Dental Treatment During Pregnancy

Two things are worth saying at the outset, because pregnancy generates a great deal of conflicting advice. First, dental treatment during pregnancy is safe and postponing necessary care carries more risk than having it. Second, pregnancy genuinely does affect the mouth, so this is a time to pay more attention, not less.

Always tell your dentist that you are pregnant and how many weeks along you are. It changes positioning, timing and choice of medication.

What pregnancy does to gums

Raised progesterone exaggerates the gum's inflammatory response to plaque. The result is pregnancy gingivitis — gums that are swollen, tender and bleed easily — which affects a large proportion of pregnancies, typically appearing in the second month and peaking around the eighth. The amount of plaque may not have changed at all; the reaction to it has.

Some women develop a pregnancy epulis, a soft red lump on the gum between teeth. It is benign, and usually resolves after delivery. It only needs removing if it bleeds heavily or interferes with eating.

Gum health is worth taking seriously here: periodontitis in pregnancy has been associated with premature birth and low birth weight in a number of studies. The association is not proof of cause, but it is one more reason not to let bleeding gums go unattended. See gum recession and periodontitis.

Morning sickness and enamel

Repeated vomiting coats the teeth in stomach acid, which softens enamel and, over months, causes noticeable erosion on the inner surfaces of the upper front teeth.

• Do not brush straight after being sick. The enamel is softened; brushing scrubs it away. Wait about an hour.
• Rinse immediately with water, or better a teaspoon of bicarbonate of soda in a cup of water, to neutralise the acid.
• If toothpaste triggers nausea, switch flavour or brush with water and use a fluoride mouthwash at a separate time.

Timing of treatment

• First trimester: check-ups, cleaning and emergency care. Elective work is usually deferred, as this is when the baby's organs are forming.
• Second trimester: the ideal window for fillings, extractions and any necessary treatment. Sickness has usually settled and lying back is still comfortable.
• Third trimester: treatment remains possible, but appointments are kept shorter and you should not lie flat for long. Lying on your back can compress a major vein and cause light-headedness; tilting slightly to the left solves it. Say something if you feel faint.

Purely cosmetic procedures — whitening in particular — are best left until after delivery, not because harm is established but because there is no reason to take an unstudied risk for an elective result.

X-rays and anaesthetic

Dental X-rays use a very low dose, are directed at the head rather than the abdomen, and are taken with a lead apron and thyroid collar. They are considered safe in pregnancy when clinically necessary, though routine ones are usually deferred. Local anaesthetic is safe; treating an infection with an untreated abscess is far more dangerous than the injection. Some antibiotics and painkillers are suitable and others are not — notably, anti-inflammatories such as ibuprofen are generally avoided, particularly in the third trimester. Never self-medicate for dental pain while pregnant; ask.

A note on the old wives' tale

Pregnancy does not leach calcium from your teeth, and you do not "lose a tooth for every child". The calcium the baby needs comes from your diet and, if necessary, your bones — not from enamel, which has no blood supply. Problems in pregnancy come from gum inflammation, acid erosion and changed eating patterns, all of which are manageable.

Frequently Asked Questions

Is it safe to go to the dentist while pregnant?

Yes. Dental treatment during pregnancy is safe, and postponing necessary care generally carries more risk than having it, since an untreated infection is dangerous for both mother and baby. Always tell your dentist you are pregnant and how many weeks along, as it affects positioning, timing and the choice of medication.

Which trimester is best for dental treatment?

The second trimester is the ideal window for fillings, extractions and other necessary work: sickness has usually settled and lying back is still comfortable. The first trimester is normally limited to check-ups, cleaning and emergencies, and in the third trimester appointments are kept shorter with the chair tilted rather than flat.

Are dental X-rays safe during pregnancy?

Dental X-rays use a very low dose, are aimed at the head rather than the abdomen, and are taken with a lead apron and thyroid collar, so they are considered safe when clinically necessary. Routine X-rays are usually deferred until after delivery, but a necessary one should not be avoided if it is needed to diagnose a problem.

Why do my gums bleed more now that I am pregnant?

Raised progesterone exaggerates the gum tissue response to plaque, producing pregnancy gingivitis. It commonly appears in the second month and peaks around the eighth, and the amount of plaque may not have changed at all. It is worth treating, as gum disease in pregnancy has been associated with premature birth and low birth weight.

Should I brush my teeth after morning sickness?

Not immediately. Stomach acid softens enamel, and brushing straight afterwards scrubs the softened surface away. Rinse at once with water, or with a teaspoon of bicarbonate of soda in a cup of water to neutralise the acid, then wait about an hour before brushing.

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