As beautiful and exciting as it is, growing a tiny human and nurturing a new life is an experience that does not come without challenges. During pregnancy, a woman can expect a bevy of relentless physical changes to sweep through her body: exhaustion, morning sickness, food aversions, mood swings, swollen hands and feet, and much more.
Undergoing these myriad biological changes is no mean feat. It can pretty much feel like a nine-month endurance test of strength and stamina, from bearing the extreme fatigue in the first trimester to the breathlessness and never-ending back ache in the third.
But what happens to her teeth and gums during this time?
Let’s find out.
A cascade of hormonal, immune, and metabolic changes orchestrate the development of a healthy fetus. These changes exert a notable impact on your oral environment that could be harmful to you and the baby if you don’t take your oral health seriously.
By the way, did you know that pregnancy could affect your oral health? If you didn’t – well, you’re not alone. A staggering 40% of women have never heard of a possible connection between pregnancy and oral health, a 2024 study finds.
And we’re here to help you with precisely that – keeping it all under control in the oral territory.
What Causes These Changes in the Oral Cavity
Let’s zero in on the culprit that causes the most trouble for now. You guessed it right: Hormonal fluctuations.
Increased levels of estrogen and progesterone, the essential hormones that help the fetus grow and develop, are responsible for most of the changes that occur in your mouth.
That said, we can’t blame it all on hormonal imbalances. Your dietary choices and oral hygiene practices have an equally significant role to play in shaping your oral environment during these months.
A study published in BioMed Central that evaluated how much pregnant women knew about the importance of oral health during pregnancy showed the following results:
- 24% lacked any sort of awareness on the matter,
- 41.5% complained of dental issues during their pregnancy, and
- 32% observed their oral health deteriorate.
The good news?
Being aware can help you recognise these changes and deal with them in a way that minimises discomfort, makes your pregnancy easier, and protects your oral and general health and that of your baby.
The Oral Manifestations of Pregnancy
We asked Dr Ihsaan Al-Hadad, an oral surgeon at Zental, an award-winning holistic dental clinic based in London, about the most common dental complaints pregnant women presented with at his practice and what could be done about it.
We’ve put it all together for you below.
Pregnancy Gingivitis
One of the most common oral health complaints during pregnancy is swollen and bleeding gums – the two very distinct features of gingivitis (mild gum disease).
There may also be other symptoms present, including:
- Redness
- Tenderness
- Shiny gum surface
- Bad breath
Pregnancy gingivitis affects nearly 60-70% of pregnant women, but the good news is that it is completely reversible. This means that even if you do experience gum discomfort during this period, you won’t have to live with it after it is over.
Now, how exactly do hormonal changes make your gums throw a pregnancy tantrum?
- They make your teeth more susceptible to accumulating plaque or ‘gunk’, which in turn irritates the gums. Irritated gums can often lead to symptoms of inflammation like swelling or bleeding.
- They increase the blood flow to the gums and alter the way your gum tissue reacts to the irritants in plaque. As a result, your gums can become red, tender, swollen, and more likely to bleed during brushing and flossing.
- These hormones, particularly progesterone, disrupt the microbial balance in your mouth by encouraging the growth of bacteria like Porphyromonas gingivalis and Prevotella intermedia, species notorious for worsening gum disease.
These symptoms are most common during the second trimester and onward.
‘We recommend more frequent professional cleanings during your second or early third trimester to help reduce the chance of developing gingivitis,’ says Dr Ihsaan.
Will this condition affect your baby?
There is no evidence that mild gum disease can harm the fetus or cause any complications during pregnancy. However, if left unaddressed, it can progress to periodontitis or severe gum disease, and that can have some very alarming consequences, including pre-eclampsia, preterm delivery or a low birth weight of the baby.
A case-controlled study revealed that women with periodontitis were at six times the risk of giving birth to premature birth infants compared to women with no periodontitis.
A cohort study of preeclamptic women showed that 49.3% of patients with mild periodontitis and 82.6% of patients with moderate to severe periodontitis delivered preterm.
How do things escalate?
