From Pregnancy to First Tooth: 11 Questions on Early Oral Health

Oral health begins before birth.

It’s widely known that a pregnant person’s oral health shapes their child’s oral health. And after birth, bacteria that cause dental caries can find their way into an infant’s mouth via shared spoons and pacifiers cleaned with parent saliva, increasing a child’s risk for developing tooth decay.

“This is why it’s especially important to address and treat active oral disease of the mother during pregnancy before the baby is born,” says Katy Battani, RDH, MS, during the recent CareQuest Institute’s webinar — in collaboration with the National Maternal and Child Oral Health Resource Center — “Oral Health from Pregnancy to Early Childhood: Improving Access, Safety, and Continuity of Care.”

“It’s important to educate [parents] about getting oral health care during pregnancy, practicing good oral hygiene behaviors, eating healthy foods, drinking water, and understanding caries prevention for the baby after they are born,” Battani says.

During the webinar, experts discussed how oral health teams can improve access, safety, and continuity of care for mothers and their children. Valerie Cuzella, RDH, BAS, Patricia Braun, MD, MPH, FAAP, and Battani answered numerous questions, but there were some they couldn’t get to in the 60-minute program. As a bonus, here are 11 more questions about the connection between oral health and maternal and pediatric health, what is safe and unsafe for pregnant patients and infants, and how to get medical providers’ buy-in on the importance of oral health:

 

1. How can a pregnant person’s periodontal disease contribute to preterm birth?

Periodontal disease can contribute to preterm birth in both direct and indirect ways:

• Through the direct pathway (bacterial translocation), the mouth acts as a space for disease-causing bacteria. Because periodontal disease increases vascular permeability and gum inflammation, activities like chewing or brushing your teeth can cause frequent, low-grade bacteria to enter the bloodstream. That bacteria can then travel through the bloodstream and take root in the placenta, amniotic fluid, and fetal membranes and cause inflammation that impacts the placenta and the support of the growing fetus.
• The indirect pathway (systemic inflammation) does not require the physical presence of oral bacteria in the uterus. Instead, it is driven by the body’s systemic response to the chronic inflammatory site in the mouth. Inflammatory markers from the chronic inflammation then circulate through the pregnant person’s body and can trigger early labor.

 

2. During pregnancy, can pregnant people get fluoride varnish?

Yes, pregnant people can get fluoride varnish.

 

3. Is it okay to numb pregnant patients who need scaling and root planing?

Yes, certain local anesthetics with epinephrine are safe to use during pregnancy (see this pharmacology table). However, articaine-epinephrine should only be given during pregnancy when benefits outweigh risks. The anesthetic has been assigned to pregnancy category C by the FDA.

 

4. How do you handle reluctance from patients/parents or health providers for use of silver diamine fluoride (SDF)?

Some parents say no, or say not to apply SDF to their child’s front teeth. Other parents accept it right away and are especially grateful to have an option that doesn’t involve general anesthesia. No matter what, it is always a shared decision-making process with parents and patients. Do not assume they will say no, and always have a discussion about all the options.

 

5. How do you answer the parent question, “Can I start cleaning a baby’s mouth at an early age with silicone or a towel for residue?”

Yes! As soon as day one, I recommend nightly cleaning of the child’s mouth with a damp cloth or silicone finger brush to reduce bacterial and fungal populations and to get the child accustomed to this before their teeth come in.

 

6. Is it okay to use benzocaine products on infants?

I discourage the use of benzocaine products for teething pain in infants because there is a small risk of them developing methemoglobinemia. Instead, focus on using cold-based teethers, like frozen fruit, to relieve infant teething pain.

 

7. Do you recommend xylitol to prevent caries?

Xylitol is a great adjunct that can help reduce bacterial and viral adherence. I use it myself as a preventive nasal spray. Xylitol does not replace fluoride as the gold standard for dental caries prevention. If patients are not open to fluoride, it is good to have some options to recommend, like xylitol.

 

8. If kids are sharing food, is that also another cause of spreading caries to other kids?

Yes, horizontal transmission of dental caries is the spread of cavity-causing bacteria (mainly Streptococcus mutans) between people in the same age group or environment, rather than from parent to child. It typically happens among siblings, classmates, or playmates through saliva-sharing activities such as using utensils, cups, or toothbrushes.

 

9. Why does the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in some states exclude dental?

States are required to develop or adopt a dental periodicity schedule. In September 2024, the Centers for Medicare & Medicaid Services (CMS) issued a letter to state health officials reminding them that EPSDT requires states to develop or adopt a dental periodicity schedule in consultation with recognized dental organizations in child health. A dental periodicity schedule outlines recommended oral health services for children on Medicaid by age.

As of May 2026, 21 states have adopted the AAPD dental periodicity schedule, 21 states have developed their own, and 8 states do not have a schedule.

 

10. What do I do if an obstetrician-gynecologist (ob-gyn) doesn’t want a pregnant patient to have routine radiographs, which are needed for full new-patient exams?

Consider sharing the National Consensus Statement (NCS) with your prenatal colleagues. The NCS states, “Take radiographs to evaluate and definitively diagnose oral diseases and conditions when clinically indicated.”

Also note that in 2024, the American Dental Association (ADA) released guidance in the Journal of the American Dental Association (JADA) on safety and regulatory aspects of radiography. In 2026, updated recommendations for planar (2-D) and cone-beam computed tomography (CBCT; 3-D) dental radiography patient selection were copublished by the ADA and the American Academy of Maxillofacial Radiology.

 

11. How can we get ob-gyns to discuss the importance of oral health with pregnant patients and/or refer them to dentists?

Consider sharing the NCS and American College of Obstetricians and Gynecologists (ACOG) committee opinion with your prenatal colleagues, perhaps via a one-on-one discussion, study club, or CE course.