How does oral health impact pregnancy outcomes?

How Oral Health Affects Pregnancy Outcomes

Poor maternal oral health during pregnancy is associated with adverse outcomes, and while dental care during pregnancy is safe and should be provided, the evidence does not support that treating periodontal disease during pregnancy improves pregnancy outcomes such as preterm birth. 1

Safety of Dental Care During Pregnancy

• Dental care during pregnancy is safe and should not be avoided. 2, 1
• Routine dental assessments, preventive dental care, oral hygiene education, and use of fluoride toothpaste are safe strategies for pregnant women. 2
• Studies examining dental treatment during pregnancy have raised no safety concerns, making dental visits appropriate throughout gestation. 1

Impact on Pregnancy Outcomes: The Evidence Gap

• Some studies have shown possible associations between periodontal infection and preterm birth, but evidence has failed to demonstrate that dental treatment during pregnancy improves outcomes. 1
• This means that while poor oral health may be a marker of risk, intervening with periodontal treatment during pregnancy does not prevent preterm birth or other adverse outcomes. 1
• The lack of benefit from treatment does not negate the importance of maintaining good oral health, as it remains crucial for overall maternal health. 1

Maternal-to-Child Transmission of Caries Risk

• Optimal maternal oral hygiene during the perinatal period may decrease the amount of caries-producing oral bacteria (Streptococcus mutans) transmitted to the infant during common parenting behaviors such as sharing spoons. 1
• Mothers are the primary transmitters of cariogenic bacteria to their children, with the critical "window of infectivity" occurring between 19-31 months of age. 3
• Infants acquire cavity-causing bacteria primarily from their mothers, and colonization requires the presence of erupted teeth. 3
• Given the evidence for bacterial transmission, preconception and prenatal screening for maternal oral health with referral for dental care is recommended. 2

Preconception Oral Health

• Dental caries and other oral diseases are common (>80% of women aged 20-39 years) and are associated with complications for women and infants. 2
• ECC prevention is optimal if initiated prenatally, making preconception counseling about oral health critical. 2
• Routine dental assessments before pregnancy allow for treatment of active caries and periodontal disease, reducing the bacterial load that could be transmitted to the infant. 2

Clinical Recommendations for Pregnant Women

During Pregnancy

• All pregnant women should be counseled about the safety and importance of oral health care during pregnancy. 1
• Recommend dental visits during pregnancy, as only 56% of U.S. women visit a dentist during pregnancy despite the safety of such care. 1
• Provide oral hygiene education emphasizing twice-daily brushing with fluoride toothpaste. 2
• Ensure pregnant women receive preconception and prenatal screening for oral health with referral for dental care. 2

For Infant Oral Health Prevention

• Educate mothers that maintaining their own oral health reduces bacterial transmission to their infants. 1
• Advise that breastfeeding for up to 12 months reduces early childhood caries (ECC) risk by half through immune-modulating effects. 2
• If breastfeeding beyond 12 months, especially with at-will nighttime feeding, wipe the infant's gums and erupting teeth to minimize caries risk, as breastfeeding beyond 12 months increases caries risk. 2
• Recommend establishing a dental home for the infant by 12 months of age. 2
• Advise supervised twice-daily use of fluoridated toothpaste starting with the first tooth eruption (rice grain-sized portion for children <36 months). 2

Common Pitfalls to Avoid

• Do not delay dental care during pregnancy due to unfounded safety concerns—the evidence clearly supports that dental procedures are safe. 1
• Do not assume that treating periodontal disease during pregnancy will prevent preterm birth—while maintaining oral health is important, treatment studies have not shown this benefit. 1
• Do not overlook the importance of maternal oral health for infant caries prevention—the bacterial transmission pathway is well-established. 1
• Access to dental care is directly related to income level, with the poorest women least likely to receive care, requiring targeted outreach to vulnerable populations. 1

Quality of Life Considerations

• Oral health is a fundamental component of overall health and physical and mental well-being. 4
• Maintaining good oral health may have positive effects on cardiovascular disease, diabetes, and other disorders beyond pregnancy outcomes. 1
• The perinatal period is a critical time when health determinants are established, making it an important window for intervention. 4