). Everything you need to know about the first trimester (weeks 1 to 12). Online at: https://www.tommys.org/pregnancy-information/im-pregnant/pregnancy-calendar/first-trimester-weeks-1-12).

NHS (No date). Morning sickness. Online at: https://www.nhs.uk/start-for-life/pregnancy/morning-sickness/#:~:text=Morning%20sickness%20begins%20early%20in,the%20causes%20of%20morning%20sickness

Healthline (No date). What to Know About Bleeding Gums During Pregnancy. Online at: https://www.healthline.com/health/pregnancy/bleeding-gums-pregnancy

British Society of Periodontology (No date). The Relationship Between Oral Health and Pregnancy: Guidelines for oral-health professionals. Online at: :https://www.bsperio.org.uk/assets/downloads/Guidelines_for_oral_health_professionals.pdf

NHS (No date) Get help with dental costs. Online at: https://www.nhs.uk/nhs-services/dentists/get-help-with-dental-costs/#:~:text=Pregnant%20women%20and%20women%20who,or%20your%20baby's%20birth%20certificate.

Resources

Oral Health Foundation (2018). Six things every new mum needs to know. Online at: https://www.dentalhealth.org/news/oral-health-and-pregnancy-six-things-every-mum-needs-to-know