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Dental Health: Your Fertility Depends On It

You probably think you’ve got preconception planning all figured out: Take vitamins, ban alcohol and sushi, make sure you’re up-to-date on vaccinations, and, of course, go to a lot of movies with your partner while you still can. Bet you weren’t planning to schedule a dentist appointment too, were you? (Didn’t think so.) It turns out that getting a thorough dental exam before you conceive is as important as an overall medical checkup. In the past few years, mounting research has indicated a link between poor oral health and preterm birth, low birth weight, and possibly pre-eclampsia (a dangerous pregnancy complication). One study in The Journal of the American Dental Association found that pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely (before 37 weeks) than those with healthy gums; women in the group with more severe periodontal disease delivered even earlier (before 32 weeks).

“If I have a new patient who tells me that she delivered prematurely twice, I’ll ask her if she had her gums checked before or during her pregnancy,” says Kenneth E. Johnson, D.O., an ob/gyn at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Florida. “If she says no, I’ll consider whether gum disease could be responsible for the bad outcomes.”

Brushing and Flossing
It doesn’t take really horrible habits to develop gingivitis (inflammation of the gums); simply being lax about brushing or flossing for a day or two can do it. Gingivitis develops when bacteria build up between your teeth and gums, causing soreness, swelling, and sometimes bleeding; if it’s not treated, it can lead to periodontal disease, where the bacteria begin to produce toxins that eat away at the tissue as well as the bone supporting the teeth. That, in turn, can lead to tooth loss. According to the National Center for Health Statistics, 45 percent of women aged 35 to 44 have gingivitis; 15 percent have more severe gum disease (periodontitis). Most people don’t even know they’re running around with low-grade oral infections (i.e., gingivitis). “Your gums may not bleed, and even if they do, many people assume this is normal during brushing and flossing, which is the biggest mistake you can make,” says Marty Zase, D.M.D., president of the American Academy of Cosmetic Dentistry. “Healthy gums do not bleed. If you were washing your hands and your hands started to bleed, you’d be frightened. You should think the same way about your gums.”

In general, women are more susceptible than men to gingivitis, especially during pregnancy, when increased hormone levels make gums supersensitive to plaque and bacteria. (The old wives’ tale that claims a woman loses a tooth with each pregnancy may be based in truth, since before modern dental care existed, pregnant women probably did lose teeth due to untreated gum disease.)

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Women taking ovulation-inducing drugs during fertility treatments are at greater risk for gingivitis, too. One study found that women who used ovulation-inducing medications for more than three menstrual cycles had higher levels of gum inflammation and bleeding than women not on the drugs, presumably due to increased levels of progesterone and estrogen. While the effect of oral health on fertility isn’t clear, it has been shown that the presence of infection anywhere in the body is associated with unsuccessful embryo development and implantation failure in IVF (in vitro fertilization) patients.

It’s not yet known precisely how gum disease influences pregnancy outcomes; experts suspect that inflamed gums can lead to inflammation throughout the body, which in turn might produce abnormalities in the placenta or uterus. In research being done by Dr. Johnson and his colleagues, they hope to show that amniotic fluid taken from women who delivered preterm carries the same organisms that cause gum disease. Another study in the Journal of Periodontology found that pregnant women with periodontitis had significantly higher levels of C-Reactive Protein (CRP), a marker of systemic inflammation.

So, if you’re trying to conceive, it’s crucial to make an appointment with your dentist as soon as possible. As a result of all the recent buzz about the importance of dental health during pregnancy, several large insurance providers are adding dental coverage specifically for pregnant women. Fortunately, just as it doesn’t take any extraordinary actions to get gum disease, it doesn’t take much to get rid of it, either. If you start brushing and flossing regularly as soon as you notice that your gums are red or bleeding, you can get rid of the inflammation and reverse the infection in two or three days, says Sally Cram, D.D.S., a consumer advisor for the American Dental Association.

Pregnancy Precautions
If you do develop gum disease while you’re pregnant, don’t panic; it’s not too late to go to your dentist and get it under control. “One misconception that many women have is that it’s not safe to visit the dentist during pregnancy,” says Dr. Cram, who stresses that standard dental cleanings are completely safe. In fact, if you’re especially prone to gingivitis, your dentist may recommend that you come in more frequently—perhaps every two to three months— while you’re pregnant, and might also prescribe a prescription antibacterial mouthwash to prevent bacteria buildup.

A preconception dental visit is also a good idea in case it turns out you need more extensive treatments—such as fillings, root canal, wisdom-tooth extraction, or x-rays. Once you’re pregnant those kinds of procedures, unlike routine exams and cleanings, are potentially risky. Local anesthesia (like Novocain) is harmless during pregnancy, but X-rays are best avoided. Procedures requiring general anesthesia will only be performed on pregnant women in emergencies, since there are known risks to the mother and baby.

Cosmetic procedures like tooth whitening, which involve chemicals, should also be done before pregnancy, or postponed until afterwards. Although there’s no hard evidence that the chemicals used to bleach the teeth are harmful during pregnancy, Dr. Zase says it’s best to avoid them. “If a woman delivers a baby with a defect or other problem, you don’t want her to worry that it was caused by whitening chemicals,” he says. “Even though that would be unlikely, it’s better to remove that concern entirely by holding off on the procedure.” As research mounts on the connection between oral health and pregnancy, ob/gyns may soon start screening their patients’ mouths as a routine part of a preconception or prenatal checkup. Until then, it’s up to you to call your dentist, make an appointment . . . and open wide.

Baby Teeth
A fetus starts developing teeth by around the sixth to eighth week of pregnancy. By the time a baby is born, it has all its primary teeth and the beginnings of some permanent ones (though of course you can’t see them yet).

While your diet is obviously important during pregnancy, it probably has little effect on your baby’s future dental health, says Paul Casamassimo, D.D.S., a spokesperson for the American Academy of Pediatric Dentistry. (Although this is not the case in some Third World countries, where women may be malnourished before and during their pregnancies.)

Dr. Casamassimo says that the percentage of kids with decay in their baby teeth is on the rise, which probably results from a combination of factors, including diets high in sugar and increased drinking of bottled water (which doesn’t usually contain fluoride). Several recent studies also suggest that pregnant women can pass on decay-causing bacteria to their babies. Another good reason to enter into pregnancy with a clean mouth!

A version of this article originally appeared in the Winter 2006 issue of Conceive Magazine.