As prevention and education specialists, dental hygienists have an important role in helping future parents prepare to conceive a baby. Growing a healthy baby starts well before conception! For most patients, brushing and maintaining a healthy mouth is the extent of their focus; they don’t realize the risk that oral diseases can pose to fetal development.
But there’s much more to it, and we need to share with our patients the impact oral infections have on their systemic health and the far-ranging effects their dental diseases, orofacial myofunctional disorders, heavy metal exposure, and sleep-airway issues have on the health of the developing fetus.
As a biological dental hygienist working in a biological and holistically oriented office, I have a focus of finding the root causes of dental diseases, addressing the oral-systemic connections, and educating patients on preventive protocols customized to fit their needs.
For women planning pregnancy, we must be very proactive. In the biological dental office, we work closely with the patient’s primary care provider to include the entire body to ensure we are stopping the cycle of disease from generation to generation. Decay is preventable, but it’s up to the entire profession to educate and inform patients on how decay progresses, how important it is to systemic health for the entire family, and how it can be prevented.
Patients need this critical information so the next generation can grow up without decay, malocclusion, and sleep apnea. It really does all start in the dental hygienist’s chair.
Building blocks for a healthy baby
We must be more proactive and preventive and share with patients what a healthy mouth entails. Just telling patients to “brush longer and floss daily” is not going to help them maintain a healthy oral cavity. Time spent educating prospective parents on heavy metals, caries, and periodontal disease as well as nutrition, gut health, nasal breathing, nasal hygiene, and oral hygiene gives them the information they need to maintain their oral health.
And we shouldn’t wait until a patient is pregnant to address gingivitis and other oral infections. Bloody gums indicate inflammation of the entire body. Research shows treating the infection while a patient is pregnant does improve the health of the mouth but doesn’t alter rates of preterm birth, low birth weight, or fetal growth restriction.1 It’s best to prevent the infection before conception.
You might also be interested in: Why you should consider becoming a biological dental hygienist
In my office, we have longer dental hygiene appointment times, often 90 minutes, so the patient benefits from one-on-one oral health guidance information without feeling rushed. We take plaque samples to use on the phase contrast microscope and show patients what’s living underneath their gums and then what they need to do at home to help change this environment. Sharing this personalized information is critical to creating a healthy body. Seeing the bacteria, parasites, and candida reminds patients these pathogens are communicable and contagious. This emphasizes that the entire family benefits from improved oral health practices because we share pathogens with saliva-to-saliva contact. Kissing, sharing utensils, and even licking a pacifier to “clean” it shares and spreads pathogens to others in both a vertical as well as horizontal transmission.
We actively treat periodontal disease in both partners to heal the infection by using guided biofilm management, ozone therapy, laser therapy, ultrasonics, and perioscopy, and we continually monitor the microbiome with the microscope until the plaque microbiome and tissues correspond to health. Periodontal infections and caries are symptoms of bigger systemic issues. We must work with the patient’s primary care provider to address gut dysbiosis because that may be the root cause of gingival dysbiosis.2
Customizing oral self-care instructions based on salivary diagnostics with the end goal of a healthy oral microbiome for both partners before conception ensures a healthier pregnancy and newborn baby.
