Dental care in pregnancy: what is safe and what can wait

Dental care in pregnancy is considered safe, and it is important. According to the American Dental Association (ADA), check-ups, a scale and polish (teeth cleaning), fillings, root canal treatment and, when necessary, an extraction can all be done at any stage of pregnancy, with local anaesthetic where needed. Many pregnant women put off seeing a dentist for fear of harming the baby, but delaying necessary treatment can lead to more complex problems.

Dental care in pregnancy: what is safe at the dentist?

According to the ADA, conditions that need prompt treatment, such as inflamed gums or an inflamed nerve inside a tooth, can be treated at any time during pregnancy.

Local anaesthetic in pregnancy

A local anaesthetic numbs only the part of your mouth being treated, so you should not feel pain during the procedure. According to the ADA, local anaesthetics such as lidocaine can be used in pregnancy, including those that contain adrenaline.

In one study cited by the ADA, there was no difference in rates of miscarriage, birth defects, premature birth or birth weight between pregnant women who had a local anaesthetic for dental treatment and those who did not (ADA MouthHealthy). So there is no reason to put up with pain during treatment.

Dental X-rays while pregnant

Dental X-rays are considered safe at any stage of pregnancy. The radiation dose is very small, and the beam is aimed only at the area being X-rayed (ADA MouthHealthy).

The ADA no longer recommends routine lead aprons or thyroid collars for dental X-rays (ADA).

Painkillers and antibiotics

Ask your dentist which painkiller to take and, if needed, check with your doctor or midwife. According to the NHS, paracetamol is usually the first choice in pregnancy, while ibuprofen should be avoided unless a doctor or pharmacist recommends it (NHS).

If you need an antibiotic, your dentist will choose one that is considered safe in pregnancy, such as amoxicillin or penicillin (ADA). Do not take antibiotics without a prescription.

Bleeding gums in pregnancy: why it happens

Pregnancy hormones make your gums more sensitive to plaque, the sticky film of bacteria that builds up on your teeth (Oral Health Foundation). Your gums can become red and swollen and may bleed when you brush. This is known as pregnancy gingivitis, and it is common.

Bleeding is not a reason to stop brushing. If plaque is left on your teeth, the inflammation can get worse. Brush gently but thoroughly, and clean between your teeth every day. Your dentist may also suggest having a scale and polish more often while you are pregnant (ADA MouthHealthy).

Some women develop a small red lump on the gum that bleeds easily, most often in the second trimester. It is sometimes called a ‘pregnancy tumour’, but it is not cancer, and it usually disappears after the birth. If it bleeds, grows or gets in the way when you eat, show it to your dentist.

Studies have not reported harmful effects from treating gum disease during pregnancy. It is still unclear whether this treatment affects the timing of the birth or the baby’s birth weight (Cochrane).

Read more: Bleeding gums: early signs of gum disease and Gum disease treatment.

Morning sickness: how to protect your tooth enamel

Being sick brings stomach acid into your mouth. This acid can weaken enamel, the hard outer layer of your teeth, and make them sensitive (Oral Health Foundation). A few simple habits can help:

• After being sick, rinse your mouth with water or a fluoride mouthwash. The ADA also suggests rinsing with a teaspoon of bicarbonate of soda (baking soda) in a cup of water.
• Then wait at least 30 minutes before brushing.
• Brush twice a day for 2 minutes with a fluoride toothpaste. Spit out the toothpaste, but do not rinse with water.
• If brushing makes you gag, try a toothbrush with a smaller head and brush slowly.
• If nausea means you are eating more often, cut down on sugary snacks and drinks. Frequent snacking gives the bacteria that cause tooth decay more to feed on (ADA MouthHealthy).
• Drink water throughout the day. Some women have less saliva in pregnancy, and a dry mouth increases the risk of decay.

More on everyday care: How to brush and clean between your teeth properly.

What can wait until after the birth?

Treatment that is optional rather than necessary can wait:

• Teeth whitening. The NHS does not recommend it while you are pregnant or breastfeeding (NHS). Read more: Teeth whitening: what works and what is safe.
• Cosmetic treatment on healthy teeth, such as composite veneers or bonding done purely for appearance.
• Replacing old amalgam fillings that are still in good condition. The US Food and Drug Administration advises against removing intact amalgam (silver) fillings without a medical reason, and recommends that pregnant women avoid new amalgam where possible (FDA). White (composite) fillings contain no mercury.
• Removing a wisdom tooth that is not causing problems. Such teeth often do not need to come out at all and are simply monitored at check-ups. More extensive planned treatment can also wait.

If your pregnancy is high-risk, your doctor or dentist may also advise postponing some other treatment.

Do not put off treatment if you have toothache, swelling, decay, a broken tooth, a lost filling or inflamed gums. The practice’s motto, ‘Save the tooth’, applies in pregnancy too: the aim is to treat the tooth in good time and keep it.

When to book a dental check-up in pregnancy

The European Federation of Periodontology (EFP) recommends a check-up early in pregnancy. Tell us straight away if you are pregnant or think you might be, and how many weeks pregnant you are (ADA MouthHealthy).

No month of pregnancy is off limits for dental treatment, whether you are in the first, second or third trimester. Even so, plan your visits around how you feel. In the early months many women have morning sickness, and in the last weeks lying on your back for a long time can be uncomfortable. Let us know if you need a break or would like to sit more upright.

For your appointment, please have ready:

• a list of any medicines, vitamins and supplements you take
• your due date
• any letter or advice from your doctor or midwife, if your pregnancy is high-risk
• your health insurance card, if you are insured with the Health Insurance Fund (FZO)

Read more: Your first visit. As an insured patient, you can register with Dr Kiril Milanovski as your chosen dentist (izbran stomatolog) under the Fund.

When to see a dentist without delay

Call us and ask for the earliest available appointment if:

• you have toothache, or pain that keeps coming back
• your gum or face is swollen, or you notice pus or a bad taste in your mouth
• your gums are very sore and swollen, or keep bleeding despite gentle, regular brushing
• a lump on your gum bleeds, grows or gets in the way when you eat
• you have broken a tooth or lost a filling
• a tooth has started to feel loose

During opening hours (Monday to Friday, 11:00–19:00), we try to see patients with toothache or a broken tooth on the same day, when a slot is available. Read more: Toothache or broken tooth: same-day appointments and Toothache: what to do until you see a dentist.

Pregnancy and your teeth: frequently asked questions

Pregnancy is a good reason to have a check-up, not a reason to put one off. Book an appointment and tell us how many weeks pregnant you are, so we can plan your visit around you.