EXPERIENCING menstruation and getting pregnant are two life-altering events for women.
Nevertheless, these times are entirely natural and highly physiological. Due to transient changes in their immune system, metabolism, hormone levels, and physical structure, women suffer greatly.
A torrent of mood swings, cravings, cramps and pain are all part of the menstrual cycle.
In contrast, pregnancy is a modified form in which the requirements have changed due to the growing foetus inside the uterus.
Women are compelled to make significant life adjustments at this time in order to accommodate the life that is developing inside of them.
Numerous difficulties are also associated with pregnancy, such as perinatal mortality (stillbirths and early infantile death), gestational diabetes and pre-eclampsia (persistent high blood pressure and abnormally high protein levels in urine).
The latter complications are all systemic outcomes, but what is the connection of these complications with oral health?
When pregnancy changes your mouth
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The physiological, hormonal and dietary changes that occur during pregnancy are essential for preserving the stable status of both the mother and the foetus.
However, these changes also influence the risk for oral diseases, including dental caries and periodontal disease, which affects the gums and all tissues surrounding the teeth. The oral cavity and other body parts of the expectant mother are likewise impacted by the delicate and intricate changes that occur during pregnancy. An intricate and varied microbiome including more than 700 species is found naturally in the mouth cavity.
A balanced microbial flora contributes to stable dental and overall health; changes in the oral microbial community during pregnancy may have an effect on the oral health of the mother, the outcome of the birth and the oral health of the unborn child.
It is known that for 60%-75% of pregnant women, toothbrushing comes with an unexpected side effect: gum bleeding, indicated by a pink-tinged toothpaste signifying pregnancy gingivitis, typically worsening between the second and third trimesters before improving near delivery.
It is important to note that pregnancy does not cause gum disease but exacerbates existing inflammation. Even women with good oral hygiene may notice increased gum sensitivity due to hormonal changes. Additionally, some pregnant women develop pregnancy tumours benign, non-cancerous growths on the gums that usually resolve after childbirth.
Oral health is made more difficult by morning sickness, a typical pregnancy symptom. Frequent vomiting exposes the teeth to stomach acid, hence damaging the tooth enamel and increasing the risk of cavity development. If basic care is neglected, dietary changes like desire for sweet foods can also lead to damage. Medical research has clearly shown that gum disease plays a major role in many pregnancy complications, such as premature birth, pre-eclampsia and gestational diabetes. For 20 decades, scientists have examined how gum disease might contribute to these problems by creating both infection and body-wide inflammation that can harm the developing foetus.
Gum disease affects pregnancy in two key ways:
First, harmful bacteria from infected gums can enter the mother's bloodstream and reach the amniotic fluid surrounding the baby. This can cause an infection of the foetal membranes (amnion and chorion), which is one of the leading causes of premature labour.
Second, pregnancy itself naturally increases inflammation in the body. When combined with gum disease, the body's hormonal changes trigger the release of inflammatory signalling molecules called cytokines.
These substances can mistakenly activate the uterus to contract too early, potentially resulting in premature delivery or, in severe cases, stillbirth.
The combination of oral bacteria spreading through the body and the naturally heightened inflammatory state of pregnancy creates a dangerous situation where the body may respond as if fighting a major infection, even when no obvious infection exists. This dual effect helps to explain why gum disease is so strongly linked to poor pregnancy outcomes.
Adverse pregnancy outcomes and their association with periodontal disease:
Pre-term birth and low birth weight
Periodontal disease, a severe gum infection, allows the proliferation of harmful bacteria in the bloodstream. These bacteria trigger inflammatory responses that may reach the placenta, potentially leading to pre-term labour (delivery before 37 weeks) or low birth weight (under 2,5kg). Studies estimate that 6%-41% of low birth weight cases worldwide may be linked to untreated gum disease.
Pre-eclampsia risk
Pre-eclampsia, a dangerous condition marked by high blood pressure and organ damage after 20 weeks of pregnancy, has been associated with chronic gum inflammation.
It is understood that oral bacteria contribute to endothelial dysfunction, impairing blood vessel health thereby increasing pre-eclampsia risk.
Gestational diabetes complications
A bidirectional relationship exists between gestational diabetes mellitus (GDM) and periodontal disease. Poor blood sugar control worsens gum infections, while gum inflammation makes glucose management more difficult. Women with GDM often experience more severe periodontal disease, emphasising the need for integrated dental and prenatal care.
Maternal-foetal bacteria transfer
After birth, cavity-causing bacteria such as Streptococcus mutans can be transmitted from the mother to the baby through shared utensils, kisses or testing food temperature with the mouth. Infants exposed to these bacteria face higher risks of early childhood cavities, reinforcing the importance of maternal oral hygiene.
Safe dental care during pregnancy
Maintaining good oral hygiene during pregnancy is of paramount importance in reducing risks. Key recommendations include:
- Brushing twice daily with fluoride toothpaste and a soft-bristled brush.
- Flossing gently to remove plaque between teeth.
- Rinsing with water or baking soda solution (1 teaspoon in a cup of water) after vomiting to neutralise acid.
- Eating a balanced diet rich in calcium (for foetal bone development) and vitamin C (for gum health).
The second trimester is ideal for dental checkups and cleaning. Necessary treatments, including fillings and extractions, can be performed safely with local anaesthetics (for example lidocaine), shielded X-rays (if urgently needed) and pregnancy-safe antibiotics (for example penicillin). However, elective procedures like teeth whitening should be postponed and tetracycline antibiotics (which stain foetal teeth) must be avoided.
- Patience Matambo is a final year BSc Dental Surgery student at the People’s Friendship University of Russia. She can be reached at patiencedental2024@gmail.com
