Dental Care & Pregnancy

Having a healthy mouth is essential to having good overall health and well being which is why proper dental care is so important throughout one’s life. There are some moments in life when dental care becomes even more important, like women who are pregnant, trying to become pregnant or nursing.

Our dental experts have spent many years working with expecting mothers and know what it takes to ensure the health of mother and baby. We also understand that there may be some anxiety surrounded with going to the dentist for pregnant women, especially those who are experiencing it for the first time. Dental care during pregnancy is not only perfectly safe, but it’s also crucial to the health of both mom and baby.

“During pregnancy studies support that it’s best to have your teeth cleaned at 12 weeks and at 24 weeks.

This is proven to lower the bacterial levels and reduce the risk of pre-term low birthweight babies.”
Amanda Tavoularis DDS

Our team of experts has created this article to help answer any questions that expecting mothers may have about dental risks while trying to conceive, pregnancy and nursing as well as how to take care of your teeth and gums during and after pregnancy.

¿Hablas Español? También tenemos este artículo aquí en Español, (Spanish).

Pregnancy & Dental Care | Printable Resources
Dental Care While Trying To Conceive
Dental Care While Pregnant
Dental Care After Pregnancy During Nursing
Major Takeaways for Dental Care During TTC, Pregnancy and Nursing”>
FAQS – Dental Care While Pregnant
Investigative resources used in this article:

Printable Resources

What to Know When You’re Trying to Conceive (PDF)
The Importance of Maintaining Good Oral Health While Pregnant(PDF)
Dental Care for Nursing Mothers (PDF)

Questions to Ask Your Dentist (PDF) – Dr. Amanda Tavoularis compiled a list of questions you should be asking your dentist. Take this printable guide with you on your next appointment.

Dental Care While Trying to Conceive

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As soon as you start trying to conceive (TTC), you and your baby’s health are the top priority. Most mothers go from minimally caring about their health and well-being to paying attention to every single thing they put into their body. TTC is a special time in your life.

You are attempting to create a human inside of your body and since a woman’s body is highly complex and many factors go into conception, you may wonder what could hamper it when it comes to dental care. Before your next dental appointment, here are some of the precautions you can take while you are TTC.

The Importance of Dental Care during TTC

Dental health can affect your chances of conceiving. This is why it’s imperative to take care of your teeth as much as you do your body when you are trying to conceive. The European Society of Human Reproduction and Embryology in Stockholm, Sweden found that thousands of women with good dental health conceived two months earlier than those with gingivitis or periodontitis.

Women who suffered from oral issues such as periodontal disease took more than seven months to conceive compared to those who didn’t have the disease who took about five months to conceive, according to the University of Western Australia.

Also, it’s important to note that this statistically significant increase in conception time only was found in non-caucasian women. In Caucasian women, there was an increase in time to conception, however, it was not considered statistically significant. Ethnicity is a known risk factor for periodontal disease, along with other genetic factors. It is possible that non-Caucasian women have immune systems that are more susceptible to periodontal disease, and are also more likely to deal with the related health consequences of gum disease.

The positive benefits of dental care on your conception makes it vital that you regularly visit the dentist, the pros outweigh the costs. So while you may be nervous about things your dentist does to preserve your dental health, it is necessary for you to continue taking care of it as you are TTC. The good news is that there are some alternatives to some of the chemicals your dental care provider uses, just make sure to ask what your options are.

Dental Health and Male Fertility

Just like in women, dental health can also affect a man’s fertility. Several studies have found that men with poor oral health – either from untreated cavities or periodontal disease – are more likely to face male factor infertility. Cavities, tooth infections, and gum disease all involve high levels of bacterial growth in the mouth. Elevated levels of bacteria in the mouth may lead to increased levels of bacteria in other areas of the body. According to the American Journal of Men’s Health, oral diseases can influence men’s reproductive health. Anyone attempting to conceive should receive comprehensive oral evaluation and treatment.

