Can women get dental care during pregnancy? Can dental care during pregnancy interfere with fetal development? These questions are often asked, so dental care is often postponed and carried out after delivery.

Dental and Oral Care during Pregnancy

The overall health of pregnant women, including dental health, will create good fetal growth and development conditions. Therefore, proper dental care during pregnant women is permitted to optimize oral health.

Maternal dental and oral care during pregnancy is intended not only for the mother's health but also for the fetus's health. Tooth and oral problems during pregnancy can affect fetal growth abnormalities that can cause congenital abnormalities and affect labor.

A. Dental and Oral Health Problems in Pregnant Women

Dental health problems in pregnant women must be treated immediately. Include dental caries, pregnancy gingivitis, periodontitis, tooth shakiness, and oral pregnancy tumors.

Dental caries

Increased progesterone during pregnancy causes a decrease in bicarbonate levels in plasma and causes a decrease in salivary pH so that the oral cavity becomes more acidic. Salivary pH is one of the main factors for maintaining enamel stability. If salivary pH is decreased, it increases the growth of cariogenic bacteria. So it makes pregnant women experience dental caries easily due to the demineralization of tooth enamel.

Pregnant women who consume a lot of sugar and experience excessive nausea and vomiting will easily experience cariogenic bacteria's growth in their oral cavity. Compensating the decrease in pH that occurs due to the increased hormone, pregnant women are advised to limit their intake of sweet and brushing food routinely using fluoride-containing toothpaste, to maintain oral hygiene and strengthen tooth enamel.

Gingivitis, Periodontitis, and Tooth Wobiness

Pregnancy gingivitis-periodontitis is a periodontal disease that can occur in about 30% of pregnant women who experience periodontal tissue inflammation and gingival hyperplasia. An increase in the hormone estrogen mainly causes this condition. Increased circulation of estrogen causes increased capillary permeability, which increases the likelihood of exposure to pregnant women with gingivitis. Untreated gingivitis can develop into periodontitis and can cause tooth sway.

Case reports and cohort studies show an association between periodontal disease and preterm birth, fetal growth restriction, and preeclampsia. The mechanism of how periodontium inflammation and infection can affect the uterus during pregnancy is still unknown. But research shows the possibility is the stimulation of inflammatory mediators and prostaglandins in the maternal circulation due to translocation of periodontal pathogens. Therefore, the examination of estrogen levels in saliva can be used to screen for potential risks from preterm birth. Estrogen levels in mothers with preterm deliveries are higher than in mothers with normal childbirth.

The treatment is controlling dental plaque and tartar. If needed, scaling, polishing, and root planing treatments can be given. Mouthwash (such as 0.12% chlorhexidine) is safe for pregnant women to prevent gingivitis and periodontitis. It is included in category B, according to the FDA (Food and Drug Administration)

Oral Pregnancy Tumor

Oral pregnancy tumor, also called pregnancy granuloma, is a benign lump in the gingiva. The main cause is poor oral hygiene. Other contributing factors are the trauma that causes rupture of blood vessels, increased estrogen and progesterone hormones, and viral infections. Maintenance of good gingival health can prevent this disease.

B. Dental and Oral Care in Pregnant Women

Guidelines on dental and oral health services for pregnant women integrated as antenatal visits, which include:
  • Health counseling in the form of providing information, education, communication (IEC) for oral health
  • Early examination for detection of dental and oral diseases
  • Refer pregnant women to the hospital if they need curative care

Based on this, several dental and oral treatments that can be performed on pregnant women are screening and preventive measures, diagnosis, and dental care.

a. Screening and Preventive 

Pregnant women should get knowledge about how to maintain healthy teeth and mouth, examinations, and treatment related to dental and mouth problems. Pregnant women also have access to dental care, as well as fluoridated drinking water. Also, education that can be provided by health workers to pregnant women includes:
  • Brush teeth properly and regularly, without injuring the soft tissue. The frequency of brushing your teeth should be twice a day, in the morning after breakfast, and at night before bed.
  • Eating nutritionally balanced foods, and avoid foods that are sweet and sticky because of increased risk of caries. Third-trimester pregnant women, or postpartum, may use mouthwash with xylitol and chlorhexidine. Both are considered capable of reducing the number of bacteria, and these ingredients are also safe to use during breastfeeding.
  • If pregnant women experience vomiting, immediately clean mouth by a mouth rinse
  • Check with the dental health service facility regularly to monitor the presence or absence of caries, gingivitis, or other dental problems for personal advice about the types of toothbrushes, fluoride toothpaste, and dental floss that need to be used.

b. Diagnose

The process of diagnosis of dental and oral care can involve radiological examination or x-ray. Preferably, the dental x-ray procedure is only performed in an emergency and postponed until after delivery, if possible. Although studies show radiation doses of less than 5 rad do not cause the risk of malformations, growth abnormalities, or miscarriage in the fetus. Therefore, if needed dental x-ray can be done at any time, provided with the right procedure and using lead protection in the thyroid area with collar and abdomen by wear apron, proper collimated beam, and high-speed film with ALARA principle (As Low As Reasonably Achievable).

