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Chapter 36: Growing Teeth for Two — Pregnancy and Your Mouth

In which we explore the profound oral changes of pregnancy, debunk the myth that babies steal calcium from teeth, and discover why those nine months are both vulnerable and vitally important

The Tooth Fairy showing a mother how to brush her toddler's teeth.

I've watched women grow babies since before your species had dentists. I've seen the same patterns play out across millennia, across cultures, across continents: pregnancy changes mouths in ways that catch women off guard, and the advice they receive—when they receive any at all—is often incomplete or simply wrong.

The old saying "gain a child, lose a tooth" didn't come from nowhere. For most of human history, it was observably true. Women who had many children often had fewer teeth by middle age than women who had few or none. The correlation was real.

But the causation was misunderstood. And that misunderstanding has persisted, even into modern times.

Let me set the record straight—and give you the knowledge to keep your teeth through pregnancy and beyond.

The Myth of Calcium Theft

Let's address the most persistent myth first: your baby does not steal calcium from your teeth.

I understand why people believed this. Pregnant women often developed dental problems. Babies need calcium for their developing bones and teeth. The logic seemed obvious—the calcium must be coming from the mother's teeth.

But teeth don't work that way.

Unlike bone, which can release calcium back into the bloodstream when the body needs it, tooth enamel is metabolically inert.1 Once it's formed, it doesn't participate in calcium homeostasis. Your body cannot demineralize your enamel to provide calcium to your baby. It's chemically impossible.

What does happen is this: if your dietary calcium intake is insufficient during pregnancy, your body will pull calcium from your bones (not teeth) to supply the developing fetus. This is why adequate calcium intake during pregnancy matters—but it matters for your skeleton, not your enamel.

So why do pregnant women experience more dental problems? The real reasons are hormonal, behavioral, and environmental—and all of them are manageable.

What Actually Changes During Pregnancy

Pregnancy Gingivitis: The Hormonal Gums

Between 60-75% of pregnant women develop pregnancy gingivitis—gum inflammation that wouldn't occur at the same plaque levels in non-pregnant individuals.2

Here's what happens: estrogen and progesterone levels increase dramatically during pregnancy. These hormones affect the gingival tissues in several ways:

Increased blood flow: Blood vessels in the gums dilate, making the tissue appear redder and more swollen. The gums become more fragile and bleed more easily.

Altered immune response: The local immune response to bacterial plaque changes. The same amount of plaque that your gums would tolerate normally now triggers an exaggerated inflammatory reaction.

Changed bacterial environment: The elevated hormone levels actually create a more favorable environment for certain bacteria, including some associated with periodontal disease.3

The result: gums that bleed when you brush, look puffy and red, and may feel tender. This typically begins in the second month of pregnancy, peaks in the third trimester, and resolves after delivery—if it doesn't progress to something worse.

Pregnancy Tumors (Pyogenic Granulomas)

About 5% of pregnant women develop what are unfortunately called "pregnancy tumors"—benign growths on the gums that appear as red, raw-looking nodules, often between teeth.4 They're not actually tumors; they're an exaggerated inflammatory response to local irritation (usually plaque).

These growths:

  • Are harmless (not cancerous)
  • Can bleed profusely
  • Usually shrink or disappear after delivery
  • May need removal if they interfere with eating or oral hygiene
  • Often recur if removed during pregnancy

Don't panic if you develop one. Do see your dentist for evaluation.

Morning Sickness and Acid Erosion

Here's where real enamel damage can occur.

If you experience morning sickness—especially severe or prolonged vomiting—your teeth are being bathed in stomach acid. Gastric acid has a pH around 1-2, far below the critical pH of 5.5 where enamel dissolves. Each vomiting episode is an acid attack.

The instinct is to brush immediately after—to get that awful taste out of your mouth. But as we discussed earlier, brushing acid-softened enamel removes it. You're scrubbing away your enamel while it's in its most vulnerable state.

