Pregnancy and Oral Health: 8 Answers that Cut Through the Myths

Medical and oral health experts have long agreed that dental care in pregnancy is safe, effective, and important. Untreated dental disease can lead to pregnancy complications and raise the risk of cavities in childhood. 

However, more than 8 in 10 obstetricians don’t routinely conduct oral exams. Some dental providers may also still hesitate to treat pregnant people. 

To clarify the facts, CareQuest Institute for Oral Health and the American College of Obstetricians and Gynecologists (ACOG) held a webinar that drew nearly 1,000 learners. Moderated by Jane Grover, DDS, MPH, senior director, Council on Advocacy for Access and Prevention, American Dental Association (ADA), the webinar’s panelists included an obstetrician-gynecologist (OB-GYN) and a dentist: 

• Hector Chapa, MD, FACOG, Assistant Clinical Professor, OBGYN, Texas A&M University, 2024–25 ACOG Fellow At Large, Texas A&M Health, ACOG 
• Elizabeth Vi Simpson, DMD, General Dentist, Chair of the Council on Advocacy for Access and Prevention for the ADA 

After robust presentations, the experts answered several thought-provoking questions for the learners. Here are the top eight. (Note: The answers have been summarized; you can view the full webinar, including the Q&A, in the CareQuest Institute webinar library.) 

1. How do you approach caring for someone who has lacked consistent dental services in the past and now has dental insurance limited to the duration of their pregnancy? 

First, start by welcoming the patient. Providers might begin by saying, “I’m so glad you're here. I’m so glad you realize the importance of getting dental care.” 

Then, assess their needs to create a treatment plan to progress through the time limitation of their insurance coverage: 

• For patients with relatively good oral health who are symptom-free, prioritize treatment from the smallest to the largest areas of concern. 
• For patients with more urgent oral health needs, address the most time-sensitive needs first. Share that you want to address all serious concerns while they have coverage, offering to schedule back-to-back appointments if they are willing to come in. 

As the patient’s coverage comes to a close, refer them to local community health centers where they can receive dental services on a sliding-fee scale. 

2. What defines a high-risk pregnancy, and when should dental providers seek guidance from the OB-GYN? 

A “high-risk” pregnancy is a broad designation. Chronic diseases such as diabetes or asthma may lead to high-risk pregnancies, but they won’t impact oral health unless they are uncontrolled. 

Some specific heart conditions may have the greatest dental implications: 

• Endocarditis, a dangerous infection of the heart’s lining 
• Uncorrected cyanotic heart disease, which lowers the oxygen level in the blood 
• Prosthetic heart valves or uncorrected heart valve issues 

Dental providers can collaborate with a patient’s obstetrician and cardiologist to manage these illnesses. 

While patients carrying twins or triplets may not be high risk, they could need other dental care accommodations. For example, they may have difficulty lying down due to pressure on their organs. Adapting chair inclines and using rolled blankets can give relief. 

In every case, providers should address pregnant patients’ dental needs as soon as possible. One study in Infectious Diseases in Obstetrics and Gynecology recounts how a pregnant woman’s cracked tooth caused a life-threatening infection, requiring emergency surgery. 

3. Is it safe to use local anesthesia when treating people who are pregnant? 

In most cases, yes. Unless a patient’s obstetrician advises otherwise, one or two carpules of local anesthetic that contain epinephrine, for example, is usually standard practice and can be well tolerated. Local anesthetic is also often used to treat pregnant people for non-dental procedures, such as for oral biopsies where cancer may be a concern. 

4. If members of our dental team are pregnant, should they take precautions when it comes to giving patients nitrous oxide? 

Nitrous oxide is a safe analgesic to use in sporadic, therapeutic doses during pregnancy. It is given to some patients during labor. However, in dental practices using it routinely, pregnant oral health providers should leave the room to reduce their own repeated exposure. 

5. What should providers tell patients who want their teeth whitened during pregnancy? 

While teeth whitening and other cosmetic procedures may not pose any real risk to a patient’s pregnancy, providers should encourage people to consider postponing these services until after they give birth. It may be in their best interest to wait, since teeth sensitivity, nausea, and similar conditions are already an issue for most pregnant people. 

6. Can you comment on the new ADA guidelines recommending that patients no longer use lead aprons to shield their pregnancy when getting dental X-rays? 

CareQuest Institute and the ADA explored this guidance in a recent joint webinar. Some states still require use of lead shields. Providers should follow their state’s mandates. 

In states that no longer require shielding, providers should engage in shared decision-making. Discuss the new recommendations with patients. If getting an X-ray without a shield will cause them undue anxiety — whether or not they are pregnant — there is little harm in letting them use a lead apron. Doing so can calm anxiety and benefit their mental health. 

7. Some pregnant patients may have bleeding gums, especially if they have not had regular access to dental care. What could be some reasons for this symptom, and how should providers treat it? 

Pregnant patients may likely have gum disease and need scaling and root planing if one or more of the following are true: 

• Their gums bleed easily after being probed. 
• They have bone loss, which may be indicated by tooth mobility. 
• They have such severe plaque/tartar buildup that it can be seen on a radiograph in many locations. 

Unless a pregnant person is immunocompromised or high risk, regular periodontal (gum disease) treatments and devices are safe to use. The small amounts of bacteria potentially entering their bloodstream from this treatment are typically well tolerated by most patients. It’s critical to address their gum disease to avoid infection later in pregnancy. 

8. Should oral health providers always seek a letter of clearance from a patient’s OBGYN or pursue a standing order? 

Both the ACOG and the ADA agree that dental care is safe during pregnancy. But it’s always okay to reach out to the OB-GYN. Dental providers can ask, “Is there anything else this patient is being treated for within their pregnancy that I should know about?” This is also an opportunity to establish a working collaboration with that office for consistent communication. 

Providers should feel free to request a letter of clearance. But first consider if the letter will become an obstacle to care, and where providers’ concern is coming from. Chances are it is to allay legal fears, rather than medical concerns. Oral health providers should feel confident treating pregnant patients. 

Editor’s note: You can view the full webinar in the CareQuest Institute webinar library.