Pregnancy and its Effects on
Oral health
Pamela Rettig RDH, MS
Indiana University School of Dentistry
Objectives
 At the completion of this session the audience will be
able to :
 Identify the clinical and oral health changes associated with
pregnant patients
 Understand the importance of preventive care during
pregnancy
 Discuss alterations in dental care for the pregnant patient.
What Happens During Pregnancy?
 Lowered Immune response to specific dental disease
 Increased Risk for Diabetes
 Associated with periodontal disease
 Changes in dietary habits
 Need to alter treatment of dental disease
Pregnancy and Gingival Disease
Clarification
Pregnancy itself does not cause
gingivitis or periodontal disease.
Gingivitis and periodontal disease
in pregnancy is caused by bacterial
plaque. Pregnancy accentuates
the gingival response to plaque.
What is it gingivitis clinically?
Gingivitis is an early stage of
periodontal disease causing the
gums to swell.
Gingivitis is a reversal condition
that can be treated by the
debridement of dental plaque
Research shows
 Gingivitis present 50-100% during pregnancy
 Severity of gingival disease increases during pregnancy in
second and third trimesters
Pregnancy Gingivitis
Red gums
Pregnancy Gingivitis
Pregnancy Gingivitis
Edema
Pyrogenic granuloma
What happens if Gingivitis is
untreated?
Periodontal Disease
Gums separate from the tooth forming
pockets and depended spaces.
Bone and supporting soft tissue are
destroyed
Teeth can become loose
Contributing Factors During
Pregnancy
Poor Oral Hygiene
Diabetes
Smoking
Pregnancy Increased Risk
 Increase in estrogen and progesterone
 Alters gingival connective tissue response and immune
response to oral bacteria
What is the big deal with gingival
disease and pregnancy?
Adverse Pregnancy Outcomes
Premature delivery
Low birth weight infants
Gestational diabetes
Preeclampsia
Data
A systematic review of the literature in
2006 examined the relationship between
periodontal disease and adverse
pregnancy outcomes:
44 studies 29 suggested an increase
risk in adverse pregnancy outcomes
15 studies showed no association
Preterm Deliveries/Low Birth Weight
 Periodontal disease provides a source of gram negative
anaerobic organisms and bacteria
 Triggers release of immune modulators – stimulates
prostaglandin E 2
 Can trigger uterine contractions
 Periodontal disease increases C-reactive protein plasma
levels which can induce labor
Periodontal Disease and
Gestational Diabetes
 American Diabetes Association indicates gestational
diabetes exists with 1 – 14% of all pregnancies
 Individuals with diabetes are more likely to have
periodontal disease
 Periodontal infections may adversely affect glycemic
levels
 Pregnant women with periodontal disease are more likely
to develop gestational diabetes than those women with
healthy gums
Research
 A study followed 256 women through their first six months
of pregnancy
 22 women developed gestational diabetes
 Women with diabetes had higher levels of periodontal
bacteria than those without gestational diabetes
Preeclampsia
 Complication of pregnancy
 Cause perinatal mortality
 5-8% of all pregnancies
Periodontal Disease and
Preeclampsia
 Periodontal pathogens can travel to the uteroplacental
area
 Placental inflammation / oxidative stress
 Placental damage leading to preeclampsia
 Preexisting preeclampsia can be aggravated by
periodontal disease
Research
 A case control study found that 82% of preeclamptic
women had severe periodontal disease.
Dental Erosion
• Occurs after
extensive vomiting
• Acid attacks teeth
• Loss of enamel
Dental Caries
Pregnancy changes
dietary habits.
More frequent snacks
Many times increase in
carbohydrates
Causes increase in dental
caries
Treatment Considerations
First Trimester
Second trimester
Third Trimester
Plaque Control
Plaque Control
Plaque control
Oral Hygiene
Instruction
Oral Hygiene
Instruction
Oral Hygiene
Instruction
Scaling, polishing
Scaling, polishing
Scaling, polishing
Avoid elective
treatment, urgent
care only
Routine Dental care
Routine Dental care
Dental Radiographs
 One of the most controversial areas in management of
the pregnant patient
 It well documented radiation should be avoided during
the first trimester due to developing fetus most
susceptible to radiation damage
 Second and Third trimester if radiographs are needed to
confirm diagnosis
 Abscess
Local Anesthetics
 Another controversial area
 Concern drug may cross the placenta and be toxic or
teratogenic to fetus.
Class B Local Anesthetics
 Etidocaine
 Lidocaine
 Prilocaine
Dental Management Considerations for Patients Who Are Pregnant
1. Evaluate patient; determine trimester and health status.
2. Confirm that medical prenatal care was provided, or facilitate entry
into medical care.
3. Provide periodontal therapy and oral hygiene instructions.
4. Educate the patient: Discuss the importance and benefits of good
plaque control and fluoride.
5. Minimize radiographic exposure.
6. Minimize drug use. Drug selection should be based on safety profile,
risk to mother and fetus, and potential for interactions and adverse
effects.
7. Avoid prolonged appointment time in the dental chair (i.e., risk of
supine hypothesion).
8. The safest time for provision of dental treatment is the second
trimester.
Table 1
Periodontal disease in pregnancy: review of the
evidence and prevention strategies.
Lachat MF; Solnik AL; Nana AD; Citron TL
Journal of Perinatal & Neonatal Nursing. 25(4):3129, 2011 Oct-Dec.
Table 1 . Promoting oral health during pregnancy
© 2011 Lippincott Williams & Wilkins, Inc.
2