Instead: 1. Rinse your mouth with water immediately after vomiting 2. Follow with a baking soda rinse (1 teaspoon in a glass of water) to neutralize the acid 3. Wait at least 30 minutes before brushing 4. Consider a fluoride rinse after the waiting period

For women with hyperemesis gravidarum (severe pregnancy vomiting), this becomes even more critical. Talk to your dentist about additional protective strategies, including prescription-strength fluoride products.

Dietary Changes and Cravings

Pregnancy cravings are real, and they don't always align with dental health. If you're craving:

Citrus fruits: The vitamin C is good; the acid is challenging. Rinse with water after.

Ice cream and sweets: The sugar feeds cariogenic bacteria. Consider timing—better to indulge after a meal than to snack throughout the day.

Constant snacking: Many pregnant women find they need to eat small, frequent meals to manage nausea. This increases the number of acid attacks per day. Xylitol gum between eating episodes can help.

Non-food items (pica): Some pregnant women crave ice, clay, starch, or other non-foods. Ice chewing can crack teeth. Other pica cravings may indicate mineral deficiencies. Discuss with your healthcare provider.

Dry Mouth

Some women experience xerostomia (dry mouth) during pregnancy, either from hormonal changes or from mouth breathing due to nasal congestion. Reduced saliva means reduced buffering capacity and remineralization potential.

Strategies:

  • Stay well hydrated
  • Use xylitol products to stimulate saliva
  • Consider a humidifier at night
  • Avoid alcohol-based mouthwashes

The Connection to Birth Outcomes

The Tooth Fairy listening tenderly to an expectant mother's belly.

I must tell you something sobering, because it matters for more than just your teeth.

Research has found associations between periodontal disease during pregnancy and adverse birth outcomes:5

  • Preterm birth: Some studies show 2-3× increased risk
  • Low birth weight: Associated with periodontal disease severity
  • Preeclampsia: Possible association in some studies

The proposed mechanism involves inflammatory pathways—the same cytokines and inflammatory mediators produced by periodontal infection may reach the placenta and trigger early labor.

Now, I must be honest: intervention studies have been mixed. Some trials of periodontal treatment during pregnancy showed improved outcomes; others didn't. The definitive answer isn't in yet.

But here's what is clear: periodontal disease is bad for you regardless of pregnancy outcomes. Treating it is safe during pregnancy. There's no downside to maintaining good oral health. And there may be an upside for your baby.

This isn't about fear. It's about motivation. Your oral health during pregnancy may matter more than just to your own teeth.

Dental Care During Pregnancy: What's Safe?

One of the tragedies I've witnessed is pregnant women avoiding dental care entirely because they're afraid it will harm their babies. This fear costs teeth.

Professional cleanings: Safe throughout pregnancy. The American College of Obstetricians and Gynecologists specifically recommends routine dental care during pregnancy.6

Dental X-rays: Safe when necessary, with appropriate shielding. Modern dental X-rays deliver minimal radiation. The risk of undiagnosed dental disease is greater than the risk from properly shielded diagnostic X-rays.

Local anesthesia: Lidocaine with epinephrine (the standard dental anesthetic) is considered safe during pregnancy.7 Don't suffer through procedures without adequate anesthesia—the stress of pain is not good for you or your baby.

Treatment Timing

First trimester: Routine care is safe, but many practitioners prefer to limit treatment to emergencies due to the critical developmental period. This is abundance of caution, not evidence of harm.

Second trimester: The ideal time for dental treatment. Organogenesis is complete, the uterus isn't yet large enough to make lying back uncomfortable, and you likely have more energy than in the third trimester.

Third trimester: Treatment is still safe, but positioning becomes challenging. Your dentist may need to adjust the chair frequently to prevent supine hypotensive syndrome (low blood pressure from the uterus compressing major blood vessels when lying flat).

