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​​Starting Right 

One cannot over-emphasize the importance of preventive dental care to maintain a healthy set of teeth and gums. Taking charge of your dental health for a healthy pregnancy starts even before you conceive​. This minimises dental uncertainties and enables you to concentrate on your pregnancy. You should visit your dentist for a check up, scaling and polishing of your teeth. 

Gum Disease in Pregnancy 

Pregnancy increases the risk for developing gingivitis and periodontitis (gum infection) due to the increase in estrogen and progesterone. 

Gingivitis (bleeding gums) is an inflammation of the gums, which appear red and swollen. You may find that they bleed easily, especially when you brush your teeth. This is most commonly seen between the second and eighth months of pregnancy. 

Periodontitis is a more severe form of gingivitis, involving destruction of the supporting bone structure surrounding the teeth. This may result in your teeth becoming shaky. You may even lose the affected teeth if the condition is allowed to deteriorate.​

​It is important to adopt the correct practice to prevent periodontitis as studies have shown a link between periodontal disease and premature delivery. 

Preventing Gum Disease 

Adopting good oral hygiene is essential to prevent gum disease. This includes brushing after each meal, flossing at least once a day, and using an anti-plaque mouth rinse. 

Visit the dentist regularly at least every six months to check that your gums are healthy and for professional cleaning of your teeth. This should be practised even prior to conception, to ensure healthy gums right from the start of pregnancy. 

Caries (Dental Decay) 

Being pregnant by itself does not cause dental decay, but the symptoms associated with it may indirectly result in caries. Morning sickness and tiredness in the first trimester can result in dental neglect and poor oral health. This increases one’s risk to caries. 

In addition, food cravings during pregnancy may result in higher or more frequent sugar intake, also increasing the risk of developing caries. 

Making the extra effort to practise good oral hygiene (brushing after meals, flossing once a day and using a fluoride mouth rinse) is thus essential to prevent caries. 

Amalgam Fillings (Silver Fillings) 

During pregnancy 

You can be exposed to inorganic mercury from the inhalation of mercury vapour released from amalgam fillings, especially greatest during the placement or removal of the filling. 

While it is comforting to know that existing amalgam fillings in the mouth do not pose a risk of mercury toxicity to the fetus during pregnancy, there has been a concern of mercury toxicity during the placement or removal of amalgam fillings in pregnancy. The good news is that there has been no evidence to prove this relationship. Similarly, there is no evidence to confirm that placement or removal of amalgam fillings during pregnancy increases the risk of low birth weight of the baby. 

However, as a precautionary measure, you should avoid any unnecessary procedures involving amalgam, if possible. You may discuss with your dentist​ about using an alternative filling material such as tooth-colored resins, which do not contain mercury. 

During breastfeeding 

Mercury from amalgam fillings can also be transferred into breast milk. However, it has not been determined if the measured amount of mercury in the breast milk is a result of mercury from the amalgam fillings or from dietary exposure, such as the consumption of fish. 

While there is insufficient evidence to suggest that placement and removal of amalgam fillings whilst breastfeeding can cause mercury toxicity to the baby, it would still be prudent to avoid such procedures, if possible, until breastfeeding has stopped. ​

Radiographs 

Dental X-rays are of very low dosage and pose little harm. However, to be cautious, dental radiographs should only be taken during pregnancy if there is an emergency. 

Some dental infections may spread to other parts of the head and neck region and need to be treated. Any trauma to the teeth may also be considered a dental emergency. In circumstances like these, dental radiographs are indicated. 

A lead apron over the abdomen can be worn to protect your baby from radiation when dental radiographs are taken, so there should be no cause for worry. 

Pregnancy Tumour 

The term “pregnancy tumour” sounds and looks intimidating, but is actually less serious than it portrays itself to be. The pregnancy tumour is also known as “pyogenic granuloma” or “pregnancy epulis”. 

It is a benign growth at the gum margin that can become quite large and bleed easily upon trauma. 

This is due to an extreme inflammatory response to local irritation such as plaque and is most common in the second trimester. 

A large pregnancy tumour may be uncomfortable and can cause difficulty in speech and eating.​ ​

Preventing Pregnancy Tumours 

Maintaining good oral hygiene and regularly receiving professional cleaning reduces your risk of a pregnancy tumor developing. 

Treatment of Pregnancy Tumours 

Pregnancy tumors usually resolve spontaneously after delivery. Thus, leave the pregnancy tumor alone if it does not cause you too much inconvenience, but continue to maintain good oral hygiene. 

However, if it causes discomfort or affects your speech or eating, you may wish to seek treatment from your dentist. Pregnancy tumors may be excised surgically under local anesthesia. This is a minor procedure and should not be a cause for alarm. 

Frequently Asked Questions

1. Are dental procedures safe during pregnancy? 

While regular check-ups and cleaning are highly recommended during pregnancy, elective major dental procedures (for example bleaching) should be postponed till after delivery of your baby. 

If fillings are required, amalgam should be avoided and an alternative filling material be used instead. 

As the first trimester is the most critical period of your baby’s development, dental treatment, if necessary, is best performed in the second trimester to minimise risk. Discuss your dental needs with your dentist. 

Treatment in the third trimester is often not recommended due to the unfavourable supine position during treatment. This position affects your blood circulation as it slows down blood flow back to the heart. Do inform your dentist if you are not comfortable and adjust the dental chair accordingly. 

In the unique situation where you may be undergoing braces treatment and got pregnant, adjustment of the braces is safe throughout pregnancy. 

2. Are braces safe for patients who are undergoing cesarean section? 

Many patients wearing braces have no problems with surgery and anesthesia. However, do inform the anesthetist if you are undergoing general anesthesia to take special precautions not to dislodge the braces during intubation of the airway.​ ​

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.