Should I Postpone Dental Work While Pregnant?

Can I get a filling done while pregnant / lactating?  When you’re pregnant you can look forward to being showered with lots of advice.  However, you’re unlikely to hear someone suggest completing dental work.  For a long time the thought was; postpone dental work or you’ll harm the baby.  This opinion is not supported by data.  In fact, physicians fully recognize the importance of oral health.  The American College of Obstetricians and Gynecologists (ACOG) recommends patients to complete all necessary dental work, even while pregnant, including any necessary x-rays, fillings, root canal treatments, extractions and crowns.  ACOG and the American Dental Association (ADA) agree that untreated oral infections pose a risk to the mother and fetus [1].  

Is fluoride ok while pregnant?  Yes.  The American Dental Association recommends all humans with teeth use a small amount of fluoride containing toothpaste twice daily for 2-3 minutes to promote strengthening of the tooth surface.  Toothpaste is not absorbed by the body in any significant way other than on the tooth surface. 

Left: My wife and OB-GYN physician carrying our 1st child.

What about local anesthesia?  We are interested in reducing your stress; so we use local anesthetic to eliminate pain.  We use the minimum amount necessary as is endorsed by the ACOG even while pregnant or lactating[1].  

What dental problems can I expect while pregnant?

Usually none, but the most common dental problems associated with pregnancy are [2]:

1. Enamel erosion due to morning sickness.  Frequent exposure to stomach acid can erode enamel.  Rinsing your mouth and using fluoride mouthwash will help strengthen the tooth surface.  
2. Gum inflammation.  Hormonal changes can promote red, sore gums.  Brush twice daily and floss to reduce swelling.
3. Dry mouth.  Rare, but increases risk of tooth decay (caries).  See my DHM article on dry mouth on our website.
4. Tooth mobility.  Seldom seen, but increased inflammation can lead to softer bone around the teeth and limited mobility.  Resolves after pregnancy
5. Periodontitis: Untreated gingivitis (inflammation of the gums) can progress into periodontitis, which is irreversible bone loss around teeth and remains the #1 cause of tooth loss in adults in the USA.
6. Benign oral lesions (Pyogenic granuloma).  Small vascular mass typically appearing on the anterior 

Should I get my deep cleanings before I give birth?  ‘Last-minute’ treatment for a chronic problem such as gum disease may not be effective at preventing low birth weight (LBW) [3,4] but may be helpful prior to pregnancy.  

Right: How periodontal disease is thought to affect the fetus.

How does dental care affect pregnancy outcomes?: While prenatal dental care has not been shown to improve birth outcomes [3,4], there is ample evidence that improved oral health may reduce transmission of decay causing bacteria to the infant and promote a sustained reduction in tooth decay risk [5,6,7].  

Conclusion: Dental care is important throughout life; that doesn’t stop during pregnancy.  Follow the recommendations of the experts at the ACOG and follow-through with all non-elective dental work for optimal maternal and fetal health.  

References:

1. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co569.pdf
2. Systemic alterations and their oral manifestations in pregnant women. J Obstet Gynaecol Res. 2017 Jan;43(1):16-22.  Silva de Araujo Figueiredo C, Gonçalves Carvalho Rosalem C, Costa Cantanhede AL, Abreu Fonseca Thomaz ÉB, Fontoura Nogueira da Cruz MC.
3. Scaling and root planing performed on pregnant women with mild to moderate periodontal disease is not efficacious in reducing preterm birth, low birth weight, or other poor pregnancy outcomes. J Evid Based Dent Pract. 2012 Sep;12(3):135-7.  Dasanayake AP
4. The effectiveness of periodontal disease treatment during pregnancy in reducing the risk of experiencing preterm birth and low birth weight: a meta-analysis. J Am Dent Assoc. 2010 Dec;141(12):1423-34.  Uppal A et al. 
5. The effect of caries-preventive measures in mothers on dental caries and the oral presence of the bacteria Strep. Mutans and Lactobacilli in their children.  Arch Oral Bioll 1984;29:879-83
6. Effectiveness of a caries preventive program in pregnant women and new mothers on their offspring.Int J Paediatr Dent. 2001 Mar;11(2):117-22.  Gomez SS1, Weber AA.
7. An early oral health care program starting during pregnancy: results of a prospective clinical long-term study.Clin Oral Investig. 2010 Jun;14(3):257-64.  Meyer K et al.,