Pregnancy causes a LOT of changes in your body. Your hips spread; your belly grows; your teeth shift.
Did that last one take you by surprise? While it isn’t as well-known of a side effect as, say, morning sickness, teeth shifting during pregnancy is well-documented. And it isn’t the only oral health side effect prenatal and postpartum mothers should be aware of.
What can you do to protect your smile? One option is orthodontic treatment, such as Invisalign or braces. However, there are some important safety and wellness considerations to keep in mind before undergoing orthodontic treatment before or after pregnancy. Here’s what you need to know about the impact of pregnancy on oral health and how you can keep your mouth healthy.
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Oral Health and Pregnancy: The Basics
From the moment you see two lines on the test, your to-do list grows exponentially. You need to attend OBGYN appointments, draw up your birth plan, and prep your home for baby. But while you are making your list, don’t forget to work in dental visits and treatments.
Oral healthcare is a vital part of prenatal care. While we rarely talk about how pregnancy impacts the teeth and gums, it is actually quite significant. Even more so when there are pre-existing conditions.
Tooth Decay and Gum Disease in Pregnant Women
Roughly half of all women enter pregnancy with either tooth decay (1 in 4 women of reproductive age) or gum disease (46 percent of all women of reproductive age), and in some cases, both. This means that many — perhaps the majority — of women start their pregnancies with a foundation of not-so-ideal oral health. However, pregnancy doesn’t need pre-existing conditions to lead to troubles with the teeth, gums, and jawbone.
The prevalence of periodontal disease in pregnancy is estimated to be as high as 100%. While tooth decay is not as common, it is still a significant concern. Morning sickness and acid reflux are common side effects of pregnancy, both of which can lead to tooth and gum erosion.
Hormones and Oral Health
Then there is the impact of progesterone and relaxin. During pregnancy, progesterone stimulates the blood vessels to ensure the fetus has an adequate blood supply for healthy development. Relaxin is a hormone that bumps up production in pregnancy to ensure the ligaments, bones, muscles, and even organs are slacker, allowing them to move and stretch to accommodate the growing baby.
This is all great — for the most part. However, the problem with hormones is that they can’t exactly differentiate the way we can. While changes to the blood vessels are essential for the health of the uterus and the fetus within, they are not so wonderful for the gums and teeth.
Formally known as pyogenic granuloma, these are benign tumors that form on the gums during pregnancy, typically between the teeth. On their own, they are not inherently dangerous, but they do make it easier for periodontal disease to develop. This is because they bleed easily, giving bacteria a pathway to enter the gums. While they typically resolve after birth, the risks they pose are notable.
Not all changes during pregnancy are outside of your control. Your choices regarding your oral health and eating habits can have a big impact on your teeth and gums.
Many pregnant women struggle to keep up with daily life since pregnancy causes fatigue. With all that they are juggling, it is normal that something has to give. In many cases, this is personal hygiene. Whether this is a purposeful choice (“I’m just too tired to floss this morning”) or the result of the infamous pregnancy brain, it has the potential to cause all sorts of issues.
Then there are pregnancy cravings. Many women find that while pregnant, they obsess over specific foods or types of foods, craving to eat them at nearly every meal. While frequently eating things like broccoli won’t cause too many issues, sweets, carbs, and acidic foods will contribute to tooth decay and gum disease.
Why Do Teeth Shift During Pregnancy?
As an adult, feeling your tooth wiggle, even the slightest bit, is disconcerting. However, this is a very common experience for pregnant women. The question is why does this happen?
The truth is that the cause is not fully known. Medical research on pregnant women is typically frowned upon, and since teeth shifting is something that can be easily fixed or controlled, there isn’t a significant need to definitively prove the root of this movement.
Right now, the leading theory is that the hormone relaxin drives shifting teeth during pregnancy. This hormone encourages various tissues in the body to relax, as the name implies. One tissue it relaxes is ligament fibers.
We tend to think of ligaments in relation to our knees, ankles, and other large joints, but we actually have them around our teeth as well. Called periodontal ligaments, these tissues connect tooth roots to their bone sockets. When they become loose, they allow the teeth to change their positions, moving closer to or farther from the surrounding teeth and even twisting in place.
Loose periodontal ligaments can lead to uncontrolled tooth shifts. However, they can also be used to make purposeful changes to tooth alignment as part of orthodontic treatment.
Is It Safe to Straighten Your Teeth While Pregnant or Breastfeeding?
When you are pregnant or breastfeeding, seemingly ordinary things can transform into threats to your baby. So it is natural to wonder if it is safe to get orthodontic treatment. The good news is that yes, it is. However, it is a little more complex than it would have been before baby.
Complications of Orthodontic Treatment During and After Pregnancy
How much more complex is orthodontic treatment when pregnant or breastfeeding? Really, it isn’t that much more difficult. However, there are a few factors to keep in mind:
- Increased Gag Reflex: One of the first signs of pregnancy many women notice is an increased gag reflex — so strong that even brushing their teeth can be difficult. Orthodontic treatment requires appliances and tools to be inserted into the mouth, which can trigger that reflex.
- Discomfort in the Dental Chair: Examinations and adjustments require that the patient be in the supine position in the dental chair. This position isn’t typically harmful (though it can be with certain pregnancy complications). However, it is uncomfortable, especially in the third trimester.
- Misinformation About X-Rays: Radiation is a risk to everyone, and especially problematic for developing fetuses. Many expecting mothers assume that X-rays are therefore detrimental to their baby. However, dental X-rays use minimal radiation and you and your baby will be protected by a special apron. Plus, there are digital alternatives that doctors can use.
- Time Commitment: Finally, there is the fact that traditional orthodontic treatments require you to commit your time to appointments on a regular basis. Whether you are expecting or have an infant in arms, making time to see your doctor every 4-10 weeks can be a stressor for moms.
