As a hygienist, with over 17 years of general practice experience, I have encountered hundreds of women who have reported suffering some degree of sickness during their pregnancies. I would often see women post pregnancy who’s teeth and gums were significantly more problematic than before their pregnancies. I would hear stories of being unable to brush due to sickness, I would see acid erosion from the vomiting and sometimes higher levels of tooth decay because women reported surviving on high sugar foods as it was often all they could stomach. I always tried to be sympathetic and understanding but could not understand how women could allow their oral health to slip so badly just due to “a bit of morning sickness”. I would offer advice but maybe could admit to being ever so slightly less than understanding as I could never imagine not taking care of my own teeth no matter what the reason. Then I myself fell pregnant and my own experience has changed my understanding beyond compare.
When people talk about morning sickness in pregnancy I think most people envision a small amount of vomiting, in the morning, in the early stages of pregnancy that will improve by the 12 week mark. What most people don’t know is that “morning sickness” is very much a misleading term. Many women suffer through the entire day and can experience sickness well past 12 weeks. The sickness can be made worse by strong smells and tastes and the gag reflex can become extremely sensitive. All of these factors can make tooth brushing with minty toothpaste virtually impossible. For most women these symptoms will not last long enough to cause too many issues with their oral health and once the sickness passes they are able to return to their normal oral health routine. There are unfortunately an unlucky few (myself included) who suffer from the more severe form of pregnancy sickness called hyperemesis gravidarum (HG). This sickness can cause severe constant nausea, vomiting up to 20-30 times a day, can lead to malnutrition and often the need for hospitalisation. Awareness of this condition became greater 3 years ago when the duchess of Cambridge was hospitalised due to suffering from HG. Its causes are generally unknown and every woman’s experience can be very different. Eating becomes very difficult and many sufferers can only cope with eating small amounts of food often high in carbohydrates (sugars). Vegetables and other “healthy foods” can become totally unpalatable and the need for calories in any form becomes a priority even if it comes from high sugar sources.
So what does this all mean for the oral health of these individuals?
The problems these women may encounter include:
- Destruction of the tooth enamel from the acid in vomit.
- High tooth decay rates as the amounts and frequency of sugar intake is very high.
- Bleeding gums as plaque can’t be removed as tooth brushing can become virtually impossible. This can lead to an increased risk of tooth loss due to gum disease.
- Bad breath caused by vomiting an inability to clean teeth properly.
- Dry mouth due to high acid levels in the mouth.
From my own personal experience the inability to brush my teeth became one of the most upsetting parts of the whole condition. As a dental hygienist I am usually beyond diligent with keeping my teeth clean and most definitely “practice what I preach”. The taste of tooth paste and trying to even get a brush past my lips became practically impossible on bad days and even on good days I could only just about clean the front few. Flossing went totally out the window and my mouth felt awful. My normally nonexistent sweet tooth went into overdrive and there were days when my only food intake would be bread and sugary drinks as these were the only calories I could consume. I had a huge fear of tooth decay from eating this much sugar and felt incredibly guilty for abuse I was putting my oral health through. I finally understood the women who have visited my surgery all these years telling me why they had neglected their teeth and gums. I realised these are not just “easy excuses” for not doing all of the things we would normally advise our patients.
So what can be done to help?
I am lucky as I have started with an already high standard of oral health and even with months of abuse my own repercussions have been limited. Unfortunately for women who do not have good oral health to begin with they do not have this safety net. They can notice much greater problems occurring much more quickly and the long term consequences can be much more severe. It is incredibly important therefore that best possible oral health levels are achieved before pregnancy. Regular visits to your dentist and hygienist and following any advice you are given can help give you a better starting point should issues occur during pregnancy.
Any cleaning is better than no cleaning. Even if brushing can only be done once a day and only a few teeth can be cleaned this is better that no cleaning at all. Using a dry brush with no toothpaste can sometimes make it easier as the strong smell of mint can be a trigger for the vomiting. Sensitive toothpastes are often helpful as many have a less overpowering taste. There is an ingredient commonly found in toothpaste called sodium laryl sulphate and this is the thing that makes toothpaste foamy. Many women have found if they go for a toothpaste without this ingredient it doesn’t trigger vomiting as much as those with the ingredient in. It may mean reading the ingredients list on many types of toothpaste in the supermarket, but there are toothpastes available that are free from this foaming agent. Toothpastes do exist that are free from SLS and flavouring but can only found on the internet.
One of the most helpful things you can make sure you are getting is fluoride. This is most commonly delivered in our toothpaste your dentist may advise as high strength fluoride toothpaste if brushing is limited so you can receive the highest dose possible when any brushing is achieved. If using toothpaste becomes impossible then an alcohol free fluoride mouthwash can be a substitute. It is often advised not to brush straight after vomiting so as not to brush the acid into the tooth surface in this case the mouthwash can be used instead. Even just rinsing your mouth with water can help wash away some of the excess stomach acid left after vomiting.
Bleeding gums are often a consequence of pregnancy whether or not you have vomiting. This is caused by an increased response to plaque build up triggered by the pregnancy hormones.
The normal advice at this point is to make sure plaque control is as good as it can be with careful brushing and cleaning in-between the teeth. With sickness problems though, this plaque control can prove to be very difficult. The best advice it to try and brush especially at the gum line and target the areas where you see the blood coming from it is important to try and do this at times when you feel able brushing does not have to be kept to mornings and evening and if you find it easier in the middle of the day then do it then. As said before any cleaning is better than no cleaning. Cleaning in-between may be impossible as putting your fingers in your mouth may trigger the gag reflex. Your dentist or hygienist can show you products that may be easier to use during this time that do not necessarily involve placing fingers inside your mouth. In absolute worst cases a strong antibacterial mouthwash may be needed to control the plaque that cannot be brushed away. You should always seek advice from a dental professional before using these products as they may not be suitable during pregnancy.
It may seem like the last thing you will want to do but a visit to your dentist during the difficult times may be extremely helpful. It may be unlikely that they can do any treatment due to the gag response, but your dentist can look for the start of any oral health problems and prepare a plan for when you feel better, they can also offer you further advice on cleaning and what products may help. If a visit whilst suffering is impossible it is important to get booked in as soon as the sickness has passed. Your dentist can help to indentify issues that may have resulted during the pregnancy and help to get your teeth back on track as quickly as possible.
The most important thing is to do as much as you feel able to and not worry too much about what you can’t do. Your dental team are there to help and any concerns or worries can always be discussed with them. The long term repercussions can be minimised by getting good professional advice during the time you are struggling and getting your teeth assessed as soon as possible after baby is born. It’s a horrible time but doesn’t have to mean teeth problems as well. Good luck from a now much more sympathetic dental hygienist.
http://www.maltingsdental.co.uk
http://www.nhs.uk/conditions/pregnancy-and…/morning–sickness-nausea.aspx
http://www.madeformums.com/pregnancy/when-does-morning-sickness-start/29336.html
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