Dental Care Is Prenatal Care—And a Gap Is Increasing Maternal Health Inequities

Photo: Getty Images/Eva-Katalin
Between all the physical, mental, and emotional changes that happen during pregnancy, your pearly whites are probably the last thing on your mind. But as it turns out, being pregnant increases your risk of dental issues, which can then increase the risk of pregnancy complications.

In other words, it’s a complex cycle that’s rarely talked about when it comes to prenatal care. Whether you’re trying to conceive, currently pregnant, or thinking about becoming pregnant one day, learning about these connections is a major step in empowering yourself as a parent.

The link between maternal dental health and pregnancy care

During pregnancy, the body naturally produces more estrogen and progesterone, the main reproductive hormones. This is crucial for your baby’s development, but it can also increase your risk of gingivitis, or gum inflammation. The exact cause is unclear, but it’s thought to be related to two mechanisms: increased blood flow to the gum tissue and an exaggerated immune response to bacteria in the gums. (In fact, 60 to 75 percent of pregnant people are estimated to have gingivitis, according to the Centers for Disease Control and Prevention.)

Without treatment, gingivitis can turn into periodontal disease, also called periodontitis or gum disease. This is a serious gum infection that happens when gums recede (pull away) from the teeth. Over time, periodontal disease can cause bone and tooth damage, and ultimately, tooth loss.

But the link between pregnancy and gum problems works in the other direction, too. “There’s some evidence that having oral disease, specifically periodontal disease, places a pregnant person at increased risk of adverse birth outcomes,” explains Stefanie Russell, DDS, MPH, PhD, associate clinical professor at NYU College of Dentistry. This includes premature birth, low birth weight, and preeclampsia, according to an article published in Scientific Reports. The reason? The bacteria behind periodontal disease, along with their metabolic byproducts, affect the immune system. This can impact the rest of the body, including the reproductive system.

The risk of cavities is also higher during pregnancy

Vomiting due to morning sickness can make the mouth more acidic than usual, potentially leading to tooth erosion and paving the way for cavities. Plus, pregnancy reduces the flow of saliva, which is essential for washing away cavity-causing germs. The overall risk of cavities is further compounded by extreme food cravings and frequent snacking, according to dentist Peter Guirguis, DDS, owner of Definitive Dental.

Cavities are more than just a painful nuisance. During pregnancy, the bacterial culprits behind cavities can be passed on to your baby. This can increase the risk of your little one developing cavities in their early years, according to the American College of Obstetricians and Gynecologists. What’s more, having cavities during pregnancy is associated with high birth weight. This may increase the risk of delivery issues like shoulder dystocia (when the baby’s shoulder gets stuck behind your pubic bone), as well as future chronic conditions like heart disease, diabetes, and obesity in your child. These complications are thought to be related to the inflammation and bacteria associated with cavities, according to researchers.

Pregnancy can make it difficult to follow a solid dental hygiene routine

Understandably, the actual experience of being pregnant can make it hard to stay on top of dental hygiene habits that would otherwise keep oral issues at bay. After all, when you’re knee-deep in checklists, nursery planning, and of course, making sure your little one is healthy and well, it’s easy to unintentionally neglect your own self-care needs.

Maybe you’re so tired that brushing your teeth feels like a daunting task. Or perhaps the action triggers nausea and vomiting, which commonly happens in the first trimester. The aforementioned pregnancy-related hormonal changes can also increase bleeding in your gums, making brushing and flossing feel super unpleasant.

Why many pregnant people don’t get the dental care they need

Despite the importance of dental health during pregnancy, many pregnant people—particularly those in marginalized groups—aren’t getting the care they need.

According to Hunter Nelson, policy analyst at the Colorado Children’s Campaign, there are many barriers that can affect access to dental care. For example, pregnant individuals may have a hard time getting to a health clinic due to lack of transportation, or there might be no clinic at all due to “redlining, discriminatory zoning, and other policies and practices that [have] placed little to no resources in neighborhoods of color,” Nelson says. In some cases, people might mistrust the healthcare system due to historical discrimination and trauma, she adds.

Additionally, employment and education discrimination and generational cycles of poverty have led to a lack of oral health providers of color, making it difficult for certain groups to find providers they can relate to, says Nelson. High uninsurance rates among marginalized communities, especially Hispanic women, can add another major obstacle.

Nelson expounds further: “While dental insurance is a required Essential Health Benefit for children, it’s not a required benefit for adults under the Affordable Care Act. Therefore, most adult insurance plans—such as those that people get from their employer—don’t include dental coverage, which makes it hard for people whose employers don’t offer a stand-alone dental plan to get care.” She adds that the federal government recently issued a request for information about people’s health insurance benefits, so now is a good time to share your insights on the importance of having dental coverage as a required health insurance benefit.

For those with access to dental care, dentist visits may be hindered by other hurdles, such as scheduling conflicts. For instance, if a single parent can’t find care for other children, they may have a hard time visiting the obstetrician, let alone the dentist, says Dr. Guirguis.

Moreover, “there are many widespread misconceptions that dental procedures may be dangerous during pregnancy, and I’ve spoken with dental providers whose patients stopped visiting after becoming pregnant,” shares Melissa LuVisi, chief strategy officer of tab32, a cloud-based dental technology platform that strives to close healthcare gaps for patients. “My own experience [during pregnancy] has shown that sometimes providers will hold off on procedures, even though there is research showing that it would have been safe.”

Dr. Russell echoes this notion, adding that it’s completely safe to receive routine and emergency care during pregnancy. “Sometimes dentists are not comfortable providing dental treatment during pregnancy, as they’ve been trained at a time when the belief was that dental care should only be provided during the second trimester,” explains Dr. Russell. However, this approach is outdated, and it can be risky for both the parent and developing child if the necessary dental care is not given, she says.

Dental health resources for pregnant people

So, how can the system minimize these gaps between dental health and prenatal care? According to Nelson, change must occur on multiple levels: Community and economic development can help bring oral health clinics to underserved communities, while Medicaid and private health coverage plans need to provide more equitable coverage of oral health care.

It’s also crucial to provide more oral health education for pregnant people, which “could include resources or training to support conversations between pregnant people and their primary care provider, doula or midwife, obstetrician, etc.,” says Nelson. LuVisi adds, “we need more collaboration between dentists and maternal healthcare practitioners, more partnerships between dental offices and community health organizations.” Together, these institutions can help spread the importance of dental health in prenatal care, particularly in marginalized communities.

“Groups like Dental Lifeline Network are partnering with dentists to provide free and low-cost services to vulnerable populations, such as disabled and elderly people,” says LuVisi. “Other organizations, like The National Maternal and Child Oral Health Resource Center at Georgetown University, are trying to close knowledge gaps by training oral health professionals to better address common problems in maternal and pediatric care.”

Additional resources include the Children’s Dental Health Project and March of Dimes, which provide educational materials for pregnant parents. There’s also Protect Tiny Teeth, a campaign created by the American Academy of Pediatrics and CDC to help dental professionals play a stronger role in parent education. Additionally, it’s worth looking into local WIC clinics and community health organizations, should they be available in your area.

Staying on top of your dental health can be challenging when you’re expecting a new family member. Fortunately, there are resources available and organizations that are working to help more pregnant individuals get the care they need.

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