Oral Health in Pregnancy

During pregnancy your body will experience many changes, some expected and some not so much. There are quite a few myths out there about pregnancy and it's effects on your oral health, whilst they may not all be entirely factual, it's important to know ways in which pregnancy can impact the mouth and talk about things to expect that may have otherwise been ignored, or embarrassing to ask about. I've caught up with Midwife Pip to talk all things healthy mouths during pregnancy, what’s normal and our top tips for a positive experience with pregnancy and your mouth.





Yes, your gums may bleed...

From the early stages of pregnancy your body produces higher level of many hormones, one being progesterone. Progesterone is a hormone which stimulates the blood vessels that supply the lining of the uterus, this allows your growing baby to get the nutrients it needs. It also allows the uterus to grow to accommodate your growing baby by inhibiting smooth muscle fibre contraction and it helps to prevent lactation until late pregnancy or after birth. However, it also causes your blood vessels to retain more fluid, and in turn increases their size, meaning they become fuller and leakier, and also sit closer to the gum surface. All of this means your gums are likely to bleed easier if you catch them with floss or a firm toothbrush head.


- Rosie says: bleeding gums is common during pregnancy and can often be scary if unexpected, the most important thing is that you don’t let the bleeding stop you from maintaining a healthy mouth. up your home care routine with daily flossing, and switch to a soft head toothbrush, make sure you are brushing for at least two minutes twice daily, don’t let the site of blood put you off, top oral hygiene is key for prevention.


- Pip says: We hear so much about all the changes that occur to women’s bodies during pregnancy, but we do not often consider the changes that occur in our mouths. During pregnancy it is really important to attend your routine dental health check-ups and given that pregnant women and women who have had a baby in the last 12 months get free NHS dental treatment there really is no reason not to.


Pregnancy gingivitis

Pregnancy gingivitis is a common condition experienced during pregnancy and involves a heightened inflammatory response to plaque bacteria causing your gums to become inflammed, sore, red and bleed more when brushing and flossing. Gingivitis is the earliest form of gum disease that occurs in response to bacterial plaque, luckily gingivitis is entirely reversible and will not cause permanent damage if treated in the early stages. The difference with pregnancy gingivitis is that due to elevated hormone levels, the inflammatory response can be triggered quicker and more severely. If you already suffer with gingivitis or a more advanced form of gum disease then pregnancy hormones can elevate the disease activity causing the disease to progress, so it’s a good idea to visit a dental professional regularly for tailored care.


- Rosie says: pregnancy gingivitis is common and shouldn’t mean your oral health needs to deteriorate, keep on top of your homecare routine and opt for a round-oscillating head electric toothbrush and daily interdental cleaning. A water flosser may help alongside your flossing efforts. I would recommend a visit to a dental hygienist/therapist at some point during your pregnancy who can assess your oral health needs and provide the best advice and treatment specifically for you.


- Pip says: Gingivitis is also the result of our Progesterone surges in pregnancy, you may begin to notice symptoms from as early as 8 weeks, but it is generally most common in the third trimester. Pregnant women are at an increased risk of both tooth decay and experiencing loose teeth so keeping your gums and teeth healthy really should feature on your pregnancy priority list.



Excessive drooling

Did you know that you may experience excess saliva flow or drooling overnight during pregnancy? Apparently, this is due to the presence of the pregnancy hormone oestrogen, causing an increase in blood flow leading to increased saliva production! Who said pregnancy wasn’t glamorous huh?!


- Rosie says: although waking up with a wet patch on your pillow probably isn’t part of the pregnancy glow you were expecting, increased saliva flow isn’t at all a bad thing for oral health! Saliva acts as a natural buffer for acids in the mouth literally reversing the presence and damaging potential of foods you have eaten that day, think of it as a natural mouthwash rinsing away debris and cancelling out sugars from your diet.


- Pip says: If it isn’t our breasts that are leaking it’s our mouth that’s drooling- oh the joys! But oestrogen is actually a very important pregnancy hormone despite its salivation side effects. It helps the womb (uterus) to grow, maintains its lining and supports the baby’s' development including the development of organs and body systems.



Managing morning sickness

Morning sickness is a condition many women suffer with during their pregnancy and even though the title suggests so, it is not usually limited to the mornings. Many women talk to both myself and Pip during our appointments about their struggles with nausea and sickness, leaving them feeling even more exhausted, grazing on certain foods and often unable to brush at their usual times.


Morning sickness is believed to be due to the surges in hormones particularly human chorionic gonadotropin in early pregnancy. This is the hormone that gives you the blue line on your pregnancy test! Its levels rise after conception and peak at 8-11 weeks, it supports the ovarian corpus luteum, which in turn supports the endometrial lining and therefore maintains the pregnancy until the placenta takes over in the second trimester. When the placenta takes over symptoms generally improve. The term ‘morning’ is very misleading though as symptoms can often be at any time of day and it is very common affecting around 85% of pregnant women.


Frequent vomiting can create a more acidic environment in the mouth leading to increased enamel erosion, and the frequent smaller snacking/grazing can also cause a spike in the natural pH in the mouth, increasing the risk of tooth decay and gum disease.

- Rosie says: although easier said than done, try keep that oral hygiene routine as regular as possible with a 2 minute brush twice a day and regular interdental cleaning. Try to delay morning meetings and appointments including the dentist to later in the day where sickness is sometimes less severe, have an extra brushing session mid afternoon, increase healthy mouth habits such as frequent sipping of water through the day to stay hydrated and neutralise those acids, chew sugar free gum between snacks and keep snacks refined sugar-free such as crackers and cheese.


- Pip says: Stabilising blood sugars is key to managing symptoms- eating something small before you go to bed and before you first get out of bed in the morning as well as having small, regular meals including complex carbohydrate sources throughout the day. Light exercise in fresh air can be helpful and eating cold over hot meals especially if the smell of cooking triggers your nausea. It’s really important you stay hydrated, but you may need to get inventive. Try small, regular sips of fluid, sucking on ice lollies, ice cream frozen fruits or ice cubes may be easier to tolerate. For 1-3 in 100 women morning sickness is severe and develops into Hyperemesis Gravidarum- If you are unable to tolerate oral fluids or diet, feel dizzy, vomiting constantly, feel dehydrated you should seek medical advice as you may require hospital admission.


Cravings

Some people experience cravings which results in the urgent desire to snack on something entirely random, whether is be that chocolate bar hiding behind the milk in the fridge door, or the need to chew on ice cubes.


- Pip says: There is no definitive reason why pregnancy cravings may develop and there is no evidence directly linking pregnancy cravings with nutritional deficiencies. It is okay to give into your cravings, what is important is to ensure your diet is a balanced and nutrient rich one.


- Rosie says: keep any snacking sessions quick and follow with drinking water and sugar free gum to neutralise those diet acids, keeping snacking as close to meal times as possible is best as it reduces the number of acid attacks on the teeth hence causing less long term damage.


Your dental visit during pregnancy

Just like your midwife appointments, it is still advisable to attend your dental check ups and hygienist appointments during your pregnancy. Your dental professional will can check Carefully for the early signs of gum disease or tooth decay, as well as screen for abnormalities in the mouth, and advise on the appropriate treatments. The use of dental x-rays may be avoided if not urgent although you have the right to decline these whether pregnant or not. Elective dental treatments may also be postponed until after baby is born. Although there is no evidence against this, tooth whitening is not carried out during pregnancy or and breastfeeding due to the potential risk of harm to the baby. Always let your dental health professional know how far into your pregnancy you are so that the best and tailored are can be provided.


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