Oral Health in Pregnancy: Risks and Safe Treatments

Why pregnancy's hormonal changes amplify the gingival inflammatory response, which dental treatments are safe and in which trimester, and what to avoid.

Pregnancy gingivitis is one of the most common oral manifestations of pregnancy, with an estimated prevalence reaching very high percentages among pregnant patients in the literature. Hormonal changes, particularly increased progesterone and estrogen, alter gingival tissue's vascular and inflammatory response to bacterial plaque: with equal oral hygiene, a pregnant patient tends to show more pronounced gingival inflammation than the same patient outside pregnancy. This doesn't mean pregnancy causes gingivitis by itself, but that it amplifies the inflammatory response to a factor — plaque — which remains the primary cause.

A specific clinical entity of this period is the so-called "pregnancy granuloma" (or pregnancy epulis), a benign hyperplastic gingival lesion that can appear especially in the second trimester, typically at an area already inflamed by plaque. In most cases it regresses spontaneously after delivery and only requires surgical removal if it bleeds persistently or interferes with chewing.

On the treatment front, the guiding principle shared by the dental community is that necessary dental care shouldn't be postponed until after delivery: an untreated dental infection poses a greater risk to maternal and fetal health than appropriate dental treatment. The second trimester is generally considered the most suitable period for elective care, when the miscarriage risk typical of the first trimester has passed and the patient doesn't yet have the third trimester's postural difficulties with lying down for long in the chair.

Local anesthesia with articaine or lidocaine is considered safe in pregnancy; dental X-rays, if clinically necessary, can be performed using a lead apron, since the radiation dose involved is extremely low. What should be avoided, except for genuine emergencies, are unnecessary elective treatments in the first trimester, certain drugs (including specific categories of antibiotics and painkillers incompatible with pregnancy), and prolonged supine-position procedures in the third trimester, which can cause supine hypotensive syndrome from vena cava compression.

On Oralzon you'll find local anesthetics, diagnostic materials and radioprotection devices to safely manage dental care for pregnant patients at every stage of pregnancy.