Dramatic hormonal changes make it difficult for women to manage their health during pregnancy. What most pregnant women don't think of is the implication those changes have on their oral health.
Between 60% and 75% of pregnant women have gingivitis—a condition marked by red, swollen gums that directly results from aggravated gum tissue and hormonal changes.
Oral health is a critical part of your overall well-being. The above stat underscores its importance for your pregnancy (prenatal) health.
What Is Dental Health, And How Does It Affect Pregnancy?
At its core, dental health (i.e., oral health) describes the overall state of your oral cavity and its surrounding structures. It includes your teeth, gums, tongue, cheeks, jaw, and other parts of the mouth.
Maintaining your dental health includes brushing and flossing teeth regularly, visiting a dentist for regular check-ups, and professional cleaning. On a macro level, these activities reduce the risk of cavities, gum diseases, and other oral health issues.
Briefly, here is an overview of how dental health affects pregnancy:
- Prenatal oral conditions can have adverse effects on pregnancy outcomes, such as preterm birth, low-birth weight, and congenital anomalies (birth defects).
- Poor oral hygiene has been linked to an increased risk of preeclampsia—a condition characterized by high blood pressure that can be life-threatening for the mother and baby.
- High levels of carcinogenic bacteria increase the child's risk of dental caries (i.e., cavities) during childhood development.
Although individual studies have historically produced conflicting results, a systemic review of 23 studies reported by the American Dental Association found compelling evidence linking periodontitis to pre-term birth, low birthweight babies, premature low birthweight babies, and the development of pre-eclampsia.
Since evidence-based practices and guidelines are still in development, oral health treatment throughout pregnancy is frequently avoided by patients (and misunderstood by physicals and dentists).
From 2007 to 2009, just 22% to 34% of women reported seeking dental care during their pregnancies. That figure has gradually increased every year, but the vast majority of soon-to-be mothers still avoid treatment. In 2022, less than half of pregnant women said they sought dental care.
How Does Pregnancy Affect Your Dental Health?
Pregnancy's effects on dental health are multifold:
- Increased progesterone and estrogen levels increase your risk of developing gingivitis and—eventually—gum disease.
- Hormonal fluctuations decrease saliva production, causing dry mouth—a condition that increases the pH level inside your mouth and causes cavities.
- Gastroesophageal reflux can cause stomach acid to reach your throat, increasing the amount of bacteria in your mouth and leading to cavities.
- High stress adversely impacts oral health and leaves pregnant women more vulnerable to infections.
- Pregnancy cravings can lead to a higher intake of sugary foods, which increase your risk of developing cavities and damaging teeth enamel.
- Vomiting caused by morning sickness erodes tooth enamel and frequently exposes your teeth to harmful acids.
- Pregnant women tend to brush their teeth less because of nausea, gum sensitivity, and swelling they associate with it.
Pregnancy also affects the way that dentists may treat you. Tooth extractions are possible during pregnancy, as are many other oral surgeries. But some forms of anesthetics and dental imaging can harm your baby. It's important to discuss any fears or concerns with your dentist before undergoing any treatment.
Teeth whitening during pregnancy is advised against due to its potential harm to the already-sensitive teeth and surrounding gum areas.
Signs And Symptoms Of Dental Problems During Pregnancy
For the most part, patients with dental problems will experience similar signs and symptoms to non-pregnant patients. These can include:
Loose Teeth
For pregnant women, loose teeth don't always mean they're about to fall out. High progesterone and estrogen levels temporarily loosen the surrounding tissue and ligaments around teeth, making them feel loose.
Of course, loose teeth are still a sign of something more serious. Pregnant women should assess their looseness contextually to decide if additional treatment is necessary.
Bad Breath
Bad breath (medically referred to as halitosis) can occur during pregnancy due to the increase in carcinogenic bacteria.
Like loose teeth, bad breath is something many pregnant women can expect to deal with regardless of whether or not they have a serious problem. If a foul taste and teeth or gum pain accompany it, further investigation is a good idea.
Mouth Sores
The most common types of mouth sores are canker sores and cold sores. The former occurs inside the mouth, while the latter forms on its periphery.
Canker sores are often related to immune system issues and heightened stress levels caused by hormonal fluctuations. They are relatively harmless (although they can cause pain).
