Oral care during pregnancy: what changes

Why gums bleed more easily in pregnancy

Hormone levels change in pregnancy and the gum reacts more strongly to the layer of bacteria sitting on the tooth. The same amount of plaque now produces more swelling and redness. Gums bleed when you brush, sometimes when you clean between the teeth, and in advanced cases on their own. For most people this starts in the second month, becomes clearer towards the final months and settles in the weeks after the birth. Some people also get a bright red lump on the gum that bleeds easily; it is harmless and usually shrinks once the baby is born.

Stopping brushing because it bleeds makes it worse

Bleeding does not mean the brush is damaging the gum; it means there is inflammation in that spot. Once the spot is avoided, plaque keeps building up, the inflammation grows and the bleeding grows with it. The right move is the opposite: do not skip the area that bleeds, clean it more slowly and more carefully. After a few days of steady cleaning most people notice the bleeding easing off.

• Brush twice a day for two minutes with a soft brush and a fluoride toothpaste.
• Clean between the teeth every day; if floss is awkward, an interdental brush is usually easier.
• Use small circular movements rather than pressure; pressing hard makes the gum recede.
• If tartar has built up, it needs removing; a scale and polish can be done during pregnancy too.

What happens in the mouth after morning sickness

When stomach acid reaches the mouth, the enamel softens for a short while. Brushing straight away wears that softened layer down, and over the years the thinning shows up most on the inner surfaces of the front teeth. Nausea also makes brushing itself harder: the smell of the toothpaste or the brush touching the back teeth can set off gagging. A small brush head, a mildly flavoured toothpaste and a time of day when the sickness has eased work for most people.

Does dental treatment have to wait until after the birth

Pregnancy is not a general barrier to dental treatment. Check-ups, a scale and polish, fillings and, where needed, root canal treatment can all be carried out in these months. On timing, the second trimester is more comfortable for most people: the sickness has usually settled and lying back in the chair is less of a strain than in the final weeks. Later on, a small cushion under the right hip so you lean slightly to the left helps. If there is swelling in the face, a temperature or pain that keeps you awake, do not wait: seek dental care the same day.

The real risk in pregnancy is not having treatment; it is carrying an untreated infection in the mouth for nine months.

How to talk about X-rays and medicines with your dentist

Say at the first visit that you are pregnant and how many weeks you are; that changes both the order of treatment and the choice of medicine. A dental X-ray is aimed at a narrow area at a low dose and the abdomen stays outside the beam. Even so, X-rays are not taken routinely in pregnancy; if one is genuinely needed, it is taken with a lead apron and a thyroid collar. That decision belongs to the dentist who is looking at your case. The same goes for painkillers and antibiotics: do not take anything on your own from lists you find online.

Does a mother lose a tooth for every baby

Despite the old saying, the baby does not draw calcium out of the mother's teeth. Enamel is not a tissue that renews itself the way bone does; once it has formed, calcium is not taken back out of it. When teeth are lost during pregnancy the reason lies elsewhere: inflamed gums, acid from being sick, frequent snacking and cleaning that slips because of tiredness. Something can be done about every one of those.

• Eating little and often keeps the mouth acidic for longer; fewer snacks means a lower risk of decay.
• A glass of water after a snack dilutes the acid and washes food debris away.
• Cheese, walnuts and unsweetened yoghurt are gentler on teeth than fruit juice or biscuits.
• If heartburn increases in the final months, an early evening meal and raising the head of the bed reduce the acid reaching the mouth.

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