The dangers of heavy metals
Does the future mother have silver-mercury amalgam fillings?3 These fillings leach mercury vapors4 when people chew or brush, and especially with every dental hygiene recare or dental drilling appointment. Mercury vapors5 are poisonous to the body and are especially damaging when they pass the blood-brain barrier due to damage it does to the central nervous system.6 Fetal brains7 are most susceptible to maternal mercury vapors, creating the potential for brain damage and brain cell death. This has wide-ranging implications for a baby’s health, impacting cognitive abilities, fine motor skills, and language development, as well as cardiovascular, renal, and reproductive health.8 Research also connects mercury vapors to Alzheimer’s disease and cognitive impairment.9 There is no safe level of mercury. According to the Environmental Protection Agency (EPA), mercury is “highly toxic.”10
When mercury-silver fillings are removed with a dental drill, the heat from the drill creates even more mercury vapors. The International Academy of Oral Medicine and Toxicology (IAOMT) does not recommend removing these fillings during a patient’s pregnancy11 or while they’re breastfeeding because of the hazards that mercury vapor exposure creates for the pregnant woman and developing fetus. If a patient is thinking about becoming pregnant, she may want to consider replacing these mercury-silver fillings well before conception. The IAOMT teaches its dental providers a safe mercury amalgam removal technique12 to reduce exposure to these vapors for not only the patient but all the professionals in the office. (Dental personnel exposed to low levels of mercury have more neuromotor behavioral problems, cognition decline, and sleep issues.)13
Biological dental offices practice “SMART” protocols: safe mercury-amalgam removal technique. Along with this protocol, we work closely with the patient’s primary care provider to help the patient safely remove mercury from the body via chelation,14 using special drugs to bind the heavy metals in the bloodstream, which are then excreted in the urine.15
Another heavy metal affecting the oral health of not only the mother but also the developing fetus is lead. Lead is stored in the bones and released during pregnancy16; in this way, it is passed down from generation to generation. Research shows that up to 11% of early childhood caries in 24- to 72-month-old children may be due to lead toxicity.17 Sharing this information helps future parents be proactive and test their lead levels, especially if they’re in a higher-risk environment such as an old house. Chelation is also used to detoxify the body of lead.
The root causes of caries
Discovering the root causes of tooth decay requires spending time diagnosing the underlying issues and finding ways to address them successfully.
We know dental caries pathogens are transferred from the mother or caregiver18 to the predentate infant via saliva.19 Ideally, we should be testing patients and potential parents before conception to assess their caries bacterial, viral, and fungal load levels and do a caries risk assessment. Reducing the pathogen load would go a long way toward helping reduce infant decay.
Using salivary diagnostics gives us critical information. Once we know the patient’s risk level and what pathogens are the potential problem, we can be more proactive and aggressive in recommending upgraded self-care routines and more frequent dental hygiene therapies, suggest products that address the pathogenic bacteria, candida, viruses or parasites, and investigate other causes of tooth decay such as vitamin and mineral deficiencies (also potentially impacting the health of the anticipated pregnancy), mouth-breathing habits, or poor saliva production or flow. By reducing tooth decay risk in a mother, we can help an infant start life with healthy deciduous teeth.
To reduce bacterial load, we can recommend five servings (six to 10 grams) of xylitol a day. This disrupts Streptococcus mutans colonization in the mother, which can reduce decay levels in the child.20 To address the viruses, parasites, and candida pathogens, we must dig deeper. In my biological office, we use ozone/oxygen therapy21 in its three forms—gas, water, and oil—to attack these pathogens. Ozone/oxygen therapy kills anaerobic pathogens; it lyses the bacterial cell wall, kills candida,22 and interferes with viral replication. (And, as an added bonus, ozone speeds healing.)23
Removing active carious lesions and restoring the teeth, as well as reevaluating oral hygiene techniques and products, helps halt decay. We should upgrade patients’ oral hygiene program to include electric brushes, interproximal tools, tongue scrapers, and oral irrigation. We can also discuss pH of products and nutrition. Tooth decay may also be due to fermentable carbohydrates as well as an acidic plaque biofilm on teeth, mouth breathing, a lack of quantity and/or quality of saliva, nutritional deficiencies, and gut dysbiosis.
The dangers of periodontal disease
Periodontal disease affects up to 40% of reproductive-age women.24 These pathogenic biofilms have been connected to adverse pregnancy outcomes.25,26 Twenty-five to 40% of preterm labor and birth are the result of periodontal disease pathogens infecting the body. Oral pathogens translocate with brushing, flossing, chewing, and dental procedures. Once introduced to the blood system,27 they travel throughout the entire body within 60 seconds. Oral pathogens from the mouth infect the entire body with every swallow, inhalation, and “bloody prophy.”