Cold sores are caused by either variant of the herpes simplex virus (HSV-1 or HSV-2). The virus remains dormant most of the time, but reactivation during pregnancy is extremely common, as is true for women who are menstruating.
Lumps On Your Gums Or Surrounding Tissue
Even the healthiest mouths can develop lumps or ulcers. The dental and medical communities haven't reached a consensus on what causes them, but the most accepted theories include:
- Unregulated blood vessel growth
- Hormonal changes
- Immune system suppression
- Infection with a virus or bacteria
- Damage to the tissue due to poor oral hygiene
Although it is common and usually harmless, its exact cause requires further investigation from a qualified dentist.
New Spaces Between Your Teeth
There are two main reasons new spaces might form between your teeth during pregnancy.
- Gum recession. When gums recede due to increased sensitivity and inflammation, they can thin and create visible gaps where teeth were originally covered by the gum line. This is a sign of a dental issue in itself, and should be addressed by a dentist.
- Softened gums. Hormonal changes during pregnancy can cause the gums to become more pliable and create spaces between teeth. This is usually a temporary issue, but it's important to note that the gaps left behind can collect bacteria and lead to infection if they are not addressed professionally.
Pus Along Your Gum Line
When your gums recede and expose the roots underneath (i.e., gum recession), bacteria overgrowth will eventually cause an infection. Infections that have time to grow around or underneath the gum line create a white or yellow-colored discharge.
This pus can cause pain and swelling along the gum line, as well as bad breath, discomfort while eating, or sensitivity to cold and hot food. If you see discharge coming from your gums, it certainly means something isn't normal—how serious your condition is can be determined by your dentist, but most cases can be treated effectively with antibiotics and regular cleanings.
Red Gums
For pregnant women, red gums are practically a guarantee. Some redness is expected, but too much could signify an oral infection.
For each patient, red gums can be described in one or more of the following ways:
- Swelling or inflammation
- Tenderness
- Shininess
- Bleeding when touched or during brushing and flossing
If your gums remain red even after brushing your teeth or flossing, it could indicate an underlying issue—in most cases, gingivitis.
Toothache Or Other Pain
Pregnant women often experience tooth sensitivity and toothache during pregnancy due to changing hormones and increased blood flow to the gums.
The pain could be caused by anything from:
- Tooth decay or cavities
- A cracked filling
- Gum disease
- Infection
Since many patients are already predisposed to sensitivity, it isn't always a serious issue. If you experience occasional toothache during pregnancy, your dentist can give you more information on what could be causing it.
Common Dental Issues Women Experience During Pregnancy
During pregnancy, women are more likely to suffer from several common dental issues. These range in severity from harmless to serious. Unfortunately, many of them are common, even among women who take care of themselves and their oral health.
Gingivitis
Gingivitis during pregnancy is commonly referred to as pregnancy gingivitis or gingivitis gravidarum. It is the most common oral health risk for pregnant women, with reported occurrences ranging from 30% to 100% (according to a wide body of clinical research) but typically falling within 60% to 75% (according to CDC data).
It is commonly accepted that hormonal changes during pregnancy can make a person more likely to develop gingivitis. Specifically, higher levels of female sex hormones are presumed to be a key factor in causing it.
During pregnancy, the impact of progesterone is stronger than that of estrogen, but the excess of both causes problems like endothelial damage, increased vascular permeability, and reduced blood flow. In layman's terms, the gums become more sensitive and prone to inflammation.
The gingival changes usually go away within a few months of giving birth (if the source of irritation—i.e., plaque—is removed).
Cavities
Cavities are common for two reasons:
- A significant amount of women have untreated cavities before pregnancy. According to CDC data, one in every four women of childbearing age has at least one untreated cavity. The number of women at serious risk for developing one is even greater.
- Pregnancy changes the oral microbiome. A lower pH level, neglect of oral hygiene due to pain and sensitivity, and pregnancy cravings favor the growth of cavity-causing bacteria.
Fortunately, cavities can be prevented and treated through regular checkups and proper oral hygiene (brushing your teeth twice a day and flossing at least once).
Pregnancy Tumors
Although the term sounds scary, pregnancy tumors (also called pyogenic granuloma) are not cancer but are commonly found in the mouth during pregnancy. These tumors are non-cancerous and usually disappear on their own after delivery.