Dental Care at Home

To prevent gum disease, you should brush your teeth at least twice a day, but after every meal is better. When choosing toothpaste, you may want to look for non-fluoride. Adverse effects on reproduction have been found with high levels of fluoride, which is 100 ppm or greater. Lower concentrations did not show any effect. A pea-sized amount of toothpaste contains about 0.3 mg of fluoride. However, to be on the safe side, you can use non-fluoride or fluoride-free toothpaste.

Some examples of fluoride-free toothpaste are:

Tom’s of Maine Natural Toothpaste – Triclosan and Fluoride Free
Jason Nutrismile
Botanique Toothpaste Neem & Pomegranate

There’s another chemical in toothpaste you should be aware of while TTC – triclosan. This chemical has been shown in studies to disrupt endocrine production, which can alter hormone levels and affect the reproductive system. It can also lower sperm count in men. In addition to fluoride-free toothpaste, you may want to seek triclosan-free ones as well. Simply look at the ingredients list on the toothpaste to see if it contains triclosan. Tom’s of Maine toothpaste is an option.

Mouthwash should be another fluoride-free choice. You can find many fluoride-free ones online and at the store.

Here are some safe chemical free mouthwashes:

Sharp Natural Oral Care Mouthwash
Listerine Antiseptic Mouthwash
Tom’s of Maine – Natural Cleansing Mouthwash Fluoride-Free Spearmint

Tom’s of Maine seems to offer great health products that are safe for ttc, pregnancy and after, due to the chemical free nature of their products. You can find their products online at Tom’s Of Maine. (not an affiliate link)

Flossing is highly important in preventing gum disease. While the flavored ones should be okay for you and your future baby, you can always choose the unflavored ones if that makes you feel more comfortable.

Seeing the Dentist During TTC

Due to the effects of dental issues on infertility and an unborn fetus, it is crucial for you to continue seeing your dentist during TTC for routine cleanings and procedures. There are precautions you should take, though.

Cleanings

During cleanings, the dental hygienist will often check your teeth for oral issues such as gingivitis. This includes scraping plaque off your teeth, especially at the gum line. This procedure is safe since there are no chemicals used.

The polish, which many people think is toothpaste, is called prophy paste. This is a pumice-based gel that has an indiscriminate amount of fluoride in it. Dentists do not offer an alternative option because of the minuscule amount and low to no risk of impact on fertility.

Fluoride treatments are what you should be vigilant about when visiting the dentist. Since concentrated fluoride can decrease fertility in women due to reducing chances of implantation, it’s best to ask the dentist to skip the fluoride treatment while TTC. In addition, if your partner is seeing the dentist, you may want to advise him to skip the fluoride treatment too. It has been shown to lower sperm count, which can have an adverse effect on fertility.

Review Your Gum Health

If you are trying to conceive, ask your dentist for a comprehensive review of your gum health. Since good gum health is important when it comes to conceiving it’s good to know the health status of your mouth. This is something your dental team should be doing already, but sometimes this doesn’t happen. Make sure your dental care team knows this is something you care about.

Dental Procedures

When determining whether to seek a dental procedure, it’s important to weigh the risks vs. benefits. If the effects of the dental problems can be more harmful to fertility than getting the procedure, usually dentists will recommend moving forward with it. If the procedure can wait, such as in the case of teeth whitening, it’s best to do so until after you have the baby.

Cavities can be a tricky decision to make because they can cause a great deal of discomfort and do pose some risk to fertility and the development of a fetus. Metal fillings are composed of a mixture of alloys and liquid mercury. Fifty percent of the mixture is elemental mercury. The Food and Drug Administration find that it is a class II device, which means it has more risk than lower classifications. It’s the vapor the fillings give off that is troublesome, since it contains mercury. The exposure to the mercury is highest when the filling is placed and when it is removed and reduces afterward.

“While pregnant it’s best to avoid high levels of mercury because of its harmful effects on the fetus.

