Much of what I will tell you in regards to nutrition will be similar to what you may have already heard from your obstetrician. Of course, nutrition is crucial to the overall health of both mother and child. A balanced and healthy diet can help mom feel well, avoid pregnancy complications such as gestational diabetes and aid in proper development of the baby.

But proper nutrition also plays a key role in the developing baby’s tooth enamel. Proper amounts of vitamins A, C and D, phosphorus, calcium and protein will help yield stronger, more decay resistant baby teeth in your child. Many of these vitamins and proteins are absorbed by consuming foods such as fruits, leafy vegetables, non-fish meats and low-fat dairy products. In addition, always add a prenatal vitamin to your diet unless your doctor says otherwise.

There have been many scientific developments in the field of oral health in the last decade. One of the most important studies has to do with the link between gum disease and several other health conditions. I won’t go into depth here about the other health conditions, as they don’t relate pregnancy but I will briefly mention them due to their extreme importance. There has been a proven relationship of gum disease to diabetic complications, stroke and heart disease. The oral bacteria which causes gum disease (which is different from those causing cavities) has been found in the heart and brain tissue of those who have had a fatal encounter with a stroke or heart attack. Diabetics with gum disease also experience more uncontrolled blood sugars. I would suggest a Google search the internet if you are interested in finding out more on the details of this relationship.

So, what does this have to do with pregnancy? Well, let me first give you a quick lesson on gum disease, since most of the population really doesn’t understand what it is. What it typically means to most people is the dreaded “you have to floss more” lecture from your dental hygienist. Basically, flossing your gums (notice I did not say teeth here) allows you to clean out the debris below the surface of your gums-in the area where popcorn kernels get caught. If that debris is not removed, it can turn into a concrete-like, bodily substance called “tartar” or “calculus” from the minerals in your saliva. This tartar can then become strongly adhered to the tooth root beneath the gums, causing inflammation which may be called gingivitis or gum disease.

Once tartar is present, it is not possible to be removed by flossing any longer. It will only come off with those dreaded scrapers we all hate at your dental cleaning appointment. Everyone gets tartar, but some people get it more abundantly than others either due to genetics, nutritional habits and/or mineral composition of saliva. This is why a dental cleaning or “prophylaxis” is needed every six months. It takes about six months for the body to develop enough tartar to elicit the start of the gum disease process.

If you don’t have your teeth cleaned, the tartar stays on the tooth root and allows more tartar to continue building on top of the existing tartar layer. This causes an even more inflammation of the gums. Eventually, the body “sees” this tartar layer as a “foreign object” and tries to get rid of through chemical and biologic means. So, this is good, right? Well, I have only told you part of the story. While the body is trying to help, it also releases special mediators that unfortunately destroy the bone around the teeth in an effort to get rid of the tartar.

If left untreated, the cycle of tartar deposited and more bone destroyed continues, causing the teeth to become loose. I always use the analogy of a “For Sale” sign in the yard-if you keep taking away the dirt around the big wooden post, eventually it becomes loose and falls out. Teeth are really as simple as that analogy. Eventually the teeth either fall out on their own, or have to be pulled because they cause a choking hazard.

In addition to this, pregnancy causes a huge hormonal shift which causes a lot more than tears, weight gain and cravings. An increase in the hormone progesterone during this time causes the gums to become more sensitive and prone to gum disease if plaque and tartar are not controlled. Signs of gum disease may be as follows: Sore, sensitive, swollen, red gums which may bleed spontaneously or especially while brushing or flossing. You may notice a black, yellow or brown, rough-appearing, grainy-looking substance along the gum-line of your teeth. You may also notice an increase in bad breath or a bad taste in your mouth.

You may hear your dentist call this process “gum disease” or “periodontal disease” (they mean the same thing) and they may tell you that you have “pockets” around your gums. These “pockets” are the popcorn-kernel-catching areas I was referring to earlier and get deeper with the deposition of more tartar over time. Certain ethnicities, such as African Americans and Hispanics are more genetically prone to getting gum disease. If you are of either of these descents, I strongly encourage you to see a dentist regularly and be sure that they are actually checking your gums every 6 months. Especially if your gums bleed when you floss or are highly sensitive.

So, of course we can see that one implication of gum disease as it relates to pregnancy would be the loss of teeth and therefore inadequate nutrition due to the inability to chew. While this is a huge concern, the primary concern is actually systemic in nature. Scientists have linked the presence of gum disease to increased incidence of pre-term delivery and low birth weight.

