The Importance of Oral Health During Pregnancy

Guest post by Maral Hindoyan, an intern with LA Best Babies Network’s Policy Team, and MPH candidate at UCLA Fielding School of Public Health. See Maral’s related post, Childhood Dental Coverage and Facts, on the L.A. County Perinatal and Early Childhood Home Visitation Consortium website.

In the United States, only 46% of pregnant people report having received a dental exam and routine cleaning during pregnancy.¹ In 2012, the Surgeon General and the Institute of Medicine declared routine cleanings, X-rays, exams, and necessary dental treatment as a safe and effective measure for pregnant people to engage in, regardless of the trimester they are in.^2–4 These treatments have no adverse effects or contraindications for the birthing person or the child.

Effects of Poor Oral Health

Dental visits are crucial during pregnancy, as habits, hormone levels, poor oral hygiene and a reduced salivary flow can directly compromise both the pregnant person’s health and the baby’s health.^2–5

Pregnancy Gingivitis and Periodontitis

Pregnancy gingivitis, including bleeding and inflammation of the gums, and pregnancy granulomas, a small area of inflammation that appears as a soft ball, are common, due to the increased level of hormones in the body.^3,4 The body’s immune system naturally reacts to plaque bacteria in the form of inflammation, but due to the increased hormone levels during pregnancy, it causes an exaggerated immune response.^3,4 It is essential for gingival disease to be monitored by a dental professional, as the progression of this disease leads to periodontitis.^3,4 Periodontitis is irreversible as it destructs the bone, and reduces the bone level and soft tissue that supports the teeth.^1,3,4

Pregnant people experiencing gingivitis or periodontitis are at a higher risk for low birth weight, preeclampsia, premature labor, and gestational diabetes.^1,3,4 A 2019 study found that people diagnosed with periodontitis during pregnancy were twice as likely to have a child with low birth weight.³ Additionally, people that did not get a cleaning during their pregnancy were 23% more likely to have a preterm delivery.^1,3,4 Periodontitis is also associated with an increased risk for gestational diabetes mellitus, which increases the risk for fetal complications and pregnant people’s risk for developing type 2 diabetes later in life.¹

Tooth Decay and Erosion

The integrity of the tooth structure is also important.² As hormone levels fluctuate during pregnancy, cravings and high-sugar diets are common.^2,4 Without good oral health, this can increase the risk of tooth decay. Tooth decay is primarily caused by cariogenic bacteria and the consumption of sugar.⁶ The cariogenic bacteria, known as Streptococcus mutans (the cavity-causing bacteria), can be transmitted to the fetus, which increases the chances of early childhood caries.^2,4 Pregnant people who have untreated tooth decay increase the chances of their child having tooth decay by three-fold.⁵ Morning sickness, which exposes the teeth to an increased level of acid, can cause tooth erosion, which removes the enamel (the protective layer of the tooth), increasing the chances of cavities.⁴

Maintaining Good Oral Health

In all, there is a misconception that dental cleanings, fillings, and other treatments are risky during pregnancy.² But the converse it true: Good oral health is key to a healthy pregnancy, delivery, and the overall health of the pregnant person and child. To maintain good oral health, it is important for pregnant people to:

1. Establish a dental home (find a dentist)
2. Visit the dentist for a routine exam and cleaning
3. Brush their teeth twice a day and floss once a day
4. Use fluoridated mouth rinses
5. Rinse their mouth with water and a teaspoon of baking soda if they vomit

Related Resources

• LABBN’s webinar on Oral Health in the Perinatal and Early Childhood Periods (04/2022)
• Dental Care During Pregnancy Based on the Pregnancy Risk Assessment Monitoring System in Utah (BMC Oral Health, 11/2019)
• Women’s Awareness Regarding the Use of Dental Imaging During Pregnancy (BMC Oral Health, 07/2021)
• Pregnancy and Oral Health (JADA, 03/2021)
• Oral Health Resource Bulletin (National Maternal and Child Oral Health Resource Center, 11/2022)
• Oral Health in Infants, Children and Pregnant Women (WIC)
• Oral Health Resources for Families (Head Start)
• SmileCalifornia.org:
  • About Medi-Cal Dental
  • Find a Dentist
  • Medi-Cal Covers Dental During Pregnancy brochure
  • Medi-Cal Covers Dental During Pregnancy flyer
  • Medi-Cal Covers Dental During Pregnancy video

References

1. Improving Access to Dental Care for Pregnant Women through Education, Integration of Health Services, Insurance Coverage, an Appropriate Dental Workforce, and Research (APHA, 10/2020)
2. Dental Care-Seeking and Information Acquisition During Pregnancy: A Qualitative Study (IJERPH, 07/2021)
3. Factors Associated with Preventive Dental Visits Before and During Pregnancy (J Womens Health, 05/2019)
4. Oral Health in Pregnancy (JOGNN, 07/2016)
5. Pregnancy and Oral Health (CDC, 03/2022)
6. Cavities/Tooth Decay: Symptoms and Causes (Mayo Clinic, 03/2022)