We recommend to postpone having several silver fillings removed while pregnant and to avoid certain types of seafood with high mercury content.”
Amanda Tavoularis DDS

Mercury can affect fertility for men and women making TTC more difficult. Mercury can affect sperm by lowering the zinc and manganese in them, which is what controls mobility. This can make it more difficult for the sperm to reach the egg. Sperm can also carry mercury and if the woman is hypersensitive to it, her body can kill off the sperm thinking it’s a threat.

For women, mercury alters hormone levels. It accumulates in the hypothalamus and pituitary, which is where the glands are for hormone production. This can cause a lot of problems with the menstrual cycle, hypomenorrhea, and hypermenorrhea.

When a filling is needed during TTC, ask the dentist for resin composite fillings. These are made of ceramic and plastic compounds. This may cost more money than the metal ones, but it may be worth it to help with trying to conceive. If you have many fillings already, you may want to consider having the metal ones replaced with the resin composite, which could decrease the amount of mercury in your blood.

Whenever you have a dental procedure, anesthesia may be a concern. While the biggest risk is for those who work with anesthesia, since the exposure is much more than those who receive it for a short time in a dentist’s chair, some of you may want to forego it if it is not necessary.

For those who work in dental offices, there have been reports of reduced fertility. Many dental procedures can be performed with Novocain. Since it is a local anesthetic, there is no risk to fertility.

You should always tell your dentist you are TTC because as you probably have already been made aware, it is inadvisable to have dental x-rays during it. While it is safe when they use the protective cover on your stomach and chest, some women feel better not having the x-ray at all, and most dentists will honor that request.

Dental Precautions to Take During Pregnancy

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Let your dental office know once you are pregnant and how far along you are when you make your appointment. Let them know what medications you’re taking as well or if you have a high-risk pregnancy. Your dentist and physician may recommend that some treatments be postponed.

Dental Risks While Pregnant

Pregnancy Gingivitis

There are some dental risks to be aware if you are pregnant or planning to get pregnant. Periodontal disease is one of the biggest risks during pregnancy. According to the Center for Disease Control, nearly 60 to 75 percent of pregnant women have gingivitis, which is an early stage of periodontal disease. During pregnancy, hormones rise which causes gums to swell and bleed, increasing the likelihood of food getting trapped in them. This irritates your gums, which can lead to severe oral issues such as gingivitis and periodontal disease. These oral infections can cause serious harm to your baby including premature birth. Actually, up to 18 out of 100 premature births are believed to be triggered by periodontal disease.

If gingivitis is not treated, the gums can become infected and the bone that supports the teeth can be lost. Without this, teeth can become loose and may have to be extracted.

Periodontitis has also been associated with poor pregnancy outcomes including preterm birth and low birth weight. However, these adverse outcomes have not been fully explored and are not completely understood yet.

Tooth Decay

A woman who is pregnant may also be more prone to cavities. This can be due to eating more carbohydrates than usual, or morning sickness. Morning Sickness can increase the amount of acid your mouth is exposed to, which can eat away at your tooth’s enamel.

“It’s important to attempt to swish with water or better yet a teaspoon of baking soda with a 6 oz glass of water after an acidic attack like vomiting.

It’s equally important to avoid brushing for 30 mins afterward as the outer layer of tooth structure called the enamel is weakened by acid and it takes roughly 30 mins for our saliva to neutralize the pH.”
Amanda Tavoularis DDS

Brushing twice a day and flossing can sometimes take a backseat during pregnancy as well. Morning sickness, sensitive gag reflex, tender gums, and exhaustion can all lead to this. It’s important to keep up your routine as poor dental habits during pregnancy have been associated with premature delivery, intrauterine growth restriction, gestational diabetes, and preeclampsia.

Pregnancy Tumors

On some occasions, pregnant women may experience overgrowths of tissue called “pregnancy tumors” which appear on the gums most often during the second trimester. It is not cancer, rather just swelling that happens most often between teeth. They may be related to excess plaque and bleed easily. They have a red, raw-looking raspberry-like appearance. They usually go away on their own once the baby is born but talk to your dentist about removing them if you are concerned.

The elevated risk of dental problems during pregnancy means it’s essential to take good care of your teeth during this time. It’s recommended to brush your teeth with fluoride toothpaste. While fluoride may have been somewhat of a risk in TTC, you are encouraged to use it during pregnancy.