Pregnancy tumors in the mouth appear as red or purplish lumps on the gums or between teeth. They can bleed easily and cause discomfort or pain. While they may seem alarming, pregnancy tumors are common.
Despite research on certain factors and pathways involved in promoting blood vessel growth, it is still unclear what is responsible for these lesions. Recent studies suggest that pregnant women have an imbalance between factors that promote and inhibit blood vessel growth. This causes fragile, lumpy capillaries to quickly form in the mouth. Other culprits include medications and hormonal changes.
Treatment for pregnancy tumors is typically not required unless they cause significant discomfort, interfere with eating or speaking, or bleed excessively. Even then, patients can usually expect these growths to disappear "spontaneously," according to Zenyep Yenen, a researcher for the Department of Restorative Dentistry at the University of Kyrenia Faculty of Dentistry.
If treatment is necessary, it usually involves a non-operative procedure like cryotherapy or laser ablation.
Enamel Erosion
Just like cavities, enamel erosion is a common problem during pregnancy. It occurs when the protective layer of enamel over the teeth wears away, leaving the tooth surface more exposed.
There are a few main causes of enamel erosion in pregnant women:
- Acid reflux
- Vomiting from morning sickness
- Excessive consumption of foods and drinks that damage teeth
- Increased levels of sex hormones
- Dry mouth that changes the pH level in the oral cavity
The good news is that most of these issues can be managed through dietary and lifestyle changes. For instance, limiting sugary snacks or beverages (especially carbonated drinks) and drinking plenty of water throughout the day can help reduce acid reflux and reduce enamel erosion.
Common Teeth Problems After Pregnancy
After pregnancy, women aren't out of the woods yet when it comes to teeth and oral health. There are still some common problems that can arise, including:
Postpartum Gum Recession
Gum recession might not have shown its extent throughout the duration of the pregnancy. But a receding gumline is irreversible—once the damage has been done, restorative measures are needed to repair the affected area.
After giving birth, women with untreated gum recession won't always notice any pain or discomfort. If they don't make any lifestyle changes that could stop the gums from receding, this recession can continue until it becomes noticeable—at which point, treatment options may be limited.
Tooth Decay From New Or Unchanged Habits
After pregnancy, some women revert to their regular daily routine. Others keep some of their new habit, form different ones as a new mother.
Here's a quick overview of what that entails:
- Dietary habits. Women often consume more sugar during times of exhaustion and eat more snacks during times of feeding. Especially if these snacks are starchy, sugary, or acidic, they can cause unprecedented tooth decay.
- Oral hygiene habits. Those who lose their typical routine during pregnancy or in the following months of new motherhood aren't giving their teeth the care they need. After pregnancy, oral care is especially critical since the teeth would have just undergone dramatic changes.
- Smoking and drinking. During pregnancy, smoking and drinking alcohol are off-limits. These habits harm teeth in a plethora of ways, and picking them back up after birth can cause new oral health problems.
Consciously changing your lifestyle and daily habits can help mitigate these issues. Visiting a general dentist shortly after childbirth is also key to maintaining overall oral health.
Yellow Teeth
Tooth discoloration is common in women after pregnancy, due to both the adverse effects of pregnancy on oral health and the concern of teeth whitening safety during pregnancy.
After pregnancy, in-office and at-home teeth whitening are both viable options, and many women choose to use them at some point.
Dental Care Before You Get Pregnant
Before pregnancy, the determining factor in future oral health is education. As previously mentioned, most women do not seek or prioritize oral health care.
The history behind this dates back several decades, when pregnant women were told to avoid all dental treatment during pregnancy. A qualitative exploration of the barriers to dental care during pregnancy has shown that this outdated advice still pervades today for the following reasons:
- Lack of education
- Overall costs of proper dental care
- Time constraints
- Fear of treatment
- Physiological changes (e.g., nausea and vomiting)
- Dentists' unwillingness to treat pregnant women
- Lack of interprofessional communication between women's health experts and dental practitioners
Though prenatal oral health education is still mostly overlooked in medical curriculums and patient care plans, the ADA recommends pregnant women seek regular checkups and cleanings throughout their gestation period. The organization's website also reiterates the safety of most dental treatments (including X-rays and anesthetics) and medications during pregnancy.