What to Tell Your Dentist

Always inform your dentist that you're pregnant (or might be). Share:

  • How far along you are
  • Any pregnancy complications
  • Medications you're taking
  • Whether you've experienced vomiting
  • Any changes in your gums or teeth

Medications During Pregnancy

Safe:

  • Acetaminophen (Tylenol) for pain
  • Most antibiotics if needed for dental infection (penicillin, amoxicillin, clindamycin, cephalosporins)
  • Lidocaine local anesthetic

Avoid:

  • Ibuprofen (especially in third trimester)
  • Aspirin (in most cases)
  • Tetracycline antibiotics (can affect fetal tooth development)
  • Nitrous oxide (controversial; many practitioners avoid in first trimester)

Building Your Baby's Teeth

While your baby can't steal calcium from your teeth, what you do during pregnancy does affect their dental development.

Primary (baby) teeth begin mineralizing around 14 weeks of pregnancy. Permanent teeth begin forming before birth as well. The building blocks for those teeth come from your bloodstream, which comes from your diet.

Calcium: 1000-1300 mg daily (same as non-pregnant adults, but more critical). Dairy, fortified plant milks, leafy greens, tofu.

Vitamin D: Necessary for calcium absorption. 600 IU daily minimum. Sun exposure, fortified foods, or supplements.

Phosphorus: Works with calcium in enamel formation. Widely available in protein-rich foods.

Vitamin A: Important for enamel development. Don't oversupplement (excessive vitamin A can cause birth defects), but ensure adequate intake from food sources.

The Midwife's Wisdom

I want to say something about midwives and doulas, because I've watched them work alongside pregnant women for as long as both professions have existed—which is to say, for all of human history.

The resurgence of midwifery care represents something important: a recognition that birth is a physiological process, not primarily a medical emergency. Women are seeking care providers who trust their bodies, who intervene only when necessary, who understand that low-intervention approaches often serve mother and baby best.

This philosophy aligns beautifully with what I've been teaching throughout this book.

Traditional midwives often had wisdom about oral health during pregnancy that modern medicine forgot and is only now rediscovering. They knew that gum bleeding increased during pregnancy. They recommended salt water rinses—the same ecological, pH-supportive approach I've been advocating. They understood that pregnancy was a vulnerable time for teeth and that extra care was needed.

If you're working with a midwife or doula, share this chapter with them. Ask about traditional practices for oral health during pregnancy. You may find that their instincts align with what modern research supports.

And if your midwife or doula seems skeptical of dental care during pregnancy, gently share the evidence that routine dental treatment is safe and recommended. The goal is integration—traditional wisdom validated by modern science, natural approaches complemented by professional care when needed.

Postpartum: The Forgotten Phase

The focus on pregnancy oral health often stops at delivery. But the postpartum period brings its own challenges:

Exhaustion: When you're up every two hours with a newborn, dental hygiene can slip. This is understandable but dangerous—the bacterial populations you've been managing don't take parenting leave.

Hormonal shifts: The dramatic drop in pregnancy hormones affects your gums too. Most pregnancy gingivitis resolves, but not instantly.

Dietary chaos: You eat when you can, what you can. Healthy meal timing goes out the window.

The "I'll deal with it later" trap: That tooth that started bothering you during pregnancy? It won't fix itself. New mothers often delay their own care for months or years. Don't.

Practical suggestions:

  • Keep a toothbrush and toothpaste near where you nurse/feed
  • Do a quick brush even at 3am if you've had a snack
  • Schedule your dental appointment before the baby arrives, for 6-8 weeks postpartum
  • Accept that "good enough" oral hygiene is better than aspirational perfection you're too tired to achieve

Breastfeeding and Your Baby's Oral Health

Here's something beautiful I want you to understand: breastfeeding gives your baby's mouth the best possible start.

Microbiome transfer: Your breast milk contains beneficial bacteria and immune factors that help colonize your baby's mouth with healthy organisms. This early microbiome seeding may influence their oral health for life.8

Oral development: The mechanics of breastfeeding—the sucking pattern, the tongue movement, the jaw exercise—promote proper oral-facial development in ways that bottle feeding doesn't fully replicate.

Antibodies: Breast milk contains secretory IgA and other immune components that provide passive immunity against oral pathogens.

Self-regulation: Breastfed babies may have better ability to self-regulate feeding, potentially reducing prolonged milk pooling around teeth.