Researchers believe that during periodontitis, the number of chemical messengers released by your immune system (pro-inflammatory cytokines) that signal your body to ‘turn up the inflammation’ goes up. This may offset systemic inflammation throughout the body, including the placenta, which may affect the development of the fetus.
What You Can Do
Prevention
Prevention is always much better than a cure when it comes to matters of the mouth, and should be taken even more seriously when you are pregnant.
A good oral health routine should involve brushing last thing at night and at least one other time during the day with fluoride toothpaste, flossing, and regular visits to the dentist. Regular dental visits will allow you to stay on top of your current oral health situation and mitigate any potential risks for complications.
If you’re due for a visit to the dentist, being pregnant shouldn’t be a reason to skip it. You can book one now at Zental, a holistic dental practice in London and Milton Keynes.
Dietary changes
One of the easiest changes you can make to care for your oral health is your diet, especially during pregnancy.
Cutting down on how often and how much sugar you consume can dramatically reduce your risk of tooth decay. Switching to natural sugar sources like fresh fruit and vegetables is a great alternative that can help you curb those sugar cravings and take better care of your teeth.
Professional Treatment
Gum disease that doesn’t get better on its own needs to be seen by a dental professional in order for it to be treated properly. If you do have signs of progressive gum disease, you can be assured that it can be treated safely during pregnancy.
This treatment typically involves a deep cleaning under the gums to remove any bacteria. And it’s now more than ever, during your pregnancy, that you need professional cleaning appointments. You may also be given suitable antibiotics to get rid of any infection.
The only risk associated with this procedure is slight soreness of the gums, which shouldn’t bother you too much.
Pregnancy Tumours (Pyogenic Granulomas)
Around 5% of pregnant women develop a pregnancy tumour, mostly in the gum tissue between the teeth. Although it may sound alarming, it really isn’t. It is a benign overgrowth of gum tissue that has a raspberry-like appearance and commonly appears in the second or third trimester.
According to a 2023 study, it forms as a result of the high levels of progesterone that make your gums more sensitive to irritation and increase plaque accumulation and gum inflammation.
This non-cancerous growth may bleed easily and make it difficult to chew comfortably. It may grow in size, from a few millimetres to several centimetres, over time, but usually does not grow bigger than 2.5 cm.
What You Can Do
In most cases, a professional dental cleaning, along with strengthening your home care routine, will help reduce inflammation.
Professional intervention: Your dentist can remove the growth surgically. ‘If you have severe symptoms or the swelling is causing too much discomfort, your dentist may decide to surgically remove the lesion,’ Dr Ihsaan said.
As it is caused by hormonal imbalances during pregnancy, a pyogenic granuloma will resolve on its own once the baby is born.
Dry Mouth (Reduced Salivary Flow and pH)
A recent study that included pregnant women in different trimesters showed that the pH levels and the flow rate of saliva gradually decreased from the first to the last trimester.
If you’re wondering what roles those two factors play in keeping your teeth healthy, let us break it down for you.
The pH of your saliva guards your oral health by making your oral environment as hostile and unhospitable as possible for harmful bacteria to thrive. It protects the enamel of your teeth by acting as a natural buffer and neutralising the acids produced by the bacteria. The more protected your enamel is, the better it is able to shield itself from damage and decay.
A healthy salivary flow gives your teeth and gums a nice wash, removing any food debris or acid left stuck there and cleansing the area while also ‘infusing’ the teeth with minerals that help strengthen them. ‘Think of it like your body’s natural rejuvenation treatment for your teeth. It’s like those glow-up treatments you normally get for your skin – but without the price tag,’ commented Dr Ihsaan.
A dry mouth can encourage the formation of cavities and worsen gum disease.
What You Can Do
Drink plenty of water to keep your mouth hydrated. Chewing on sugar-free gum or candy can also help stimulate the flow of saliva.
Your dentist may recommend saliva substitutes.
Dental Erosion
While we all know how common it is for pregnant women to experience morning sickness, particularly in the first trimester, not many know of the oral side effects of it.
When you throw up, your teeth are exposed to the acid from the regurgitation.
