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Dr Craig Peck and Prof Nadia Mohamed in Baby’s and Beyond Magazine

Author: Dr Craig Peck and Prof Nadia Mohamed

It is well-accepted that pregnancy is associated with many physiological and hormonal changes, many of which affect the oral cavity in a variety of ways.


(Published - 8 September 2020)

The most important pregnancy hormones are oestrogen and progesterone and changes in these blood levels during pregnancy have a marked effect on gum health. Both oestrogen and progesterone show a gradual increase during pregnancy until the eighth month and then stabilise at the ninth month. These levels return to pre-pregnancy levels within two months after delivery. It is during this period when the two hormones are fluctuating that pregnant women often express noticeable changes in their gum health. The reason for this is that oestrogen and progesterone both effect changes in the vascular system (blood vessels) and the immune system, which could exacerbate gum inflammation. It has been shown that an increased level of progesterone in gingival fluid (which is the fluid secreted normally from the gums and supporting socket of the tooth), can have an immunesuppressive effect and result in a chronic type of inflammatory response.

As a result of these changes, 30% to 100% of pregnant women have reported some degree of change to their normal gum health. These signs and symptoms range from increased bleeding from the gums, localised or generalised swelling, tenderness during eating or brushing, redness and even a thickened gum margin. Although gingivitis during pregnancy can start from as early as the first month, it is more likely to occur in the third trimester (when levels of oestrogen and progesterone are higher). The worst symptoms have been reported to occur during the third and eighth months of pregnancy.

It is important to note that although gingivitis could be experienced during pregnancy, it is no different from gingivitis in non-pregnant women. The only difference is that hormonal changes during pregnancy lead to vascular changes in the blood vessels, which could increase the chances of bleeding and gum sensitivity. Despite the changes in the blood vessels and fluctuating levels of oestrogen and progesterone during pregnancy, gum health is still largely dependent on maintaining optimal oral care. Neglecting this aspect during pregnancy is more likely to contribute to the development of gingivitis. Stabilisation of oestrogen and progesterone after delivery tends to have a positive effect on the gum health. Some research has reported a greater degree of tooth mobility, especially around the eighth and ninth month. It is suspected that this is linked to the highest peaks of oestrogen and progesterone within the oral soft tissues. This mobility however appears to stabilise following delivery when hormone levels return to normal. It is very important to take note that any pre-existing disease of the soft tissue and underlying bone that remains untreated during pregnancy is associated with a 5% to 8% higher incidence of pre-term births. Good oral health and gum health before and during pregnancy is therefore extremely important to counter the effect of the hormonal changes on the oral health and ensure general well-being.

There has been a longstanding and controversial debate regarding tooth decay during pregnancy. Previously, the accepted belief was that calcium was drawn out from inside the tooth and into the bloodstream to support foetal growth and development. This notion has since been rejected on the basis that the chemical composition of teeth do not change during pregnancy. However, the nature and composition of saliva do change. Calcium and phosphate ions in saliva are essential for maintaining healthy tooth structure. During the second and third trimesters of pregnancy, the levels of calcium and phosphate decline, increasing the susceptibility for cavity formation. Additionally, the pH and buffering capacity of saliva reduces noticeably during the third trimester. This acidic environment therefore has the potential to exacerbate existing cavities and weaken tooth structure. These physiological changes in saliva during pregnancy, together with an altered salivary flow rate, reduced antibody levels in the saliva and possible tooth erosion from morning sickness could therefore theoretically predispose a pregnant woman to tooth decay.

The aetiology and development of cavities is however multifactorial in nature. Oral bacterial load, dietary control, frequency of snacking, type of snacking (especially sugary foods and drinks), and the

susceptibility of tooth structure, all play a role in the development of cavities. It should however be noted that the duration of pregnancy is too short a time for the potential negative salivary changes to result in tooth decay. An increase in salivary sialic acid during the latter part of pregnancy also has a protective effect as it facilitates the bacterial clearance from the mouth, thereby reducing the chances of developing cavities.

Oral care (before, during and after pregnancy) should be an essential part of everyone’s daily healthcare programme. However, due to the possible oral effects of the hormonal changes during pregnancy, pregnant women should take extra care to ensure optimal oral health. Starting pregnancy with healthy teeth and gums (as confirmed by a dentist), brushing twice a day and flossing once a day, are invaluable in maintaining good oral health in order to reduce the possible effects of the many physiological changes during pregnancy. The use of a daily fluoride containing mouthwash could help to strengthen and protect tooth structure, reduce the acidity of the saliva and lower the bacterial load in the mouth. All these factors are essential to prevent the development of cavities.

It is important to remember that dental emergencies during pregnancy pose a challenge for dental treatment. In addition to hormonal changes, pregnancy results in physiological changes in the various organ systems, which could complicate dental treatment, especially when drugs need to be administered. This could cause harm to the unborn child, especially during the first trimester. Regular dental check-ups in order to identify and treat minor dental problems before they progress, would ensure that complex dental treatment is not required during the crucial period of growth and development for the unborn child. Good oral health habits will not only benefit the overall health and well-being of the mother, but also that of the unborn child. Maintaining good oral health during this time is therefore essential.



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