Mothers in Unity

Media item: article

Date published: 10 May 2013

This page records the media item. The original article is the property of its publisher and is not reproduced here.

The date falls immediately before Mother's Day, and this page carries general information on the subject that is most useful alongside it: maternal oral health, which is one of the most neglected areas of dental care in Australia. The companion item in this archive is Labour of Love.

The myth first, because it does real damage

"A tooth for every child."

This old saying holds that pregnancy leaches calcium from the mother's teeth, and it is false. The calcium in your teeth is not mobilised for a developing baby. Enamel is not a reservoir the body can draw down; unlike bone, it has no cellular turnover — see Enamel is the hardest substance in the body — so why do teeth break? and Dental myths exposed.

What actually causes tooth loss around pregnancy is entirely different and entirely preventable:

• Vomiting and reflux, which erode enamel with stomach acid — see What is acid wear and how can I avoid it?
• Changed eating patterns — frequent small meals, and the sugary things that settle nausea. See How does your diet affect your teeth?
• Pregnancy gingivitis, which makes gums bleed and makes people brush less because of it
• Skipping dental appointments, out of a mistaken belief that treatment is unsafe — see Is it safe to visit the dentist in pregnancy?
• And then not going for the following five years, because there is a small child

None of that is calcium loss. All of it is manageable.

What actually changes in the mouth during pregnancy

The articles on this are Oral health care while pregnant, Protecting your teeth in pregnancy and A dental check-up when pregnant; the wider hormonal picture is in Why are women especially prone to oral health problems?

Pregnancy gingivitis

Very common. Hormonal changes exaggerate the gum's inflammatory response to the same amount of plaque. Gums become red, swollen and bleed easily, often from the second month, typically peaking in the middle trimesters. See Bleeding Gums and What is gum disease?

Bleeding gums are not a reason to stop brushing — they are the reason to keep going, gently and thoroughly, plus interdental cleaning. Inflammation settles as plaque comes off. See Is flossing really that important? and Dental Cleans and Hygienists.

Pregnancy epulis (pyogenic granuloma)

A localised red lump on the gum, usually between teeth, that bleeds readily. It is benign, and it commonly resolves after the birth. It should be examined — to confirm what it is — and is usually only removed if it is painful, interfering with eating, or persists afterwards. On when a lump or ulcer warrants closer attention, see Oral cancer: how a dentist can help with early detection.

Erosion from morning sickness

Repeated vomiting exposes the palatal surfaces of the upper front teeth to stomach acid, and the erosion is permanent — see How is dental erosion addressed?

The single most useful instruction: do not brush immediately after vomiting. Softened enamel abrades — see Over-brushing. Rinse with water, or with a teaspoon of bicarbonate of soda in a glass of water, and wait about an hour before brushing.

Dry mouth, cravings and grazing

Frequency of acid exposure is what causes decay, not quantity of sugar. Constant grazing and sipping is the pattern that does the damage, and pregnancy is when it is hardest to avoid. Water and plain milk between meals; keep the sweet things to mealtimes. See How does sugar affect your dental health? and My mouth is always dry.

Dental treatment in pregnancy is safe — and is recommended

This is the point that most needs stating, because avoidance is common and costly.

• Examinations, cleans and periodontal treatment are safe and encouraged at any stage. See General Dentistry.
• The second trimester is generally the most comfortable time for elective treatment — the first trimester carries the most nausea, and lying flat late in pregnancy is uncomfortable and can cause supine hypotension. Say if lying back is uncomfortable; the chair can be adjusted and you can be positioned on your left side.
• Local anaesthetic is used routinely in pregnancy. Untreated dental infection is a far greater risk than the anaesthetic — see Can a dental abscess affect your general health?
• Radiographs when genuinely needed are taken, with appropriate protection and justification. Dental radiographs are low dose and directed away from the abdomen — see How safe are dental X-rays? An X-ray that will change management is not deferred because of pregnancy.
• Urgent treatment is never deferred. A dental abscess in pregnancy is treated, promptly — see Emergency Dentistry and How is a tooth abscess treated?
• Tell the practice you are pregnant, and how far along. It changes positioning, timing and prescribing — see Contact Us.
• Prescribing changes: some antibiotics and analgesics are avoided in pregnancy and breastfeeding, which is why the practitioner needs to know rather than guess. See Should I see a GP for antibiotics for toothache?

Breastfeeding does not prevent dental treatment either. Local anaesthetic is compatible with breastfeeding, and most necessary prescribing has a safe option.

What passes to the baby

This is the part that surprises people.

Babies are not born with the bacteria that cause decay. They acquire them, usually from their primary carer. See Can you catch dental decay from someone else's toothbrush?

Transmission happens through shared spoons, tasting food, cleaning a dummy in your own mouth, and kissing on the mouth. A mother with untreated active decay has a higher bacterial load and passes on more — see How does tooth decay develop?

Which means treating the mother's decay is part of preventing the child's. It is one of the few genuinely well-supported preventive interventions in this area — see Preventing dental decay.

