What changes during pregnancy
A pregnancy affects the whole body, including the oral cavity. Three changes are particularly relevant for dental health.
Hormonal changes. Estrogen and progesterone levels rise significantly. The gum reacts more sensitively to bacterial plaque; the inflammation tendency increases.
Saliva composition. Saliva becomes more acidic; at the same time some pregnant women produce less saliva. Both increase the caries risk because saliva normally neutralizes acids and releases remineralizing minerals to the teeth.
Vomiting in early pregnancy. Frequent vomiting, especially in the first trimester, brings stomach acid into contact with the teeth. The acid attacks the tooth enamel directly. Anyone who brushes their teeth immediately after vomiting rubs off the enamel layer softened by the acid. Better: rinse the mouth with water or fluoride rinse, wait half an hour, then brush.
Pregnancy gingivitis
The most common oral health change during pregnancy is gingivitis, an inflammation of the gum. Studies show that over fifty percent of all pregnant women develop some form of gingivitis, often between the second and eighth month of pregnancy.
The symptoms are:
- Redness and swelling of the gum
- Bleeding when brushing
- Enlargement of the gum papillae between the teeth
- In rare cases a localized “pregnancy tumor” (granuloma gravidarum), a benign growth that recedes on its own after birth
The treatment is the same as with normal gingivitis: thorough oral hygiene, professional cleaning in the practice. Untreated gingivitis can develop into periodontitis, which causes bone loss and long-term endangers teeth. Several studies have shown a statistical correlation between severe periodontitis in pregnancy and a slightly elevated risk for preterm birth and low birth weight. The causal relationship is not yet conclusively clarified, but dental hygiene is harmless in every trimester and recommended as a preventive measure.
Caries risk in pregnancy
The combination of more acidic saliva, more frequent vomiting and changed eating habits (e.g. frequent small snacks against nausea) increases the caries risk. Those who are not attentive during pregnancy can have more new caries after birth than before.
Preventive measures:
- Brush teeth thoroughly twice daily, use a fluoride-containing toothpaste
- Do not neglect interdental care
- With frequent small meals, if possible, water to rinse
- Avoid sugary or acidic drinks between meals
- Keep routine check-ups, ideally plan one hygiene session in the second trimester
What is harmless
Routine dental treatments are safe during pregnancy and should not be postponed if they are medically necessary.
Routine check-up examinations. Can be performed in every trimester.
Dental hygiene sessions. Harmless at any time, especially recommended preventively.
Local anesthesia. Standard local anesthetics without adrenaline or with low adrenaline content are safe during pregnancy. With treatments that would be painful for you without anesthesia, the anesthesia is safer than the uninhibited stress reaction.
Caries treatment with composite fillings. Safe in every trimester. Postponement with small caries is possible; with deep caries or pain timely treatment is important.
Emergency treatments. An acute inflammation at the tooth is a treatment reason in every trimester. An untreated pulp inflammation can develop into an abscess that can have systemic significance.
Root canal treatment. If medically necessary, performable in every trimester. More on root canal treatment in the corresponding article.
X-ray with indication. Standard dental X-rays with modern technique (digital, focused beam, lead apron) have a very low radiation exposure that lies significantly below natural background radiation values. With clear indication an image is also justifiable during pregnancy. With only slightly helpful indication the image is postponed to the time after pregnancy if possible.
What is avoided
Some treatments are postponed during pregnancy to the time afterward because the necessity is not acute and the postponement has no medical disadvantages.
Whitening and aesthetic treatments. Postponed because no sufficient study evidence on the harmlessness of bleaching agents during pregnancy exists. More on whitening in the corresponding article.
Routine X-rays without clear indication. Postponement because every avoidable radiation exposure is sensible.
Implants and elective surgical procedures. Postponed to after pregnancy because they are plannable. With acute surgical necessities (e.g. abscess drainage), operations are also done during pregnancy.
Certain medications. Some antibiotics and pain medications are not allowed during pregnancy. Tetracyclines, for example, cause discolorations of the child’s permanent teeth. During pregnancy we only prescribe medications approved for pregnancy.
Which trimester for what
First trimester (week 1-12). The most critical phase for the child’s organ formation. Routine check-ups and dental hygiene are possible; elective treatments are postponed to the second trimester. Emergency treatments are performed.
Second trimester (week 13-26). The calmest phase. Here ideally all plannable treatments take place: caries treatments, dental hygiene, possibly necessary root canal treatments.
Third trimester (week 27-birth). Less ideal for longer treatments because longer lying on the back intensifies the pressure of the uterus on the lower vena cava (vena cava syndrome). We therefore position patients in the third trimester slightly to the left side or with knee roll. Routine check-ups and hygiene sessions are possible; elaborate treatments are postponed to after birth if possible.
After birth
The hormonal changes subside after birth. The gingivitis usually recedes, provided oral hygiene is consistently continued.
A recall check-up three to six months after birth is sensible. If caries developed during pregnancy, it is now treated. Postponed elective treatments such as whitening or implants can be planned.
When breastfeeding most dental treatments are harmless. With medications we clarify the breastfeeding compatibility individually.
Dental care for infants and toddlers
Mouth care for the child begins with the first tooth, that is, typically around the sixth month of life. We recommend:
- From the first tooth on, brush once daily with soft baby toothbrush and a rice-grain-sized amount of fluoride toothpaste; from two years twice daily.
- Minimize caries transmission. Caries bacteria are transmitted from caregivers to the child, often via the shared spoon or licking the pacifier. If you as caregiver have caries, treat it before you regularly kiss the child or have saliva contact.
- First visit at the practice between the first and second birthday. More on children’s dentistry on the service overview.
- Avoid bottles with juices and sweet drinks. Early childhood caries (bottle caries) often develops through continuous contact with sugar.
How Resident accompanies pregnant patients
Upon notification of a pregnancy we recommend a hygiene session in the second trimester and possibly a check-up examination. If you suffer more from nausea in the first weeks, we clarify oral hygiene adjustments by phone or email.
With acute complaints during pregnancy we are available at all locations. Mon-Fri 07:00 to 20:00, in Winterthur and Rapperswil-Jona also on weekends. With emergencies outside consultation hours you find the emergency information on the emergency landing page.
If you are planning a pregnancy or have just had a pregnancy confirmed, prior consultation is sensible. We discuss your findings, plan the routine check-ups and clarify what should be treated before the pregnancy. Arrange an appointment at your practice.