General
G eneral
Oral health care during pregnancy
Dr. Nishu Singla
1
Dr. Ritesh Singla
2
Assistant Professor Assistant Professor
Introduction
Pregnancy is not a reason to defer routine dental care or treatment.
Delay in necessary treatment could cause unforeseen harm to the
mother and possibly to the fetus. Appropriate and timely dental
care can lead to improved pregnancy outcomes as well as greater
comfort for the woman. The treatment of periodontitis, as well
as the use of local anesthetics, amalgams, and x-ray scans, does
not pose an increased risk to the developing fetus and is, in fact,
important in contributing to maintaining optimal health for mother
and baby. Several organizations have undertaken efforts to promote
oral health during pregnancy. The National Center for Education
in Maternal and Child Health published Bright Futures in Practice:
Oral Health1 (supported by the Maternal and Child Health Bureau) to
promote and improve the health and well-being of pregnant women
and infants. The intent of this paper is to provide the relevant
information on the oral health problems of the pregnant women.
This article can assist oral care professionals in the implementation
of oral health care and to achieve and maintain an optimal oral
condition in pregnant women.
Normal changes during pregnancy
Cardiovascular changes
Maternal cardiovascular response to pregnancy involves enormous
changes. During gestation, plasma volume and cardiac output
increase, peripheral vascular resistance decreases, and there is a
modest decline in mean blood pressure during mid-gestation. Due
to the enlarging uterus from about mid-pregnancy, women in the
64 GUIDENT  |  Your Guide on the path of Dentistry
Sept 2013
A Review
1
Department of Public Health Dentistry
2
Department of Orthodontics
Manipal College of Dental Sciences, Manipal, India
Pregnancy is a unique period in a woman’s lifetime.
Good oral health during pregnancy is important to the
overall health of both the expectant mother and her
baby. Oral health care should be part of comprehensive
prenatal care for all women and every general medical
practitioner should consider referral of a newly
pregnant woman to a dentist as routine. The aim of
this paper is to provide and distribute information to
dentist about the importance of maintaining oral health
during pregnancy.
Key Words: Pregnancy, Oral health.
supine position are at risk for aortic and venal canal compression by
the gravid uterus. Thus, avoiding the flat supine position, particularly
in a dental chair, by displacing the uterus laterally is important.2
Respiratory changes
As pregnancy progresses, the enlarging uterus assumes a
more important role in the alteration of respiratory functions.
Conformational changes in the chest (e.g., rise in the diaphragm)
may affect sleep patterns. Shortness of breath reflects increased
respiratory drive and airway edema.3 Total lung volume and lung
 Sept 2013
capacities are not greatly changed by pregnancy; changes are
primarily limited to the functional residual capacity (FRC), which is
decreased 15-20% in the woman at term, and tidal volume, which
is increased 30-40%.
Gastroesophageal changes
Pregnancy is also associated with pressure on the stomach caused
by the enlarged uterus. Heartburn, nausea and vomiting and rapid
satiety (feeling of fullness) are common. Heartburn is primarily a
result of decreased gastroesophageal junction tone and increased
gastric reflux. Stomach acid refluxed up through the esophagus and
into the oral cavity is a concern because excessive vomiting can
result in enamel erosion.4
Hematologic changes
Common hematologic changes during pregnancy include a mild
decrease in mean platelet count (gestational thrombocytopenia),
mild increases in mean white blood cell counts, and increased iron
demands secondary to increased erythropoiesis which requires
iron supplementation to maintain hemoglobin level and avoid
depletion.5
Medical Conditions and Dental
Treatment Considerations
Hypertensive Disorders and Pregnancy
Hypertensive disorders, including both preexisting or chronic
hypertension and gestational hypertension, occur in 12–22%
of pregnant women. Oral health professionals should be aware
of hypertensive disorders in pregnancy. Uncontrolled severe
hypertension may increase the risk of bleeding during dental
procedures. Prenatal care providers should be consulted before
initiating dental procedures in women with hypertension to classify
the type and severity of hypertension and to rule out preeclampsia
if indicated.6
Diabetes and Pregnancy
It is usually diagnosed after 24 weeks of gestation. Any inflammatory
process, including acute and chronic periodontal infection, can
make diabetes control more difficult. Poorly controlled diabetes is
associated with adverse pregnancy outcomes such as preeclampsia,
congenital anomalies, and large-for gestational age newborns.7
Meticulous control to avoid or minimize dental infection is important
for pregnant women with diabetes. Controlling all sources of acute
or chronic inflammation helps control diabetes.
Risk of Aspiration and Positioning During Pregnancy
Pregnant women have delayed gastric emptying and are considered
to always have a “full stomach.” Thus, they are at increased risk for
aspiration. After 20 weeks gestation, they should be maintained in
General
G
a semi-seated position or a pillow should be placed underneath the
eneral
right side of the body to allow left lateral uterine displacement off
the vena cava. This positioning is generally comfortable and will
help avoid hypotension, nausea, and aspiration.8,9
Dental Conditions and
Considerations
Tooth Decay
Tooth decay is a chronic bacterial disease that can affect all people
across all age groups. Pregnancy impacts oral health in several
ways. Changes in the woman’s diet and oral hygiene practices
during pregnancy can result in an increase in tooth decay. In
addition, nausea and vomiting during pregnancy can cause extensive
erosion of the tooth surface and lead to deteriorating oral health
status. Treatment of tooth decay in pregnant women cannot only
improve the overall health of the mother but also helps decrease
the transmission of dental caries causing bacteria from the mother
to the infant.10 Children whose mothers have poor oral health and
high levels of oral bacteria are at greater risk for developing dental
caries or tooth decay, as compared with children whose mothers
have good oral health and lower levels of oral bacteria.11
Pregnancy gingivitis
Periodontal treatment is very important during pregnancy. The
hormones that are released in the pregnant woman’s body make her
more susceptible to plaque and in turn gum bleeding12,13 (condition
known as pregnancy gingivitis). Many pregnant women mistakenly
think that gum bleeding is normal during pregnancy and they do
not seek dental care.10 The dentist has to inform the pregnant
woman and give her instructions on how to improve her oral health.
Furthermore, if necessary, more frequent visits to the dentist should
be scheduled.
Pregnancy epulis
A periodontal lesion characteristic during pregnancy is the pregnancy
epulis. The lesion is estimated to affect 0.2-5% of pregnant women
and is more common in the maxillary gingiva. It is a form of
pyogenic granuloma that is hormone related. Lesions may regress
spontaneously after birth. If not, they should be surgically removed.
If they are bleeding excessively and cause trouble in mastication
they may be removed with safety during pregnancy.14
Role of the Dentist
XX Explain the importance of oral hygiene and oral health care.
XX Explain that oral health care during pregnancy is safe and effective
and that it is essential for the pregnant woman and the fetus.
XX Tell women that diagnosis (including necessary dental X-rays15) and
treatment for conditions requiring immediate attention are safe during
the first trimester of pregnancy.
  |  GUIDENT
Your Guide on the path of Dentistry 65
General
G eneral
XX Inform women that necessary treatment can be provided throughout Conclusion
Sept 2013

