By Sharon Boyd
Registered Dental Hygenist
When I attended dental hygiene school we were taught that pregnancy has absolutely no affect on the health of a woman’s teeth. After getting out into private practice I found that my patients constantly told me otherwise. Not yet being a mother myself, women consistently explained that they never had dental problems until they were pregnant, and then they seemed to all come at one time. Dental professionals are always told about the effects that bulimia nervosa and gastrointestinal reflux have on eroding tooth enamel, but we’re taught to think that a vomiting pregnant woman doesn’t affect dental health at all. Then there was hyperemesis gravidarum, aka “HG.” If any pregnant women had problems with their teeth, it was these moms.
The severity of vomiting in some Hyperemesis Gravidarum (HG) patients is even more frequent than that in a bulimic patient. Some women with HG vomit hundreds of times every day, and we’re not talking about dry heaves. I speak from experience. I had 3 HG pregnancies. On my worst days, I vomited every 20 minutes on the dot for hours in a row. I even timed myself with the clock on my nightstand – it was exactly every 20 minutes. Even if I tried my hardest to not give in, I still lost. Based on these well known facts and a simple poll among women in the HG community, HG moms are considered predisposed to enamel erosion and possibly dental caries just as much if not more so than people with conditions that are already known to cause severe dental problems (i.e. Bulimia nervosa and gastrointestinal reflux disease.) Compound that with the fact that oral hygiene may not be optimal and a compromised diet may predispose the mother to tooth decay (hey, you eat what you can, right?) Sometimes it’s downright impossible for women with HG to brush their teeth. Even me, a dental hygienist, went at least a month at one point in one of my pregnancies without brushing my teeth. That’s a dental sin if I’ve ever heard of one.
Bulimic dental patients are known to have moderate to severe enamel erosion on the tongue-side surface of their upper anterior teeth from all of the purging that takes place. One of the things we recommend to these patients is to not brush their teeth immediately after vomiting. That simply mechanically moves the acids across the teeth and is thought to do more harm than good. Instead, we recommend that they rinse thoroughly with water after vomiting episodes to wash away the acid. Heavy saliva is a common complaint of women with HG. But did you know it’s actually a good thing? A more active saliva flow is linked with less tooth decay; saliva naturally cleanses teeth.
Adding a fluoride rinse to your daily oral care plan is a must. I recommend ACT fluoride rinse, which is a product primarily marketed toward children but it is very effective at remineralizing tooth enamel that is in the early stages of decalcification. Typically I recommend rinsing with it once a day (preferably at night), but if you’re not able to brush you may want to use it twice each day. A prescription strength fluoride gel such as Prevident can be requested from your dentist.
Xylitol!!! Have you heard of it? This 5-carbon sugar actually keeps plaque from forming on your teeth. Don’t believe me? A group of dental students did a study where they went an entire week without brushing their teeth, and instead, chewed gum containing Xylitol each day. At the end of the experiment, there was less plaque biofilm in the mouths of the students than when they brushed their teeth before the study started. That’s because the chemical component of Xylitol interferes with plaque’s ability to cling together or deposit itself on the teeth. Now, I’m not saying give up toothbrushing, but 5 exposures of Xylitol each day is the next best thing if you can chew gum but can’t get a toothbrush into your mouth. Research also suggests mothers that chew Xylitol gum during their pregnancies give birth to children who have healthier teeth. There are other forms of Xylitol available, such as sprays, toothpastes, and drops (check your local health food store.)
Limit your exposure times to food and drinks. If all you can get down is a soda, I understand that…just do me a favor and drink from a straw. Straws will help reduce exposure to the teeth (but won’t eliminate it completely.) Eat when you can, but if you’re snacking frequently then you need to try to rinse your mouth out regularly as well. Every time you eat or drink something, those natural acidic breakdowns last for 30 minutes inside of your mouth. We want to minimize how often that happens. Sipping that soda every 20 minutes all day long is going to wreak havoc on the teeth, but if it keeps you from throwing up I will forgive you.
You don’t have to use toothpaste. Some of the hygienists that I respect the most suggest dry-toothbrushing as a way to remove more plaque from your teeth than if you used toothpaste. Start with the inside of your bottom front teeth first, and work your way around your entire mouth until everything feels clean, then brush with toothpaste if you want to. Electric toothbrushes and water flossers are your best friend. They do everything for you, and you won’t have to stick your fingers in your mouth.
Regular preventive dental care is important. Request your hygienist apply a fluoride varnish to your teeth after your cleanings. Decay should be treated when it’s small, before it spreads to other teeth or enlarges into more significant (and costly) conditions. Visit your dentist twice each year and keep your teeth in a disease-free state by completing any treatment in a timely manner, especially if you plan on getting pregnant. Oral infections like gum disease are shown to have an increased risk of premature birth in pregnant women, and moms with active decay-causing bacteria can pass them on to their infants.
I’ll be the first person to tell you that as an HG mom I don’t expect you to be able to do all of these things, if even some of them, and feel like I need an “if you can tolerate it” disclaimer on every paragraph. My hope is that I can simply inform you of some methods that work for patients that are at a high risk of decay, and that you can pick and choose which work best for your needs. There were times when I wouldn’t even dream of sticking a toothbrush in my mouth, but if you’re able to get through one or two of these tips then I am confident that you’ll be better off than without any intervention at all, and have healthier teeth in the end because of it. Your child’s healthy smile starts with yours. Good luck!
About the author:
Sharon Boyd, RDH has practiced dental hygiene in Texas since 2001. She is a published author of continuing education materials for dental professionals in the US and UK, and writer for dental marketing companies across the globe. Her husband is a candy salesman (we wish we were joking), her 3 sons were all HG babies weighing in close to 9 pounds when they were born, and her daughter was born under the beautiful Ethiopian stars. In her spare time, Sharon enjoys running, teaching bible class, and traveling. Her personal blog is located at http://texastoethiopia.blogspot.com