CT scanning provides a higher radiation dose than conventional x-rays. Still, if it is very necessary, the dose of exposure to the fetus can be reduced by using protective equipment.

c. Treatment and Therapy for Dental and Oral Care in pregnancy

The right time to do dental care during pregnancy
Dental care should ideally be carried out in the second trimester when fetal organogenesis is complete. However, if the need for dental care is urgent, it can be done in the trimester by considering the benefits and possible risks.

Some things that need to be considered by a dentist when performing dental care for a third-trimester pregnant patient is to maintain blood circulation and adjust a comfortable position while sitting in a dental chair or dental unit. In the third trimester, in the supine position, the uterus can suppress inferior vena cava and inhibit the heart's flow, only causing hypotensive syndrome and loss of consciousness. To avoid this, in pregnant women, the head position should be higher than the legs and use a pillow to support the waist so that the uterus does not compress the inferior vena cava.

Routine care that must be done by pregnant women is to clean plaque and tartar with scaling, polishing, and root planning, as well as filling or restoration measures for cavities if needed.

The use of amalgam as a dental patch material should be avoided during pregnancy because it contains mercury. Through the blood circulation, it can enter the placenta, Although the mercury dosage that can be released by the amalgam to the oral cavity can still be tolerated.

As an alternative to amalgam, dentists can use glass-ionomer cement, composite resin, inlay / onlay, or porcelain crowns. In contrast, the teeth extraction in pregnant women is only done when it is very necessary and recommended to be done in the second trimester gestational age.

Safe Medicines in Dental and Oral Care Procedures
Pregnant women should not take drugs without a prescription and supervision from doctors and dentists because some drugs can interfere with the fetus's growth. The FDA (Food and Drug Administration) determines the categories of safe use based on the risk of pregnancy in categories A, B, C, D, and X.

1. Local Anesthesia Drugs
Some provisions on the use of local anesthetics are:
  • category B (animal studies show risks, but there are no adequate studies in humans): lidocaine, prilocaine, and etidocaine as long as the dose is adjusted appropriately
  • Category C (in studies in humans and animals giving positive results for risks to the fetus, but there are no well-controlled clinical trials in humans): epinephrine
  • Category D (there is positive evidence of risk to the fetus, but can be used if it is more beneficial than the risk): benzodiazepines, barbiturates, and nitrous oxide. Should not be administrated during pregnancy.

2. Antibiotics
In pregnant women, the use of category B antibiotics may be used. As the first therapy penicillin, amoxicillin or cephalexin can be chosen. If there is an allergy to penicillin, give erythromycin or clindamycin. Cephalosporin and clindamycin can be an option if pregnant women require antibiotics that are given intravenously. While tetracycline antibiotics fall into the D category so pregnant women should not consume it.

3. Analgesic drugs
The main choice of analgesic drugs to deal with dental pain in pregnant women is paracetamol and ibuprofen. Paracetamol oral preparations fall into category B, and intravenous preparations fall into category C. While ibuprofen falls into category C.

However, a study revealed that ibuprofen is not good for the 2nd and 3rd trimester of pregnancy because it found an association between the use of ibuprofen with low birth weight and the risk of asthma in children.

Summary of recommendations for dental and oral care for pregnant women

A summary of recommended dental and oral care for pregnant women based on the pregnancy trimester is as follows:

First Trimester

  1. Limit dental care procedures. Do it if only for urgent care
  2. Providing education to pregnant women regarding changes in teeth and mouth during pregnancy
  3. Suggestions for maintaining oral hygiene, and routine plaque control at home with fluoride paste
  4. Dental and oral care takes priority in the prevention of periodontal disease and emergency management
  5. Avoid using x-rays for routine checks and only be done selectively and when needed

Second Trimester

  1. Keep monitoring routine habits in maintaining oral hygiene and dental plaque control
  2. Various dental care procedures are safe in this trimester. If necessary, scaling, polishing, root planing, curettage, restorative care, root canal treatment, and tooth extraction can be done.
  3. The use of an x-ray is still avoided and only done if needed with good procedures and protection.

Third Trimester

  1. Keep monitoring routine habits in maintaining oral hygiene and dental plaque control
  2. Dental care may be done because it is not too dangerous for the fetus
  3. Treatment procedures often cause problems for the mother's comfort, which can be overcome by adjusting positions during treatment
  4. Scaling, polishing, curettage, and the handling of other urgent dental and oral diseases may be done if necessary

The use of x-ray is still avoided and only done if needed with good procedures and protection
Consider delaying non-urgent dental and oral care procedures until after delivery, if the gestational age is above 32 weeks.