Oral Health During Pregnancy: Integral to Overall Health for Both Mother and Child

A Need for an Interprofessional Health Care Approach

Pregnancy is a dynamic period with many changes in a woman’s body, including her mouth. Hormonal fluctuations, dietary modifications, dry mouth, and nausea can impact the oral health of a pregnant woman. An increased inflammatory response along with poor oral hygiene during pregnancy causes the gingiva to swell and bleed. Untreated gingivitis can lead to periodontitis, an infection that affects the ligament and bone surrounding the teeth.¹ Gingivitis is present in 60-75% of pregnant women.^2,3 Research suggests oral bacteria and inflammation may play a role in preterm birth and cause other adverse pregnancy outcomes.^4,5,6 Preterm and low birth weight infants are more likely to have enamel hypoplasia, a tooth defect that increases the risk of dental caries.⁷

An overwhelming number of pregnant women experience nausea and vomiting during pregnancy.⁸ Women should not brush their teeth immediately after vomiting or an acid reflux episode because the synergistic effect of brushing with acid in the mouth can lead to erosion of tooth enamel, an irreversible loss of the hard protective layer of the tooth. Reducing the occurrence of vomiting/reflux and neutralizing the acids in mouth with buffering oral rinses can help prevent damage to the teeth.

 Dental caries, also known as tooth decay is seen by experts as an infectious, transmittable disease. Cariogenic bacteria, primarily mutans streptococci and lactobacillis species, metabolize carbohydrates to produce acid which over time demineralizes tooth enamel. Frequent eating and poor food choices increase the likelihood of caries. A pregnant woman with untreated dental caries has high levels of mutans streptococci. When maternal salivary mutans streptococci are high, there is a greater risk the infant will be infected with the bacteria.^9,10 The transmission of the mutans streptococci to the infant can occur after birth and before teeth erupt.¹¹ Women with dental caries are twice as likely to have children with dental caries.¹²

Using fluoridated toothpaste, chewing or sucking on xylitol containing products to reduce bacteria, and eating nutritious non-cariogenic foods help minimize caries risk.¹³ Prenatal counselling about oral health care has been shown to be highly correlated with professional dental cleaning during pregnancy.¹⁴ Professional dental care can be accomplished safely throughout pregnancy including check-ups, radiographs, treatment of cavities, periodontal disease, and administration of local anaesthesia.¹⁵ By working together, dental and medical professionals can exert their influence to support oral health and general health during pregnancy.

Pregnancy provides an opportunity to educate women about infant oral health. Unfortunately, many studies conclude that pregnant women are not receiving guidance on oral care for their infants.¹⁶ Beginning an oral care routine with an infant shortly after birth, avoiding behaviours that pass saliva to infants (e.g., sharing utensils, pre-chewing food, and cleaning a dropped pacifier by mouth), and receiving an infant oral exam by one year of age are important measures to prevent early childhood caries.¹³

Barriers are present within professional health care that prevent women from receiving dental treatment and oral/systemic health education during pregnancy. These obstacles include a lack of knowledge of the connection between oral health and pregnancy outcomes, educational inconsistencies within health care disciplines, and poor communication between medical and dental professionals. Dental professionals report minimal experiences treating pregnant women during their training, creating uncertainties in how to care for pregnant women. In addition, obstetricians state a lack of faculty expertise with prenatal oral health care education along with deficient oral health curriculum guidelines in residency training programs.^17,18 All health care professionals need to increase their knowledge of oral health care needs of pregnant women and their infants.^19,20 Additionally, research on interprofessional communication illustrates the gap in interaction between health care professionals.²¹ Education, communication, and collaboration between health care professionals are imperative to increasing oral care during pregnancy.

Several other factors may affect women’s access to oral care, such as lack of finances, employment schedules, cultural influences, not recognizing the value of oral care during pregnancy, language hurdles and negative oral health experiences. One of the primary reasons pregnant women did not seek dental care during pregnancy was lack of perceived need.²² These findings call to attention the need for further awareness regarding the importance oral health during pregnancy.

In conclusion, to improve oral health outcomes of pregnant women and their new-borns, it is imperative to increase prenatal oral health education and training experiences with health care professionals both medical and dental, along with the development of interprofessional collaborations and communication. Oral care during pregnancy is essential to the overall health of pregnant women and their children. 

