By: Prof. Dr. Aruni Tilakaratne, Dr. Goh Yet Ching, Dr. Irosha Rukmali Perera
Did you know that oral health is very closely connected to the rest of the body’s health? In fact, oral health is both integral and inseparable from one’s overall health. Surprisingly though, the oral health status of a pregnant woman can forecast the future oral and dental status of the infant she is bearing. At the same time, the pregnancy itself pushes the mother to be more susceptible towards common oral diseases like gum disease and tooth decay. Therefore, maintaining good oral health is extremely important for a pregnant mother.
What are the adverse effects of poor oral health to the infant?
One of the main concerns is the increased risk for tooth decay (dental caries) when the infant’s teeth begin to erupt. This is due to the transfer of oral bacteria to the newborn from the mother’s oral cavity, if the mother carries a high load of decay-causing oral bacteria (e.g., from untreated caries). Oral bacterial contamination from the mother to the newborn happens unintentionally, during the day-to-day close physical contact, especially through mother’s saliva. This may happen with habits like sharing feeding utensils, blowing on baby’s food for cooling, kissing and nuzzling baby’s face.
Contamination of the baby’s mouth with decay-causing oral bacteria, and sugars introduced by frequent snacking or bottle feeding make the baby be susceptible to develop what is referred to as ‘early childhood caries’. It has been reported that, if the mother has a high level of untreated dental caries, her babies are three times more likely to develop dental caries. Thus, a woman’s oral health during pregnancy is considered as a strong predictor of her newborn’s risk for tooth decay and oral health status later in life.
Another significant concern of poor oral health in pregnant women is the possibility of having birth complications. Poor oral health of a pregnant woman has been linked to birth complications, such as preeclampsia (hypertensive disorder specific to pregnancy), fetal growth restrictions, and pre-term low birthweight (PLBW) deliveries. Research has made an association between poor maternal oral health (mainly due to severe gum disease) and preeclampsia.
Preeclampsia and PLBW predisposes the infant for serious medical complications at birth and later in life. PLBW is a significant risk factor for infant mortality, accounting for approximately 75% perinatal deaths and more than 50% of long-term morbidities. Babies who are small for their gestational age generally become predisposed to chronic disorders such as hypertension, diabetes, heart disease and issues related to growth and development during their adulthood. Therefore, even if the PLBW babies survive infancy, they are still at increased risk of having numerous health issues later in life.
Since preterm births have been prevalent worldwide, it is recognized as a public health issue. It also comes with a heavy price on social, psychological aspects and a significant economic burden for a country’s health care system. To lessen this burden, oral health advocates and family members should encourage pregnant women to take care of their oral health.
What are the adverse effects for the mother?
A pregnant mother becomes more susceptible for gingivitis, due to the effects of increased hormones at pregnancy. Swollen and bleeding gums is a common finding in pregnant women. Although bleeding gums are caused by dental plaque build-up, the hormonal changes during pregnancy can make your gums more vulnerable to plaque, leading to worsening of gum inflammation, swelling and bleeding. This is called pregnancy gingivitis. Generally, about 60% to 75% of pregnant women may present with gingivitis. If gingivitis is not treated on time, it can progress further into loss of bone. Teeth with little or no bone support become loose and they may need extraction.
Pregnant women also bear a high risk for dental caries. This is mainly due to changes in dietary habits (e.g. frequent snacking) and oral hygiene behaviours associated with pregnancy. Research also indicates that the increased caries risk in pregnancy is due to other reasons such as changes in her saliva, oral bacteria, hormonal changes (e.g. estrogen and progesterone), vomiting and acid reflux, and inadequate oral hygiene practice. High acidity level in the mouth is a significant risk factor for dental caries.
It is also alarming that maternal oral infections, especially severe gum disease, is recognized as a significant risk factor for pre-eclampsia. According to the WHO, preeclampsia is the third cause of maternal death, accounting for 16% of the global maternal mortality rate. However, identifying women at risk of preeclampsia due to oral diseases requires thorough oral examinations and treatment.
At a global scale, a significant proportion of pregnant women appears to have tooth decay and gum disease, yet many of them do not receive adequate dental care. This invariably exerts a negative impact on their quality of life. One prevailing misconception among pregnant women could be their misbelief that receiving dental treatment may not be safe during pregnancy. However, looking after oral health during pregnancy is an invaluable investment in safeguarding the oral health of the mother and the baby.
Since dental caries and gum disease are preventable diseases, they can be managed by preventive and early intervention measures, which are less costly. All women in childbearing age should be encouraged to keep to regular dental appointments, so that the dentist can identify any oral health problem early. They should also practice regular, twice-daily toothbrushing with fluoridated toothpaste, and avoid frequent snacking of sugar-containing Eats and Drinks which promote tooth decay.
As an attempt to mitigate all the adverse effects explained above, pregnant women should be well guided to follow the recommended oral health care practices before, during and after pregnancy. So that the mothers can offer their newborns with the best gift of healthy beginnings.
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The authors are from the Faculty of Dentistry, Universiti Malaya.
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