According to a national consensus statement published by the National Maternal and Child Oral Health Resource Center, prenatal care professionals are typically the first line of defense when it comes to educating pregnant women on the importance of oral health care.
During an initial prenatal evaluation, patients should relay the following information regarding their current oral health and upcoming changes:
- Any current oral health concerns, such as morning sickness or gum inflammation
- Questions regarding how to access oral care as a pregnant woman
- If any medication is being taken to manage existing dental issues
- The habits they need to adopt, keep, and change for acceptable oral health during pregnancy (e.g., brushing twice a day and flossing)
- Upcoming oral procedures they might need during their pregnancy
The most important things for women to do regarding their oral health before pregnancy is to learn what changes to expect in their mouth or teeth. They might not be able to avoid them, but they can proactively create habits that minimize their impact and find a reputable healthcare provider ahead of time.
Dental Care While Pregnant
The viability of dental care while pregnant depends on two factors:
- The type of procedure a pregnant woman needs
- Her current pregnancy trimester
Generally, cleanings, X-rays, and fillings are safe during pregnancy. However, the patient should inform her general dentist before starting any procedure so they can take necessary precautions.
The third trimester is the least favorable for dental care. Unpredictable fetal movements and the heavy weight of the baby won't make the procedure harmful, but they do make it tough for women to sit in the dental chair for an extended period of time.
In the first trimester, dental procedures are certainly possible. But the high degree of fetal development and sudden onset of hormonal changes make the complete evaluation of potential risks impossible. Roughly 70% of women experience nausea and vomiting throughout the first trimester, for example.
For the reasons above, almost all medical and dental experts agree that the second trimester is the "sweet spot" for oral health care.
A few critical points for women to remember when getting oral health treatment while pregnant:
- Women should take the same preventive measures they normally would, including visiting the dentist for checkups and cleanings twice every year.
- Access to proper healthcare is one of the biggest barriers for pregnant women seeking dental care. Finding a qualified practitioner ahead of time goes a long way when staying on top of your dental health.
- Women must communicate any concerns about oral health care with their practitioners in advance of treatment.
- Although gingivitis might be unavoidable, more serious conditions are easily prevented with proper oral hygiene habits and regular checkups.
- Contrary to the myths, X-rays, medications, and anesthetics are generally recognized as safe, even during pregnancy.
Dental Care After Pregnancy
After pregnancy, women need to choose their habits wisely. Healthy habits don't just impact them and their oral health, but the overall health of their newborn child.
Eating A Healthy Diet
Dietary needs will change, especially for breastfeeding mothers. Snacking or "grazing" during times of feeding is common, and it's during this time that women need to be extra mindful of what they're putting into their mouths.
Examples of foods to eat while breastfeeding include:
- Lean proteins
- Fruits and vegetables rich in vitamins and minerals
- Whole grains
- Unsaturated fats from avocados, nuts, and fatty fish
- Calcium-rich foods, including dairy products
Children should eventually begin to adopt similar dietary habits to ensure proper development (including that of their mouths).
Regular Dental Visits
Even though a baby's teeth won't start to appear until around age six months, it's still important for mothers and children to visit their dentist regularly.
The dentist can help monitor the overall oral health of the parents and child, as well as provide guidance on proper nutrition, brushing techniques, fluoride treatments, and more.
Practicing Good Oral Hygiene
Women should use the following oral health routine when caring for themselves and their children:
- Brushing the teeth twice daily with a soft-bristled toothbrush
- Using fluoridated toothpaste
- Flossing at least once each day
- Rinsing with baking soda and water (not brushing) after vomiting
- Limiting sugar intake
Avoiding Tobacco, Vapes, And Alcohol
Smoking and drinking damage your teeth, and the resulting gum irritation, tooth decay, and discoloration that comes with picking these habits back up post-pregnancy will make them difficult to reverse.
Even vaping, which is often seen as a "safer alternative" to tobacco products, has serious implications for your oral health.
Ensuring Proper Dental Health For Your Child
Baby teeth begin to erupt no later than the child's first birthday. And once they start coming in, dentists recommend using the following tips to protect their teeth from decay:
- Visit a pediatric dentist regularly while baby teeth are growing.
- Take preliminary X-rays to prepare for the child's first visit to the dentist.