These oral pathogens have far-ranging consequences. They cause bacteremia and can trigger a heart attack up to four weeks post-prophy, as well as contribute to rheumatoid arthritis and dementia.28
Oral pathogens have been found colonized in the placenta and are connected to low birth-weight babies, preterm births,29 and fetal death.30 Severe periodontal infections have been implicated in spontaneous very preterm birth (under 32 weeks).31 Lower newborn Apgar scores and a decrease in birth size corresponded with the severity of the mother’s periodontal infection.32
Not only do periodontal disease pathogens affect the developing fetus; they also increase the mother’s risk of preeclampsia.33 Preeclampsia is the second most common cause of death in new mothers and increases the risk of premature birth, low birth weight, stillbirth, and death for the newborn, as well.34
Salivary diagnostics as well as chairside phase contrast microscopy are ideal tools for uncovering dental health issues before they become full-blown infections, and for discovering what level of pathogens are residing within the gingival tissues and oral cavity (tonsils and tongue surfaces have similar microbiomes).
Our goal should be to encourage a healthy oral microbiome rather than eradicate all the oral bacteria. Good bacteria have an important role to play in oral health. (Good oral bacteria help create nitric oxide, which our bodies need to be healthy. By using an antibacterial mouthwash, we eradicate both the bad and the good.) Bacteria, as well as viruses and fungi, are supposed to be there, but in the right proportions. Salivary diagnostic testing tells us if this is occurring.
Our role in healthy sleep
Dental hygienists are a patient’s first line of defense in screening for airway and sleep issues. We see all the signs of brewing airway issues with broken and cracked, sensitive, fractured, and worn teeth. Periodontal disease and caries are signs of airway issues. Breathing-disordered sleep has far-ranging consequences35 such as heart attacks, stroke, atrial fibrillation, and cognitive impairment.36 Clenching, grinding, gnashing, and bruxing all find their roots in breathing issues during sleep.37 Acid-wear facets are small but significant signs of airway troubles brewing.38 While hardly noticeable, they are a red alert to future problems.
If an expectant mother has trouble breathing at night, so will her growing baby, and this lack of oxygen will dramatically affect fetal growth.39 Autism40 and birth defects41 can be the result of a lack of oxygen during sleep. Future dads also need airway and sleep screening because airway issues can contribute to reduced quality of the semen.42
Screening for sleep apnea, upper airway resistance syndrome, and other sleep-breathing issues before pregnancy can help ensure a healthier pregnancy and birth outcome.
Screen both the mom- and dad-to-be for signs of sleep breathing disorders, recommend sleep studies, and suggest sleep apps or other sleep monitoring devices. Most people say they sleep “fine”; they have no other comparison. Without testing, we’re only guessing and we need better answers than that; the consequences are too severe. Teach your patients where their tongue should rest to create a strong tongue that stays there during sleep. Orofacial myofunctional therapists (OMTs) call this “proper oral rest posture.” The tongue belongs on the roof of the mouth, teeth apart, and lips gently but firmly together. Learn more about the importance of nasal breathing so you can share this information with your patients. Orofacial myofunctional disorders (OMDs) are often the reason we have caries, periodontal infections, bone loss, broken teeth, and so much more.
As dental professionals, we’re in charge of everything from the neck up. Learn more about OMDs and become an airway specialist by becoming an OMT. Everything starts with oxygen. No one else monitors this area as well as we do, so we need to learn all we can about airway development.
Proactive prenatal protocols
Dentistry can do its part to ensure future generations are born healthy and stay healthy. Our patients need to learn more about the airway, heavy metal toxicity, dental caries, and periodontal disease/systemic connections as well as preventive oral hygiene self-care. Spending extra time testing, diagnosing, and educating are the missing links in our dental health services. Future parents need this critical information on how to have healthy bodies so they can grow healthy children. Dental hygienists should be allowed the time and support to share this vital information. Being proactive is well worth our time and attention.
