Robert J. Buch, DDS, MD
There has been much confusion and many misconceptions regarding dentists providing and patients receiving dental treatment during pregnancy. According to a recent NY Times survey, 77% of OB-GYNs report patients who were declined dental services due to pregnancy. The same survey reported that 60-70% of pregnant women have gingivitis.
Providing needed dental treatment, managing oral disease, and controlling pain are essential functions of dentists for helping patients maintain overall health during pregnancy.
An overwhelming number of women do not recognize the importance of dental care during pregnancy and as a result, they do not seek care. Not enough obstetricians incorporate discussions of the necessity of routine dental care into their prenatal care visits. Worse yet, some dentists avoid treating pregnant women due to their misconceptions regarding the safety of dental treatment.
Dental care is not only safe during pregnancy but can also prevent long-term health problems for both the mother and child. The American College of Obstetricians and Gynecologists (ACOG) in a July 26, 2013 statement, advised OB-GYNs to perform routing oral health assessments at the first prenatal visit and encourage their patients to see a dentist during pregnancy.
Pregnancy brings about many changes in a woman’s body. Almost every organ system must adapt to the normal physiologic changes that occur during pregnancy. The oral cavity is not immune to these effects and changes. The increase in progesterone levels during pregnancy causes a decrease in the lower esophageal tone, as well as gastric and intestinal motility.
Additionally, as the size of the uterus increases, it displaces the stomach superiorly and increases pressure within the stomach. The combined effects of these anatomical, mechanical, and hormonal changes in the GI system increase the risk of gastric (stomach) acid reflux which causes tooth enamel erosion and significant gingival inflammation.
During pregnancy, the capillaries (small blood vessels) in the upper respiratory system become engorged, leading to edematous changes (swelling) in the soft tissues lining the nasal cavity and trachea. This results in nasal congestion and often forces the expectant mother into a pattern of open-mouth breathing, especially at night. Mouth breathing can lead to Xerostomia (dry mouth), which eliminates the protection against dental decay afforded by saliva. Oral x-rays are necessary to detect this dental decay in its early stages.
ACOG in its statement reassured patients that prevention, diagnosis and treatment of oral conditions including dental x-rays (with a lead shield) and local anesthesia (with and without epinephrine) are safe during pregnancy.
The American Academy of Periodontology recommends that pregnant women with periodontal disease receive treatment during pregnancy. Periodontal disease is the loss of bony support around teeth, usually as a result of prolonged swelling in the gum tissue, know as gingivitis. Gingivitis is commonly observed, beginning in the second month of pregnancy.
Altered fibrinolysis and increased levels of progesterone and estrogen in pregnant women causes an exaggerated gingival inflammatory response to local irritants such as plaque and calculus deposits. Without proper, regular cleaning, the gingiva (gum tissue) becomes red, swollen, tender, and bleeds easily.
In some individuals, the condition will develop into a pyogenic granuloma or pregnancy tumor of the gingiva. The maternal immune system becomes mildly depressed in response to the changes caused by pregnancy. There is a decrease in the activity of white blood cells and a compromise of other cell-mediated immune responses. As a result, infections can spread more rapidly and can potentially become more severe in pregnant patients.
Multiple studies have shown an association between periodontal disease, oral infections, and adverse pregnancy outcomes such as low birth weight and preterm labor. ACOG’s statement informed women that conditions requiring immediate treatment, such as extractions, root canals, and dental restorations (fillings), may be done at any time during pregnancy. Delaying treatment may result in more complex problems.
It is important that patients adhere to their regular dental hygiene practices and realize that dental care is safe and important throughout pregnancy. Maintaining a healthy lifestyle, including optimal oral health is essential for women who are currently pregnant or planning to become pregnant. Insist that your dental practitioners provide all necessary care for you during your pregnancy.