Are dental procedures safe during pregnancy?

Is dental anesthesia safe during pregnancy? What dental procedures are allowed while pregnant? We get many such queries from expecting mums on theAsianparent app.

During pregnancy, several oral health issues are common:

• Hormonal changes during pregnancy can make your gums more vulnerable to plaque, leading to inflammation and bleeding. This is also called pregnancy gingivitis or gum disease.

You may find that your gums bleed easily, especially when you brush your teeth. This is most commonly seen between the second and eighth months of pregnancy. 

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

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. If left untreated, you may even lose the affected teeth. In fact, according to studies, periodontitis is linked to preterm labour and low birth weight.

• Dental caries may also occur due to changes in diet such as increased snacking, increased acidity in the mouth due to vomiting, dry mouth or poor oral hygiene stemming from nausea and vomiting.

It is best to delay any non-emergency dental work (such as teeth whitening and other cosmetic procedures), until after delivery. In case of urgencies, always make sure that your dentist knows that you are pregnant. 

Dental treatment, if necessary, is best performed in the second trimester to minimise any risks. It is best to avoid it during the first trimester because that is the most critical period of your baby’s development.Treatment in the third trimester​ is also not recommended, because of the uncomfortable lying-on-your-back position you will have to be in, during treatment. 

If fillings are required, amalgam should be avoided and an alternative filling material (such as tooth-colored resins), which does not contain mercury, should be used instead, to prevent mercury toxicity.

If you need a dental X-ray, your dentist will usually wait until you've had your baby, even though most dental X-rays do not affect the tummy (abdomen) or pelvic area.

For the info, the American College of Obstetrics and Gynecology says that all dental X-ray examinations (with the usual leaded shielding over the abdomen and thyroid) are safe during pregnancy. Your dentist will also cover your throat with a leaded collar to protect your thyroid from radiation.

Also, dental work often requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled category B for safety in pregnancy, may be prescribed after your procedure.

If you were undergoing braces treatment and got pregnant, adjustment of the braces is safe throughout pregnancy. However, it is not recommended to fit new braces during pregnancy.

It is essential that you inform your dentist about your pregnancy so they can choose suitable anaesthetics and set appropriate levels. According to American College of Obstetrics and Gynecology, use of local anesthesia (lidocaine with or without epinephrine) is safe during pregnancy. 

A study in the August 2015 issue of the Journal of the American Dental Association followed a group of pregnant women who had procedures that used anesthetics like lidocaine shots and a group that did not. The study showed these treatments were safe during pregnancy, as they cause no difference in the rate of miscarriages, birth defects, prematurity or weight of the baby.

According to study author Dr. Hagai, “Our study identified no evidence to show that dental treatment with anesthetics is harmful during pregnancy. We aimed to determine if there was a significant risk associated with dental treatment with anesthesia and pregnancy outcomes. We did not find any such risk.”

As far as possible, your dentist will try to save your tooth. However, if your tooth is too severely damaged by decay or injury, it could put your oral and overall health at risk, and is best removed. Bacteria from a bad tooth infection could spread throughout your bloodstream.

Your dentist is likely to recommend the second trimester as the ideal time for a tooth extraction. That way you can avoid having X-rays in the crucial first trimester, as well as the discomfort of having to lie on your back for prolonged periods during the third trimester.

When tooth decay reaches the inside of your tooth where the nerve endings are, it can get extremely painful. 

In root canal treatment,  you repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. The tooth is fitted with a natural-looking crown. This eliminates the need for tooth extraction.

In case of emergency, a root canal can be performed at any stage of pregnancy and shouldn't be delayed. However, because X-rays are involved, the ideal time for treatment is during the second trimester.

It is best to delay teeth whitening and other non-emergency cosmetic dental procedures until after delivery.

Such treatment should be especially avoided during the third trimester as you may find it uncomfortable to lie still on your back while the whitening gel is applied and cured.

If you're using a home teeth whitening kit, do make sure that you check that the concentration of hydrogen peroxide is no more than six percent.

If you are already undergoing orthodontic treatment, you can continue it during pregnancy. Due to hormonal changes, some pregnant women may experience swelling of the gums, which can sometimes cause irritation from brace wires and brackets. Your dentist might provide safe gels to help numb the pain.

In case of having new braces fitted during pregnancy, your dentist may recommend that you wait until after delivery.

This is because fitting braces requires X-rays, which you want to avoid as much as possible during pregnancy. Also, you gain weight during pregnancy, which is likely to alter the shape of your face and mouth, and make adjusting and fitting braces more complicated.

Here's how you can look after your teeth and gums during pregnancy: 

• Clean your teeth carefully twice a day for 2 minutes with a fluoride toothpaste. 
• Floss once a day to remove small bits of food from between your teeth, which will help to prevent the build-up of plaque.
• If you have morning sickness (nausea and vomiting), avoid brushing your teeth straight after morning sickness, as they will be softened by the acid from your stomach. This can damage the enamel surface of your teeth. 

Instead, rinse your mouth with water and wait for about an hour before brushing. This will help prevent the acid in your vomit from damaging your teeth. You can also rinse with a baking soda solution (1 tsp of baking soda dissolved in 1 cup of water) to neutralise the acid.

• Avoid having sugary drinks (such as fizzy drinks or sweet tea) and sugary foods too often.
• Drink plenty of water throughout the day, especially between meals and snacks.
• If you're hungry between meals, snack on foods such as vegetables, fresh fruit or plain yoghurt, and avoid sugary or acidic foods. 
• Avoid mouthwashes that contain alcohol.
• A daily salt rinse (1 teaspoon of salt added to a cup of warm water) can help reduce gum inflammation. Swirl the wash around your mouth a few times before spitting it out (do not swallow).

(Source: American Pregnancy Association, American Dental Association, NHS, HealthHub)

Also READ: Best family-friendly dentists in Singapore for your child