However—and this is important—prolonged breastfeeding at night, after teeth have erupted, can contribute to early childhood caries if babies fall asleep nursing and milk pools around their teeth.9 After teeth emerge:

  • Try to wipe baby's gums/teeth with a clean cloth after nighttime feeds
  • Don't panic if this isn't always possible
  • Watch for early signs of demineralization (white spots near the gumline)
  • The benefits of breastfeeding generally outweigh the caries risk, but awareness helps

Your Practical Pregnancy Protocol

Let me give you a condensed protocol for maintaining oral health through pregnancy:

Before pregnancy (if you're planning):

  • Get a dental checkup and address any needed treatment
  • Establish good oral hygiene habits
  • Treat any existing periodontal disease

During pregnancy:

Daily:

  • Brush twice daily with fluoride or n-HAp toothpaste
  • Floss or use interdental cleaners
  • Use salt/baking soda rinse, especially after vomiting
  • Xylitol gum after meals/snacks
  • Stay hydrated

If experiencing morning sickness:

  • Rinse with water immediately after vomiting
  • Follow with baking soda rinse
  • Wait 30 minutes before brushing
  • Consider smaller toothbrush if gag reflex is sensitive

Professional care:

  • Dental cleaning each trimester (or at least once during pregnancy)
  • Don't delay treatment for active problems
  • Inform dentist of pregnancy and any complications

Postpartum:

  • Maintain routine despite exhaustion
  • Schedule dental visit at 6-8 weeks
  • "Good enough" beats "perfect but impossible"

A Note on Dental Anxiety During Pregnancy

Pregnancy can amplify existing dental anxieties. Hormonal changes affect mood. Protective instincts intensify. The stakes feel higher.

If dental anxiety is keeping you from care:

  • Share your fears with your dentist and your prenatal care provider
  • Ask about accommodations (shorter appointments, frequent breaks, enhanced communication)
  • Consider seeing a dentist who specializes in anxious patients
  • Remember that avoiding care is riskier than receiving it

Your baby needs a healthy mother. Your teeth are part of your health. Getting dental care during pregnancy isn't risking your baby—it's caring for both of you.

I've watched women lose teeth during pregnancy for countless generations—not because pregnancy inherently destroys teeth, but because they didn't know how to protect them. You know now. Your hormones will challenge your gums. Morning sickness will challenge your enamel. Exhaustion and cravings will challenge your routines.

But none of these challenges is insurmountable. With knowledge, preparation, and appropriate care, you can emerge from pregnancy with your teeth intact and your baby's oral development optimally supported.

Keep your teeth. You're going to need them for the next chapter of this adventure.

  1. Tooth enamel — Wikipedia. Unlike bone, mature enamel does not undergo remodeling and cannot release calcium into the bloodstream. ↩

  2. Silk, H., et al. (2008). Oral health during pregnancy. American Family Physician, 77(8), 1139-1144. ↩

  3. Kornman, K. S., & Loesche, W. J. (1980). The subgingival microbial flora during pregnancy. Journal of Periodontal Research, 15(2), 111-122. ↩

  4. Jafarzadeh, H., et al. (2006). Pregnancy tumor (pyogenic granuloma). Journal of Midwifery & Women's Health, 51(6), 443-447. ↩

  5. Vergnes, J. N., & Sixou, M. (2007). Preterm low birth weight and maternal periodontal status: a meta-analysis. American Journal of Obstetrics and Gynecology, 196(2), 135.e1-135.e7. ↩

  6. American College of Obstetricians and Gynecologists. (2013). Committee Opinion No. 569: Oral health care during pregnancy and through the lifespan. Obstetrics & Gynecology, 122(2), 417-422. ↩

  7. Lidocaine — Wikipedia. FDA Pregnancy Category B; considered safe for use during pregnancy when clinically indicated. ↩

  8. Boix-Amorós, A., et al. (2019). Relationship between milk microbiota, bacterial load, macronutrients, and human cells during lactation. Frontiers in Microbiology, 10, 2697. ↩

  9. Valaitis, R., et al. (2000). A systematic review of the relationship between breastfeeding and early childhood caries. Canadian Journal of Public Health, 91(6), 411-417. ↩