Gastric acid has an extremely low pH (~1.5-3.5), meaning that it is disastrous for your tooth enamel. It can cause the enamel to erode and weaken your teeth.
Oh, and remember those salivary changes we talked about earlier? They only make matters worse.
The reduced buffering capacity of the saliva, coupled with its low pH (acidic saliva), exerts a cumulative damaging effect. It causes the enamel to lose protective minerals and erode (low pH) and decreases the ability of the teeth to protect themselves against the effects of acid (weak buffering ability).
Also worth mentioning here are those cravings for pickles, chocolate, and ice – which, astonishingly, are craved by pregnant women all over the world, according to the top Google searches for the most-craved-for foods in various continents.
These foods, in all their sweet and acidic glory, bring only more bad news for your teeth.
What You Can Do
Try to rinse with fluoride mouthwash or water after vomiting, and do NOT exercise haste when reaching for your toothbrush.
‘Wait at least 30 minutes before you brush,’ recommends Dr Ihsan.
Your already-weakened tooth enamel will only be further damaged if you brush it any sooner.
Giving it time can allow it to remineralise and gain back some of its lost strength.
If morning sickness makes it difficult for you to brush your teeth, try changing to a bland-tasting toothpaste. Your dentist or hygienist can recommend a suitable brand.
Professional intervention:
If you’ve lost a significant amount of enamel, you might need a filling or a crown to repair the damage and protect the remaining tooth structure.
Tooth Mobility (Loose Teeth)
If you notice your teeth feeling loose or feel as if the regular alignment of your teeth has changed, you might be experiencing one of the unexpected but quite common side effects of pregnancy: tooth mobility.
One of the lesser-known hormones produced during pregnancy is relaxin, which aids in softening muscles, joints, and ligaments. Its main job is to loosen the muscles and ligaments in the pelvis to help with childbirth, but it can also affect the periodontal ligaments surrounding your teeth.
If you’re wondering what a ‘periodontal ligament’ is, here’s an easy explanation:
It is a complex support system that holds our teeth securely in their sockets. Instead of being fused rigidly to the jaw, as you might have imagined, each tooth root is surrounded by a periodontal ligament within its socket. This ligament is largely composed of flexible connective tissue and attaches to both the root of the tooth and the jawbone, securing the tooth in place. Its flexibility helps cushion your tooth from pressure and sudden impact.
It’s, therefore, not uncommon to find that your teeth feel a bit looser, your natural tooth alignment has changed, or you’re experiencing discomfort in your jaw joint (especially if you have a habit of grinding or clenching your teeth).
What You Can Do
Fortunately, while wobbly teeth can be alarming, it’s most often only temporary. Your teeth and ligaments should return to their normal state after your baby is born.
However, because dental health can affect fetal health and development, be sure to see a dentist if you notice any changes in your smile. It’s best to rule out any other causes of tooth mobility, which can include gum disease, tooth abscesses, or other serious conditions that could cause tooth mobility.
Words of Advice
Don’t let your dental neglect take a toll on your or your baby’s health. Learn how you can manage these symptoms effectively to safeguard yourself and your baby during these precious yet critical months.
- Inform your dentists when you learn about your pregnancy. They can offer valuable suggestions for caring for yourself and your dental health during this time.
- Keep up with your dental hygiene. Brushing and flossing are key to keeping your gums healthy.
- As your gums might be more prone to gingivitis now, extra cleanings as needed can keep plaque from building up and triggering trouble.
- Don’t forget to show up for your regular dental appointments for exams and cleanings. Your dentist wants to do their best to help prevent any small problems from progressing into serious concerns.
Parting Note
‘Oral problems during these nine months of pregnancy can be unsettling,’ says Dr Ihsaan Al-Hadad. ‘Educating women on the potential reasons for these changes they are experiencing can be incredibly affirming during this challenging time.’
Now that you have all the evidence and information you need to care for your teeth and gums while pregnant, we know you can do it!
Remember: you’re smiling for two now.
To help you take better care of your teeth and gums, consider scheduling an appointment at Zental – a practice run by holistic dental professionals who excel in treating oral health issues in a way that makes you feel and look good from the inside out.
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