- Michalowicz BS, Hodges JS, DiAngelis AJ, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med. 2006;355(18):1885-1894. doi:10.1056/NEJMoa062249
- Cai Z, Zhu T, Liu F, Zhuang Z, Zhao L. Co-pathogens in periodontitis and inflammatory bowel disease. Front Med (Lausanne). 2021;8:723719. doi:10.3389/fmed.2021.723719
- Health effects of exposures to mercury. US Environmental Protection Agency (EPA). Accessed May 23, 2023. https://www.epa.gov/mercury/health-effects-exposures-mercury
- Burhenne M. Mercury fillings dangers, who is at risk & removal checklist. Ask the Dentist. Oct. 26, 2021. https://askthedentist.com/mercury-fillings-safe/
- The Smoking Tooth part 1 of 3. Layton Dental. https://youtube/gCpVmcezCrI
- Cariccio VL, Samà A, Bramanti P, Mazzon E. Mercury involvement in neuronal damage and in neurodegenerative diseases. Biol Trace Elem Res. 2019;187(2):341-356. doi:10.1007/s12011-018-1380-4
- Abbott L, Nigussie F. Mercury toxicity and neurogenesis in the mammalian brain. Int J Mol Sci. 2021;22(14):7520. doi:10.3390/ijms22147520
- Falck AJ, Sundararajan S, Al-Mudares F, et al. Fetal exposure to mercury and lead from intrauterine blood transfusion. Pediatr Res. 2019;86(4):510-514. doi:10.1038/s41390-019-0463-z
- Azar J, Yousef MH, El-Fawal HAN, et al. Mercury and Alzheimer’s disease: a look at the links and evidence. Metab Brain Dis. 2021;36:361-374. https://doi.org/10.1007/s11011-020-00649-5
- Basic information about mercury. US Environmental Protection Agency (EPA). Accessed May 23, 2023. https://www.epa.gov/mercury/basic-information-about-mercury
- Safe amalgam removal. International Academy of Oral Medicine and Toxicology (IAOMT). Accessed May 23, 2023. https://iaomt.org/for-patients/safe-amalgam-removal/
- The Safe Mercury Amalgam Removal Technique (SMART). International Academy of Oral Medicine and Toxicology (IAOMT). Accessed May 23, 2023. https://iaomt.org/resources/safe-removal-amalgam-fillings/
- Bjorklund G, Hilt B, Dadar M, Lindh U, Aaseth J. Neurotoxic events of mercury exposure in dental personnel. Basic Clin Pharmacol Toxico. 2019;124(5):568-574. doi:10.1111/bcpt.13199
- Cao Y, Skaug M, Andersen O, Aaseth J. Chelation therapy in intoxications with mercury, lead and copper. J Trace Elem Med Biol. 2015;31:188-92. doi:10.1016/j.jtemb.2014.04.010
- Brodkin E, Copes R, Mattman A, Kennedy J, Kling R, Yassi A. Lead and mercury exposures: interpretation and action. CMAJ. 2007;176(1):59-63. doi:10.1503/cmaj.060790
- Childhood lead poisoning prevention. Pregnant women. Centers for Disease Control and Prevention. Page last reviewed July 21, 2022.
- Wiener RC, Long DL, Jurevic RJ. Blood levels of the heavy metal, lead, and caries in children aged 24-72 months: NHANES III. Caries Res. 2014;49(1):26-33. doi:10.1159/000365297
- Featherstone JDB. Dental caries: a dynamic disease process. Aust Dent J. 2008;53(3):286-291.
- Berkowitz RJ. Acquisition and transmission of mutans streptococci. J Calif Dent Assoc. 2003;31(2):135-138.
- Nakai Y, Shinga-Ishihara C, Kaji M, et al. Xylitol gum and maternal transmission of mutans streptococci. J Dent Res. 2010;89(1):56-60. doi:10.1177/0022034509352958
- Manjunath SN, Sakar M, Katapadi M, Geetha Balakrishna R. Recent case studies on the use of ozone to combat coronavirus: problems and perspectives. Environ Technol Innov. 2021;21:101313. doi:10.1016/j.eti.2020.101313
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