- Avoid overfeeding your baby from a bottle, especially as baby teeth come in (breastfeed if possible).
- Wipe your baby's gums after breastfeeding or bottle feeding.
What Are The Dangers Of Dental Work While Pregnant?
Although dental work is safe during pregnancy, invasive procedures mean more dramatic side effects.
Women should avoid unnecessary treatments and elective procedures during pregnancy, as they can lead to infection or cause other adverse reactions.
They should not, under any circumstances, avoid a necessary (or emergency) procedure, as it could put their health and that of their baby at risk.
According to experts from the American Pregnancy Association, the following dangers are prevalent among pregnant women:
- Anesthetics. There is uncertainty regarding the safety of using medications during dental work on a developing fetus, as conflicting studies exist. The most commonly used drug for dental work is Lidocaine, which is categorized as Category B, and crosses the placenta after being administered. Still, research has shown no effect
- Radiographs. Despite myths that X-ray radiation causes harm to unborn children, the FDA officially reports that X-rays do not cause adverse health effects to the developing fetus (when appropriately administered).
- Teeth whitening. Teeth whitening kits don't cause harm to an unborn child, but they do cause severe damage to teeth and gums, which could lead to serious oral health issues later on in life.
- Oral surgery. Women shouldn't forgo emergency surgery at any stage of their pregnancies. Ideally, the procedure would take place in the second trimester when the risk of harm to the fetus is lower.
Sensitive Teeth During Pregnancy: What To Expect And How To Cope
Dentin hypersensitivity (i.e., tooth sensitivity) is common after teeth cleaning or whitening options, and roughly 12% of adults have it to some degree.
For pregnant women, that figure is much higher. The vast majority of women suffer from sensitivity in their mouths or teeth due to the bodily changes mentioned above.
Here are a few tips to help pregnant women cope with the discomfort:
- Use a desensitizing toothpaste to reduce sensitivity.
- Avoid overly acidic or sugary foods and drinks.
- Brush gently, using only soft-bristled toothbrushes.
- Apply clove oil on sensitive teeth for temporary relief.
- Discuss any additional medication with your dentist and doctor before taking it (ibuprofen, for example, is not safe).
For most women, sensitivity is a normal side effect that goes away after pregnancy but, if it persists or worsens, it’s best to consult with a dentist.
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How Can I Prevent My Teeth From Falling Out During Pregnancy?
Even though as many as 3 in every 4 pregnant women suffer from dental problems, tooth loss is a much less common occurrence. Pregnant women don't need to worry about waking up to missing teeth—there will be plenty of other signs leading up to tooth loss.
Usually, it is caused by severe tooth decay or enamel erosion. Even then, it is not a sudden change, and most dental professionals will be able to recognize the signs of impending tooth loss during regular check-ups.
Here are three things pregnant women can do to prevent their teeth from falling out:
- Consult with a dentist prior to pregnancy. Having an oral health evaluation before pregnancy can help soon-to-be mothers prepare for and adjust to any changes may occur. Dentists can pinpoint and begin to treat any potential oral health issues that could turn into tooth loss during pregnancy.
- Practice good oral hygiene by brushing and flossing regularly. Plaque buildup will accelerate the rate of bacteria growth, especially in a rapidly changing, hormonally-sensitive environment.
- Eat the right foods. Avoiding sugary foods (despite the cravings) and opting for healthy foods like crunchy fruits and vegetables can help reduce the risk of tooth decay.
Can You Lose A Tooth From Pregnancy?
Most of the time, a nine-month pregnancy term isn't long enough for a tooth to go from "perfectly healthy" to "rotten and falling out." If a pregnant woman loses a tooth, it is usually due to severe decay or gum disease.
It's worth noting that women are much more susceptible to many of the preceding conditions to tooth loss. Gingivitis (and gum disease, by extension) is a serious concern for all pregnant women, with up to 75% suffering from it. Untreated gum disease can eventually lead to tooth loss.
In short, it is possible to lose a tooth from pregnancy. But pregnancy itself wouldn't be the root cause—it is, at most, a catalyst.
Can A Tooth Infection Spread To An Unborn Baby?
Tooth infections themselves cannot spread to an unborn baby. However, research mentioned in this article points to the possibility of additional complications associated with poor oral health in pregnant women. The existing body of research is equal parts inconclusive and conflicting. In any case, the best move is to take preventive action when it comes to oral health.