Can Pregnancy Improve Treatment Outcomes?
It’s clear that pregnancy can complicate certain aspects of orthodontic treatment. But could it also improve others?
This is an interesting question and one that hasn’t been well researched yet. However, in theory, the looser ligaments caused by pregnancy could make it easier to move the teeth into their ideal positions.
Micropulse technology has been used for several years to help loosen the ligaments and speed up bone remodeling as part of orthodontic treatment. One popular clear aligner company, Byte, even includes micropulse devices as a standard part of their standard protocol. Pregnancy hormones might allow patients to achieve similar treatment times without the use of micropulse devices and move their teeth without as much dental soreness as the average patient experiences.
Orthodontic Treatment and the Health of the Mother and Fetus
Oral health is often treated as isolated from overall health, but the truth is that they are very closely linked. For example, there is a clear connection between gum disease and cardiovascular problems. But what about health concerns specific to pregnancy?
Pregnant women with periodontal disease are at an increased risk of developing pre-eclampsia and the related HELLP syndrome. Their babies are also more likely to be born early or have a low birth weight if born full term. Both of these are associated with long-term health problems for the child.
The good news is that orthodontic treatment can help. If you experience gum disease or tooth decay due to issues related to tooth alignment, straightening your teeth can improve conditions and make it easier to heal. However, this must be supported by the correct treatments from your general dentist or periodontist to achieve the desired results.
Best Options for Straightening Your Teeth While Pregnant
Whether you are looking to make corrections to long-term alignment problems, prevent teeth from shifting, or address changes that have come up since being pregnant, orthodontic treatment can help. There are three main options available to you:
These are fixed appliances combining brackets and archwires to direct force against the teeth, encouraging controlled movement.
Traditional Clear Aligners
These are clear trays that place force against the teeth based on their shape. Traditional clear aligners like Invisalign can only be obtained through a dentist or orthodontist.
At-Home Clear Aligners
These are similar to traditional in-office aligners, except they are administered remotely and can only make cosmetic changes to alignment.
Which Treatment Option Is Best?
Out of the options above, clear aligners are generally the best for pregnant women and new mothers. Since they are removable, they make it much easier to maintain oral hygiene. While braces aren’t inherently bad, when you are expecting or caring for a newborn, you generally don’t want to further restrict your diet or relearn how to brush and floss. They also require fewer appointments and no adjustments to the appliance, which is better for patients with sensitive gag reflexes.
But between traditional clear aligners and at-home clear aligners, which one is better for pregnant women and new mothers? This is a very personal decision. However, we lean towards at-home clear aligners. They are more affordable — leaving more of your budget open for all those baby essentials — and require less of your time since there are no doctor’s appointments.
Ways to Support Oral Health Before, During, and After Pregnancy
Orthodontic treatment can be a wonderful option for supporting your oral health. However, it cannot stand on its own. You must take a well-rounded approach to keep your teeth and gums healthy.
Start by knowing what signs indicate that your teeth or gums are being impacted by pregnancy or breastfeeding. These include:
- Bad breath.
- Sores inside the mouth.
- Bumps on the gums.
- New spaces between the teeth.
- New crowding of the teeth.
- Teeth that have begun twisting in place.
- Receding gums.
- Red or swollen gums.
- General tenderness in the mouth.
- Gums that bleed when brushing.
If you notice any of the above, schedule an appointment so your dentist can determine if something is wrong and make a treatment plan if there is.
However, you shouldn’t wait for problems to see your dentist. As soon as you decide to start trying to conceive, schedule an appointment with your regular doctor. Talk to them about your plans and ways you can boost your oral health. This will give you the ideal foundation for entering into pregnancy.
While pregnant and breastfeeding, do NOT skip your regular dental appointments. You should still get your check-ups every six months, and depending on the advice of your doctor, possibly more often.
Other things you can do to protect your teeth and gums are:
- Make sure to brush at least twice a day and floss at least once a day. If you struggle to remember, set reminders using your phone or other smart devices.
- Switch to a soft-bristled toothbrush if you haven’t already. This will still clean the teeth and gums well but will be less likely to cause the gums to recede.
- If you have morning sickness, do not brush your teeth directly after vomiting. This can drive the acid into your enamel and cause damage to it. Instead, use antacids (if approved by your doctor) or a mixture of one teaspoon of baking soda to one cup of water to rinse your mouth.
- Avoid foods that can cause tooth and gum problems. Limit sweets and carbs and focus on fruits, vegetables, and lean meats.
- Stay hydrated. A dry mouth allows bacteria to thrive and tartar to harden.
- Talk to your doctor about calcium supplements. Both pregnant and breastfeeding women can struggle to replenish their calcium, making these supplements a good choice for many.
Ultimately, your oral health is always important, but it is even more so when pregnant or caring for a little one. Be sure to take the necessary steps to protect your teeth and gums.
Is it a good idea to get clear aligner treatment while pregnant or when postpartum? While there are many factors to consider, and the decision is quite personal, understand that straightening your teeth is safe to do unless your doctor tells you otherwise. If you are trying to decide on whether or not to get orthodontic treatment, consider the following:
- Straight teeth are healthy teeth because they are easier to clean and give tartar and plaque fewer places to hide.
- Good oral health is associated with better outcomes for both mother and child.
- When you are in orthodontic treatment, you tend to focus on your teeth more in general, improving your oral health.
- Being in active treatment can prevent the tooth shifts that often come with pregnancy, improving or preserving your bite.
However, there are situations where it might not be a good choice. If you have active tooth decay or gum disease, this needs to be treated first. Additionally, if your OBGYN or general doctor expresses concern, you should heed their advice. While pregnancy lasts just nine months, you can correct your tooth alignment at any point in your life.