¹World health organization global policy for improvement of oral health - word health assembly 2007. Petersen PE, International Dental Journal 2008; 58: 115-121.
²Oral health during pregnancy. Silk H, Douglass A, Douglass JM, Silk L, American Family Physician 2008; 77(8): 1139-1144.
³Relationship between gingival inflammation and pregnancy. Wu M, Chen SW, Jian SY, Mediators of Inflammation 2015; 623-427.
⁴Epidemiology of association between maternal periodonatal disease and adverse pregnancy outcomes - systematic review. Ide M, Papapanou PN, Journal of Periodontology 2013; 84: 181-194
⁵Maternal periodontal disease, pregnancy, and neonatal outcomes. Dasanayake AP, Gennaro S, Hendricks-Munoz KD, Chhun N, The American Journal of Maternal Child Nursing 2008; 33(1): 45-49.
⁶Exploring the relationship between periodontal disease and pregnancy complications. Bobetsis YA, Barros SP, Offenbacher S, Journal of the American Dental Association 2006; 147: 7-13.
⁷Hypoplasia associated severe early childhood caries - a proposed definition. Caufield PW, Li Y, Bromage TG, Journal Dental Research 2012; 91(6): 544-550.
⁸Resident obstetricians' awareness of the oral health component in management of nausea and vomiting in pregnancy. Enabulele J, Ibhawoh L, Pregnancy Childbirth 2014; 14: 388.
⁹Early childhood caries and mutans streptococci: a systematic review. Parisotto TM, Steiner-Oliveira C, Silva CM, Rodrigues LK, Nobre-dos-Santos M, Oral Health and Preventive Dentistry 2020; 8(1): 59-70.
¹⁰Association of mutans streptococci between caregivers and their children. Douglass JM, Li Y, Tinanoff N, Pediatric Dentistry 2008; 30(5): 375-387.
¹¹Mutans streptococci: acquisition and transmission. Berkowitz RJ, Pediatric Dentistry 2006; 28(2); 174-179.
¹²Mothers' caries increases odds of childrens' caries. Weintraub JA, Prakash P, Shain SG, Laccabue M, Gansky SA, Journal of Dental Research 2010; 89(9): 954-958.
¹³Policy on early childhood caries: classifications, consequences, and preventive strategies. American Academy of Pediatric Dentistry 2014.
¹⁴Dental cleaning before and during pregnancy among Maryland mothers. Thompson TA, Cheng D, Strobino D, Maternal Child Health Journal 2013; 17(1): 110-118.
¹⁵Oral health care during pregnancy expert workshop 2012. Oral health care during pregnancy: a national consensus statement. Washington DC: National Maternal and Child Oral Health Resrouce Center.
¹⁶Racial/ethnic disparities in maternal oral health experiences in 10 states, pregnancy risk assessment monitoring system, 2004-2006. Hwang SS, Smith VC, McCormick MC, Barfield WD, Maternal and Child Health Journal 2011; 15(6): 722-229.
¹⁷Prenatal oral health education in U.S. dental schools and obstetrics and gynecology residencies. Curtis M, Silk HJ, Savageau JA, Journal of Dental Education 2013; 77(11): 1461-1468.
¹⁸Dental care for pregnant women. Prada da Costa E, Lee JY, Rozier G, Zeldin L, Journal of the American Dental Association 2010; 141: 986-994.
¹⁹Midwives' oral health recommendations for pregnant women, infants and young children: results of a nationalwide survey in Germany. Wagner Y, Heinrich-Welzien R, Oral Health 2016; 16:36.
²⁰Oral health in pregnancy. Hartnett E, Haber J, Krainovich-Miller b, Bella A, Vasilyeva A, Lange-Kessler J, Journal of Obstetric, Gynecologic, and Neonatal Nursing 2016; 45: 565-573.
²¹Research and practice communications between oral health providers and prenatal health providers: a bibliometric analysis. Skvoretz J, Dyer K, Daley E, Debate R, Vamos C, Kline N, Thompson E, Maternal and Child Health Journal 2016; 20: 1607-1619.
²²Most pregnant women in California do not receive dental care: findings from a population-based study. Marchi KS, Fisher-Owen SA, Weintraub JA, Yu Z, Braveman PA, Public Health Reports 2010; 123(6): 831-842.