Practical, without becoming paranoid about ordinary affection:

• Have your own decay treated, ideally before the baby arrives
• Do not share spoons or clean a dummy in your mouth
• Chew sugar-free gum — xylitol-containing gum has some evidence for reducing transmission; see Does chewing sugar-free gum really help prevent cavities?
• No bottle in bed containing anything but water. Milk, formula and juice pooling around the upper front teeth overnight, when saliva flow is low, produces a recognised and severe pattern of early childhood decay — see Protecting your child from dental disease.
• Start brushing at the first tooth, with a smear of children's toothpaste. See Baby teething: signs, symptoms and treatments, The order of baby teeth and The benefits of fluoride.
• On the first dental visit: Smile Solutions recommends from age three, and sooner if there is any sign of decay; widely used professional guidance recommends by about the first birthday, or within six months of the first tooth. Children’s Dentistry sets out both, along with First visit to the dentist and When should a child first visit the dentist?

The window that gets missed

The years immediately after a birth are when adults most often stop attending. Time, money, exhaustion, and the fact that nothing hurts. See How often should I go to the dentist?

And because gum disease and decay are painless until late, the problems found five years later are considerably larger than the ones that would have been found at the time. On the psychological side of that avoidance, see Unity in Smiling: Suzanne Carbone and Dental Anxiety.

If cost is the barrier: check public dental eligibility in Victoria through a community dental agency or the Royal Dental Hospital of Melbourne — concession and health care card holders are usually eligible — and check the Child Dental Benefits Schedule for the children through Services Australia or myGov. It is substantially under-claimed. See Child Dental Benefit Schedule, how the scheme operates and the Price Guide.

Related pages: Children’s Dentistry, Bleeding Gums, Kids get the brush off, More than healthy teeth, and the full Our Media archive.

Common questions

I am planning a pregnancy. Is there anything worth doing before I conceive?

Yes, and it is the step most often skipped. An Australian Dental Association consumer survey of 25,000 Australian adults found that 75% of women did not have a dental check-up before conception — which the ADA describes as vital "because poor oral health in pregnant mothers is associated with poorer pregnancy outcomes like low birthweight babies."

In practice that means having active decay treated before the baby arrives rather than after, which is also how you reduce what you pass on; and getting gum inflammation under control before hormonal changes start exaggerating it. Doing it beforehand is easier to fit into a diary and leaves room for anything that needs staging over more than one appointment.

If I need an X-ray while pregnant, how much radiation is that actually?

Published figures are in microsieverts. A study of 4,455 intraoral radiographs reported an average effective dose of 0.77 µSv for dental and bitewing films; a review of the literature published between 2010 and 2020 reported a mean of 1.32 µSv across a range of 0.60 to 2.56 µSv. A panoramic film is several times higher — 17.93 µSv in that same review.

The beam is directed at the jaw and away from the abdomen, and protection is used. What does not change in pregnancy is the justification test: a film that will not alter what is done should not be taken, pregnant or not. Ask what the radiograph is expected to show, and what would follow from each possible answer.

How much does the Child Dental Benefits Schedule actually pay, and what is left out?

Services Australia sets the benefit at up to $1,158 for each eligible child across two consecutive calendar years. The two-year period starts at the beginning of the calendar year in which the child both becomes eligible and has their first dental service. The full amount can be used in the first year, which leaves nothing for the second; anything unused when the two years end is lost rather than carried forward.

What it does not cover: orthodontic work, cosmetic work, and any dental service provided in a hospital. Eligibility depends on the family receiving a qualifying payment and the rules change, so confirm the current position with Services Australia. See Child Dental Benefit Schedule.

My toddler has two teeth touching. Is flossing a small child's teeth really necessary?

Once there are two or more baby teeth side by side, yes. The ADA's advice is that parents floss daily from the point a child has two or more baby teeth adjacent to each other — because the surface between two touching teeth is the one a brush cannot reach, and it is where decay starts.

It is also the instruction least often followed. The same ADA survey found 76% of children never floss and are never flossed by a parent, with many respondents saying they thought it not worthwhile while baby teeth were still in place. Baby molars hold their place in the arch for years, and losing one early has consequences for what erupts after it.

What happens if we leave a child's decay alone because nothing hurts?

The ADA's Children and Young People Oral Health Tracker records that nearly 11 — 10.8 — in every 1,000 children aged 5 to 9 are hospitalised for potentially preventable problems due to dental conditions, rising to 14.3 per 1,000 for Indigenous children. ‘Potentially preventable’ is the operative phrase: these are admissions earlier treatment would have avoided.

Against that, 34% of children aged 5 to 6 have experienced decay in primary teeth, 27% aged 5 to 10 have untreated decay in primary teeth, and only 56% of children see a dentist before age 5. Decay in a child is usually painless until it reaches the nerve, so ‘nothing hurts’ is not information about whether it is there.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. See also Our Location.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published article and its date, with general information. It is not a diagnosis, a treatment plan or medical advice about your pregnancy. Discuss any concern with your GP, midwife or obstetrician as well as your dentist. Figures attributed to the Australian Dental Association, its consumer survey and the Children and Young People Oral Health Tracker are that organisation's; radiograph dose figures are from published studies and vary with equipment and technique; Child Dental Benefits Schedule amounts and eligibility are set by Services Australia and change. Third-party published content is not reproduced.

Smile Solutions trades under ABN 28 193 514 103.