Introduction
World Health Day, observed on April 7, 2025, will launch a year-long campaign dedicated to maternal and newborn health. Titled Healthy Beginnings, Hopeful Futures, the campaign will encourage governments and healthcare providers to intensify their efforts to eliminate preventable maternal and newborn deaths and prioritize the long-term health and well-being of women.
Throughout the year, WHO and its partners will provide valuable information and resources aimed at promoting healthy pregnancies, safe births, and improved postnatal care.
Pregnancy gingivitis
Pregnancy gingivitis is recognized as one of the most common oral manifestations during pregnancy, affecting a significant proportion of pregnant women worldwide.
The underlying pathophysiology of pregnancy gingivitis is multifactorial, involving complex interactions between hormonal changes, immune system modifications, and alterations in the oral microbiome.
During pregnancy, elevated levels of estrogen and progesterone affect gingival tissues by increasing vascular permeability and modulating inflammatory responses. These hormonal changes worsen plaque-induced gingival inflammation, creating an environment conducive to bacterial proliferation.[1]
Growing evidence suggests that pregnancy gingivitis may have implications beyond oral health, potentially affecting pregnancy outcomes.
Research has identified gingival inflammation as a potential risk factor for adverse pregnancy outcomes, establishing important connections between oral and systemic health during pregnancy.
In this article, we give evidence-based recommendations to pregnant women to maintain their tooth and gum health before, during, and after pregnancy.
A. Oral care recommendations: Before Pregnancy
Optimizing your oral health before conception can reduce risks associated with pregnancy gingivitis and other oral complications.
Precautions :
1. Comprehensive Dental Examination:
- Undergo a thorough dental check-up to detect and treat periodontal (gum) disease or tooth decay early.
- Periodontal treatment before pregnancy reduces inflammation risks during pregnancy [2].
2. Establish Good Oral Hygiene Habits:
- Brush twice daily with a soft or ultrasoft toothbrush, clean between teeth using a floss or proxabrush, and use antimicrobial mouthwash if your dentist advises.
- Effective plaque control lowers the likelihood of gingival inflammation [3].
3. Address Nutritional Deficiencies:
- Maintain a balanced diet rich in vitamins C, D, calcium, and folic acid to support healthy gums and teeth [7]
B. Oral care recommendations: During Pregnancy
Oral hygiene is especially critical during pregnancy due to hormonal changes and increased vulnerability to gum disease. Let’s learn more about precautions to be taken in each trimester:
First Trimester
- Schedule a dental check-up and inform your dentist about your pregnancy.
- Avoid elective dental procedures unless urgently needed; preventive care like cleaning is safe.
- Manage nausea and vomiting:
- Rinse your mouth with water after vomiting to neutralize acids, but avoid brushing immediately afterward to prevent enamel erosion [4].
Second Trimester
- Ideal time for dental treatments like professional cleaning, scaling, and fillings.
- Maintain meticulous oral hygiene:
Brush twice daily with a soft-bristle or ultrasoft toothbrush to minimize gum irritation.
Floss gently to avoid gum trauma. Use proxabrush to clean the gaps between teeth.
Obstetricians and gynecologists should suggest that pregnant women go to the dentist for a dental examination and scaling treatment every 3 months during pregnancy, and that those preparing for pregnancy undergo regular 6-month scaling [5].
Third Trimester
- Maintain regular oral hygiene routines despite possible increased gum sensitivity.
- Position yourself comfortably during dental visits to prevent dizziness or discomfort from lying on your back for extended periods. Consider lying slightly on your left side.
- Delay non-urgent treatments until after delivery.
C. Oral care recommendations: After Pregnancy
Oral care post-pregnancy remains essential, particularly to address lingering gum issues and prevent dental complications.
Precautions:
1. Postpartum Dental Check-up:
- Schedule a comprehensive oral examination soon after delivery to identify and treat any residual gum inflammation or decay.
- Professional cleaning helps manage postpartum gingival changes [6]
2. Continued Oral Hygiene:
- Maintain diligent oral hygiene routines to reverse any gingival inflammation experienced during pregnancy.
- Continue brushing, flossing, and using fluoride-containing oral care products daily.
3. Diet and Nutrition:
- Continue consuming a nutritious diet rich in calcium, vitamin D, vitamin C, and essential nutrients, especially if breastfeeding, to promote overall health, including oral health.[7]
Key Takeaways
- Proactive oral health management before pregnancy significantly reduces complications.
- Regular, gentle oral hygiene routines during pregnancy protect against pregnancy gingivitis.
- Postpartum dental care helps restore and maintain oral health, supporting overall wellness for mother and baby.
Consistent professional guidance from dental professionals combined with informed personal care is the cornerstone for excellent oral health during this critical life phase.
References:
- Le QA, Eslick GD, Coulton KM, Akhter R, et al. Does Treatment of Gingivitis During Pregnancy Improve Pregnancy Outcomes? A Systematic Review and Meta-Analysis. Oral Health Prev Dent. 2021 Oct 22;19:565-572. doi: 10.3290/j.ohpd.b2183059. PMID: 34673848; PMCID: PMC11641198.
- Figuero E, Carrillo-de-Albornoz A, Martín C, et al. Effect of pregnancy on gingival inflammation in systemically healthy women: a systematic review. J Clin Periodontol. 2013 May;40(5):457-73. doi: 10.1111/jcpe.12053. PMID: 23557432.
- Jepsen S, Caton JG, Albandar JM, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S237-S248. doi: 10.1002/JPER.17-0733. PMID: 29926943.
- American Dental Association (ADA) Guidelines (2021)
“Pregnancy and oral health.”
https://www.ada.org/resources/ada-library/oral-health-topics/pregnancy - Chen JJ, Wu DR, Lin WS, Chen IC, Liu JF, Chen HL, Lin CH. Impact of Scaling and Periodontal Treatment during Pregnancy on the Risk of AdverseBirth Outcomes. J Pers Med. 2022 Jan 20;12(2):137. doi: 10.3390/jpm12020137. PMID: 35207626; PMCID: PMC8877129.
- Raju K, Berens L. Periodontology and pregnancy: An overview of biomedical and epidemiological evidence. Periodontol 2000. 2021 Oct;87(1):132-142. doi: 10.1111/prd.12394. PMID: 34463990.
- Nannan M, Xiaoping L, Ying J. Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies. Front Med (Lausanne). 2022 Oct 25;9:963956. doi: 10.3389/fmed.2022.963956. PMID: 36388896; PMCID: PMC9640773.