As mentioned earlier, the body’s attempts to resolve gum disease result in the release of bodily chemicals. These chemicals can cause the early onset of contractions, leading to pre-mature birth. Premature birth can cause a myriad of problems for the baby including, breathing difficulties (due to immature lung development), seizures and bleeding in the brain, difficulties in feeding and thus slow weight gain and poor nutrition. There are many other problems which can arise from pre-term labor and if you have concerns regarding this link with gum disease, talk to your physician and dentist. The best protection against this is to brush and floss regularly and to see your dentist regularly for a check-up and cleaning before, during and after pregnancy.

I know most people hate flossing (myself included) and despise going to the dentist. I know too that food is one of life’s greatest pleasures, especially during pregnancy. However, as parents, something in us changes and causes us to care for our children (event the unborn ones) and allows us to do the best for our children. Modification of routines and following a few simple guidelines will only eliminate one more thing to have to worry about during pregnancy. They are factors which we can control when so many other things during this amazing time are out of our control.

There is, what I call a dental “urban legend” which I hear from 90% of my patients who are also mothers: “I never had cavities until I had my first child-now I have a cavity for each child born! ” I know from personal experience that pregnancy can bring about many new symptoms, most not enjoyable, few which are. Some symptoms I had, were an insatiable appetite, strange cravings and peculiar repulsion of things I normally enjoyed. Unfortunately, I did not get repulsed by chocolate, desserts or picnic foods like some lucky mothers do. I have found through my experience of two pregnancies, that most other moms experience the same. And so, the junk-food and snacking festivities often begin with the onset of pregnancy.

While typically, as a woman, we may also be concerned with excess weight gain during pregnancy, there is yet a bigger danger lurking beneath the moon-pies and chocolate chip ice cream. It is called CAVITIES! An increase in frequency of snacking, even with healthy items such as fruits and whole grain breads can cause cavities to crop up without any warning. Let’s face it, the last thing on our minds as a pregnant woman is our teeth. We are typically overwhelmed with other essentials such as, what color stroller and car-seat we want or how to use the crazy looking apparatus called a breast pump.

So, how do we combat these cavity-causing snacking frenzies? Well, as a mother, I am not about to tell you to stop snacking, as that would likely induce some tears followed by more snacking. What I will tell you is that if you increase your snacking, be sure to increase your tooth-brushing. Cavities are formed by bacteria in your mouth and on your teeth which feed on the snacks you provide for them. A bacterial layer is created on the surface of your teeth and can easily be removed with your tooth brush. No need to brush hard, as this can cause damage to your teeth. The best type of toothbrush to use is a “sonicare” or “Oral-B” electric toothbrush. They do a remarkable job. However, a soft nylon bristled tooth brush is fine as well. Make sure you use a fluoride containing toothpaste and brush at least three times a day. You can use over-the-counter mouthwashes if you like, just be careful not to ingest them.

Snacking is not the only worry when it comes to cavities. Many moms experience gastro-esophageal reflux during pregnancy, and it can often be severe. This constant exposure of stomach acids to the mouth causes the teeth to be more prone to cavities for many reasons. If you are suffering from heart burn, or gastro-esophageal reflux, then be sure you are rinsing your mouth or drinking plenty of water and limiting the amount of sugary snacking you do. You may want to talk to your obstetrician about medication and diet options if you feel it is severe.

The other reason keeping cavities away in mom is important, is that the bacteria that cause cavities can be passed along to your newborn. Yikes!

With this in mind, I strongly suggest that you see your dentist prior to attempting to conceive. If you are a planner of course! The best scenario is to have a check up and complete any necessary work before getting pregnant. In general, once you become pregnant, no dental treatment is done unless it is a true emergency. This is because we use certain medications and x-rays which can be harmful to the baby, especially during the first trimester. It is not to say that if we have to use them in an emergency that they will definitely cause damage to the developing baby, however, we would rather not take any chances. So, x-rays and routine dental work are often postponed until after delivery. If you see your dentist before conception, you may abate any emergencies by performing the needed care before it actually becomes an emergency.

Also, any dentist worth a pinch of puppy poo should ask if you may be pregnant. If they don’t, make sure to tell them. Or go find a more conscientious dentist!