Moms-to-be, brush up: good oral health important during pregnancy

June 5, 2000
Web posted at: 4:17 PM EDT (2017 GMT)

In this story: The hormone connection Preventing premature labor RELATEDS

(WebMD) -- I was three months pregnant when my dentist sent a postcard reminding me of my annual checkup and cleaning. I immediately called to cancel; I was working full-time, feeling exhausted and still suffering from morning sickness. Between routine visits to my ob-gyn, ultrasound scans and a weird pregnancy-related rash that prompted three trips to my dermatologist, I was constantly at the doctor's office. I had no time. My teeth could wait, right? Wrong.

Pregnancy is a bad time to skip a dental checkup, according to experts. I learned this firsthand when, a month after the missed appointment, my mouth started bleeding during brushing. Cause for alarm? Perhaps. An infection in the mouth can set off a chain of events resulting in a premature birth, putting the health of the unborn baby at serious risk. In fact, women with gum disease are six times more likely to deliver early than women with healthy gums, according to a study led by Dr. Steven Offenbacher, director of the Center for Oral Systemic Disease at the University of North Carolina, Chapel Hill. The study was published in October 1996 in Annals of Periodontology.

"The scary thing is you could have gum disease and not even know because it may be symptomless until it's quite advanced," says Dr. Marjorie Jeffcoat, chairwoman of periodontics at the University of Alabama School of Dentistry at Birmingham. "And pregnant women are particularly susceptible to gum disease." According to Offenbacher's research, about 17 percent of pregnant women studied had gum disease.

Jeffcoat's statistics show that even more pregnant women may be at risk. In her ongoing study, which so far has tracked 800 women from pregnancy through delivery, 22 percent had advanced gum disease, compared with 20 percent of women in the area who were not pregnant. Of the pregnant women who did have gum disease, 9 percent had a premature birth, compared with 1 percent of the pregnant women not suffering from gum disease. Jeffcoat notes that she drew participants from a rural area, many of whom had never seen a dentist, which could explain why her research shows a higher risk.

Why are pregnant women more susceptible to gum disease? Hormone levels rise considerably in early pregnancy, resulting in an increase of blood flow throughout certain tissues of the body, including the gums. As a result, gums may become puffy, red and tender. Plaque may also irritate the gums more than normal during pregnancy, due to this higher level of hormones. The result of all this irritation and swelling may be gingivitis, an early form of gum disease, says Dr. Kim Harms, a dentist in Farmington, Minnesota, and a spokeswoman for the American Dental Association. Your gums won't necessarily hurt, but they may bleed during brushing.

You may be wondering how an infection in the mouth has anything to do with your baby. The two are connected by labor-causing responses to bacteria. One trigger of labor in a normal pregnancy is the rising level of substances called prostaglandins and cytokines (molecules that are associated with inflammation) in the amniotic fluid. "They increase steadily throughout the pregnancy until they reach a critical level, causing the uterus to contract and the cervix to thin and dilate," Offenbacher says.

Offenbacher's research has found that the body also responds to an infection in the mouth by producing prostaglandins and cytokines. These substances may get into the amniotic fluid, causing higher than normal levels earlier in the pregnancy -- resulting in premature labor for some women.

There are steps you can take to combat gum disease and lower your risk of premature labor. First of all, call your dentist as soon as you discover you're pregnant. She'll advise you whether to stick to your regular checkup schedule or to come in sooner. "A thorough cleaning at least once during pregnancy can remove the plaque, reducing the risk of gum disease," says Harms. "If you take care of (gum disease), it doesn't lead to permanent problems. But left untreated, it can progress to the bone, and the bone and soft tissues that support the teeth can be destroyed."

It's an old wives' tale that a pregnant woman loses a tooth for every baby. But advanced gum disease, called periodontitis, can lead to tooth loss, so the belief is likely based on this condition. Women with periodontitis during pregnancy are at highest risk of premature labor. Even a fairly mild case can trigger the start of labor in some women.

Luckily, in my case -- as with most pregnant women who take good care of their teeth -- the situation wasn't that dire. My plaque problem was worse than usual and my gums hurt during the cleaning. But my dentist, after delivering a lecture on the virtues of flossing every day, said I should be fine, and that she didn't need to see me again until after the birth. ("Don't forget to floss, and bring pictures!" she said.) And when I got pregnant with my second child, I didn't wait for the reminder card to come. My dentist was one of the first to hear the happy news.

© 2000 Healtheon/WebMD. All rights reserved.

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Periodontal disease
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American Dental Association: Pregnancy and oral health
The American Academy of Periodontology: Connection between gum disease and pregnancy problems
The American Dental Hygienists' Association: Periodontal disease

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