pregnancy; however, the period between the 14th and the 20th week
of pregnancy is the best time to provide treatment.16 Advise women
that delaying necessary treatment could result in significant risk to the
mother and indirectly to the fetus.
XX Educate women and encourage behaviors that support good oral
health: Brushing teeth twice daily with fluoridated toothpaste,
especially before bedtime, and flossing daily. Taking prenatal vitamins,
including folic acid to reduce the risk of birth defects such as cleft lip
and palate, and eating foods high in protein, calcium, phosphorus and
vitamins A, C and D. Chewing xylitol-containing gum or other xylitol-
containing products, two to three times a day, after eating.
XX Position Pregnant Women Appropriately During Treatment: Keep the
head at a higher level than the feet. Place a small pillow under the
right hip, or have women turn slightly to the left to avoid dizziness
or nausea.
XX Consult with the prenatal care health professional when considering
the following: Deferring treatment because of pregnancy, Co-morbid
conditions or medication use (e.g., diabetes, hypertension, heparin
use) that may affect management of oral problems, Intravenous
sedation or general anesthesia to complete dental procedures.
XX Use the Following When Clinically Indicated: X-rays with thyroid collar,
and abdominal apron, Local anesthetic with epinephrine, Appropriate
analgesics and/or antibiotics.17 (Refer Table 1), Dental amalgam with
proper isolation and high-speed evacuation.18,19
Oral health care in pregnancy is often avoided and misunderstood
by dentists, physicians and pregnant women because of the lack of
information or perceptions about the safety and importance of dental
treatment during pregnancy. Prevention, diagnosis and treatment
of oral diseases, including needed dental radiographs and use of
local anesthesia, are highly beneficial and can be undertaken during
pregnancy with no additional fetal or maternal risk when compared
to the risk of not providing care. Good oral health and control of oral
disease protects a woman’s health and quality of life and has the
potential to reduce the transmission of pathogenic bacteria from
mothers to their children.
References
1. Casamassimo P, ed. (1996). Bright Futures in Practice: Oral Health.
Arlington, VA: National Center for Education in Maternal and Child
Health. Accessed on June 12, 2013 at: http://www.brightfutures.org/
oralhealth/pdf/index.html.
2. Duvekot JJ, Peeters LLH. Maternal cardiovascular hemodynamic
adaptation to pregnancy. Obstet Gynecol Surv. December 1994;49(12)
Supplement:S1.
3. Toppozada H, Michaeals L, Toppozada M, et al. The human respiratory
nasal mucosa in pregnancy. An electron microscopic and histochemical
study. J Laryngol Otol. 1982;96:613-626.
More references are available on request

Table 1: Acceptable and Unacceptable Drugs for Pregnant Women

These drugs may be used These drugs should NOT be
FDA Category FDA Category
during pregnancy. used during pregnancy.
ANTIBIOTICS B ANTIBIOTICS D
Penicillin B Tetracyclines B
Amoxicilln B Erythromycin in the estolate form C
Cephalosporins B Quinolines C
Clindamycin B Clarithrimycin
Erythromycin (extolate form) B
ANALGESICS B ANALGESICS
Acetaminophen C Aspirin C
Acetaminophen with codeine C
C
Codeine
B
Hydrocodone
B
Meperidine
Moephine
After 1st trimester for 24 to 72
hrs only B
Ibuprofen B
Naprosyn

66 GUIDENT  |  Your Guide on the path of Dentistry

Copyright of Guident is the property of Ivory India and its content may not be copied or
emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use.