Three months into your pregnancy, your baby develops teeth and the fluoride can help him or her grow strong, healthy teeth. It’s also critical during this stage to eat vitamin-rich foods, especially those containing vitamin A, C, D, and nutrients such as protein, calcium, and phosphorous.

Hopefully, you won’t experience any dental emergencies while pregnant, but there is the chance that you might. Dental emergencies include things like root canals or abscessed teeth. If you need to have a root canal done while pregnant, you can easily find an endodontist near you to complete the procedure. The sooner you can be seen by an endodontist the better.

Don’t forget to floss at least once a day. Since your gums are swollen and food gets trapped in them easily during pregnancy, flossing can get it out before it turns into a problem. Brushing gently, using floss, and a fluoride, non-alcoholic based mouthwash multiple times daily will preserve your oral health throughout pregnancy.

Whitening your teeth is not recommended during pregnancy at any stage. While there is no research that identifies what it is in whitening that could be potentially hazardous to your baby, dentists believe it’s best to wait until after the baby is born.

Dental Work During Pregnancy

If you need dental work during pregnancy, it’s best to wait until after the first trimester. The first trimester is the time all of your baby’s organs are being formed, so it’s best not to introduce anything that could potentially be a risk to your baby’s development.

If you need a dental x-ray during your second trimester, tell your dentist about your pregnancy. He or she may forgo the x-ray or if it’s really needed, use two lead cover-ups over your belly. The American College of Radiology reports a diagnostic x-ray does not deliver any significant amount of radiation that can lead to adverse effects in a developing embryo or fetus.

If a dental procedure needs to be done because the oral problem may lead to infection harming the baby, lidocaine is advised. It is the most common one for dental work during pregnancy and it is regarded as a Category B medication – indicating it is safe.

If anesthesia must be administered during pregnancy, it’s given in small doses until optimal comfort is achieved. Stress can have an adverse effect on you and your baby and can reduce the effectiveness of the anesthesia. Be sure to meditate or take part in some other stress-relieving activities before your appointment.

Following the dental procedure, you may be prescribed antibiotics to prevent infection. It’s important to take this medication because infection can lead to problems with your baby’s development. Antibiotics regarded as safe during pregnancy (Category B) are:

Penicillin
Amoxicillin
Clindamycin

Tylenol is the only suitable pain relief for pregnant women, unless the pain is extreme. In cases of severe pain, oxycodone may be prescribed. There are also codeine, hydrocodone and propoxyphene that have been regarded as safe during pregnancy. It’s best to speak to your dentist about any side effects of taking these pain medications during pregnancy.

As mentioned in the TTC section, amalgam fillings contain mercury. This mercury crosses the placenta. While research has shown no health effects from the fillings in pregnant women, some may want to avoid them. High levels of mercury can lead to brain damage, and hearing and vision problems for the developing baby.

It’s best if you do need to have a cavity filled to use the resin or other type your dentist will recommend. Keep in mind, other types of fillings may not be covered by your dental insurance. While you may have to pay out of pocket for them, it’s the best choice to avoid mercury exposure.

Dental appointments during the third trimester may be uncomfortable for you. Lying on your back in a dentist’s chair may not be possible. Schedule dental care during the second trimester if possible. If a dental appointment needs to be done during the third trimester, it’s important to ask the dentist to elevate your right hip to keep blood from pooling in your leg. If you do become faint, switch over to your side.

Dental health is more important than ever while you are pregnant. As scary as it may be to go to the dentist or clean your teeth with fluoride, trust in the research that advises it’s best for you and your baby’s development. Not caring for your teeth is much more of a risk than caring for it at this point, so be sure to schedule a dental appointment and keep up on your oral hygiene.

Dental Precautions While Nursing

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Dental Care at Home

Just as it’s important to keep your teeth healthy while you’re TTCing and pregnant, it’s essential during nursing too. Actually, it’s even more important because if you have a cavity or other oral issue, you may end up transferring those germs to your baby, even through simple things like sharing a spoon. Be sure to keep up with your dental routine by brushing twice a day, and flossing once, to help prevent cavities.