Can A Dentist Pull An Infected Tooth While Pregnant?
Tooth extraction during pregnancy is both safe and commonplace. Timing is everything for pregnant women dealing with any serious medical procedure for the following reasons:
- A weakened immune system during pregnancy increases the risk of post-operative infection.
- Gum inflammation from pregnancy will make tooth extraction more painful.
- Early-trimester pregnancy is a big adjustment for expecting mothers (that typically involves frequent bouts of morning sickness).
- Late-trimester pregnancy makes it tough to lay down in a reclined position, which is necessary for a successful extraction.
- Certain anesthetics are not safe for use, so dentists need to take additional precautions.
Can You Get Dental Fillings During Pregnancy?
Yes, you can get dental fillings during pregnancy. In fact, it is highly recommended that pregnant women address any cavities as soon as possible in order to prevent further damage and consequent extraction.
Dental professionals will typically recommend the use of composite fillings (which are free from mercury) over traditional amalgam fillings (which aren't used much anymore, anyways).
What Can I Do For Tooth Pain While Pregnant?
To relieve tooth pain while pregnant, you have a few different options:
- Salt water rinse. Salt water is the cheapest and most natural option—simply gargle a mixture of warm water mixed with salt every few hours.
- Over-the-counter pain reliever. Acetaminophen (Tylenol) is the only medication deemed safe to take during pregnancy. Do not take aspirin or nonsteroidal anti-inflammatory drugs (Motrin or Advil).
- Prescription pain reliever. In serious cases, dentists will prescribe a pain reliever specifically designed for pregnant women.
- Cold compress. Apply a cold compress to the affected area for short periods of time.
- Dental visit. Ultimately, the best way to alleviate tooth pain while pregnant is to see a dentist and get professional treatment.
Do Babies Take Calcium From Your Teeth?
Fetuses do not draw calcium from their mothers' teeth. This myth likely stemmed from the fact that pregnant women often experience tooth sensitivity—an issue that can be partly attributed to hormonal changes.
That said, calcium deficiency during pregnancy can lead to preterm labor, low birthweight, and bone fragility in newborns.
How Can I Relieve Gum Pain During Pregnancy?
Salt water is the fastest way to temporarily relieve gum pain in pregnant women. Here's how:
- Mix 1 teaspoon of salt into a cup of warm water.
- Stir until the salt has dissolved completely.
- Gargle the solution for 30 seconds and spit it out.
- Repeat this process 2-3 times daily, or however often you feel gum pain coming on.
You can also try rubbing clove oil onto the affected area to provide relief.
To prevent chronic gum pain, a prescription topical solution may be possible through your dentist.
Can A Pregnant Woman Go To The Dentist?
The American College of Obstetricians and Gynecologists (ACOG) recommends pregnant women visit their dentist at least once during pregnancy. This ensures that any existing oral health issues (such as cavities, gum disease, and tooth pain) are identified quickly and treated properly.
Untreated dental infections can have serious consequences for both mother and baby.
Is Tooth Sensitivity A Sign Of Early Pregnancy?
Sudden soreness in the teeth and gums is a common indicator of the hormonal changes that occur during early pregnancy. The only way to know for sure if this sensitivity is a sign of pregnancy is to take a home test or visit your doctor for a blood test. If the test is positive, pregnancy could be the reason. Still, visiting a dentist can either confirm or deny this.
How Can I Get Rid Of A Toothache While Pregnant?
Here are a few at-home treatments for toothaches during pregnancy:
- Baking soda. In addition to helping you improve your smile, homemade baking soda paste can provide natural pain relief from pregnancy-related toothaches
- Aloe vera. Popular for its antibacterial properties, aloe vera can help reduce bacterial growth on your teeth and inflammation and pain in the gums and surrounding tissue.
- Garlic. Garlic has natural anti-inflammatory effects that may help reduce pain associated with toothaches.
- Tea tree oil. This essential oil is known for its analgesic and antiseptic qualities. To use, mix a few drops with olive or coconut oil and apply directly onto the sore tooth.
- Clove oil. Clove oil is renowned for its anesthetic properties and can provide relief from toothaches while pregnant. To use, mix a few drops with petroleum jelly or olive oil and apply to the affected area.