One of the concerns during fertility was the fluoride in toothpaste and mouthwash. This is not a concern while breastfeeding. Research has found no data on the excretion of fluoride into breast milk. However, there seems to be evidence that high concentrations of fluoride can decrease milk production. High concentration means 98 to 137 mg per kilogram of body weight. Since it’s nearly impossible to digest that amount with brushing your teeth and using mouthwash, it’s not a problem.

Dental Procedures

Since x-rays for the teeth are close to the chest, many nursing mothers become concerned about radiation. The good news is you do not have to be wary of it. Not only will you be wearing the lead vest, but the radiation will not seep into and transfer to your baby via breast milk. The only effect it may have is killing off some of the living cells in the milk. Again, this is okay because those cells regenerate after feedings, so your baby won’t be affected.

If you need a cavity filled or another dental procedure, local anesthesia is acceptable during breastfeeding. Novocaine or lidocaine are both considered compatible (no risk for baby). In addition, most medications (oral or IV) for sedation are also compatible.

Laughing gas or nitrous oxide is also compatible with breastfeeding. The gas leaves the body quickly by going to the brain and then to the lungs out your mouth. After the laughing gas mask is removed, recovery only takes three to five minutes. For this reason, ingesting nitrous oxide via breastmilk is rare.

Major Takeaways for Dental Care During TTC, Pregnancy and Nursing

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The major takeaways are to continue dental care through TTC, pregnancy, and nursing. Neglecting dental care is far worse than your exposure to potential toxins in the products you use.

If you believe fluoride may be the reason you’re having a difficult time conceiving, switch over to the fluoride and triclosan-free toothpaste and mouthwashes. Just switch back to fluoride toothpaste when you are pregnant, so your baby can benefit from it as he or she starts developing teeth. When you’re at the dentist, skip the fluoride if you’re TTC. You can always get it at your next visit if you are pregnant.

During pregnancy, wait until your second trimester to do any dental procedures (if that’s possible). Your dentist will discuss the risks vs. benefits of having dental procedures during the first and third trimesters. If you have a serious oral issue that could end up harming the fetus, it may be better to have the procedure done sooner than the second trimester.

After having your baby and during nursing, you don’t have to worry about any toxins with toothpaste, mouthwash, or flossing your teeth. Dental procedures are okay too including x-rays, Novocain, lidocaine, and even sedatives. If you need a long dental surgery, nurse your baby before it, and then after you are awake enough to hold your baby.

Additionally, we all know that dental work strikes when it wants, not when we want. If you have an emergency and need to visit a weekend dentist you may end up having to ingest something that isn’t on the approved list for breasfeeding. The solution is just to learn from the doctor how long it will be in your system and avoid breastfeeding during that period.

FAQS – Dental Care While Pregnant

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Why is dental care so important during pregnancy?

Dental care is important during pregnancy because pregnancy hormones can increase your risk of developing oral disease which can affect the health of your developing baby.

How often should I go to the dentist while pregnant?

A healthy mouth supports a healthy pregnancy, so it’s important for you to continue regular dental visits twice a year while pregnant.

Can you get a teeth cleaning while pregnant?

Yes. Taking care of your mouth during your pregnancy is important for both you and your baby.

Do you have to tell your dentist you’re pregnant?

If you go to the dentist during your first trimester, tell your dentist that you’re pregnant and have only a checkup and routine cleaning. If possible, postpone any major dental work until after your first trimester.

How can I keep my teeth healthy during pregnancy?

To keep your mouth healthy throughout your pregnancy, brush twice a day and floss once a day. Eat a balanced and nutritious diet and visit your dentist regularly for routine check-ups and cleanings.

What trimester is safe for dental treatment?

If dental work is done during pregnancy, the second trimester is ideal. Once you reach the third trimester, it may be very difficult to lie on your back for an extended period of time.

Investigative resources used in this article:

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