A dental “deep cleaning,” formally known as Scaling and Root Planing (SRP), is a non-surgical procedure used to treat periodontitis, a serious form of gum disease. This procedure removes bacterial plaque and hardened tartar (calculus) from the tooth root surfaces below the gum line, an area inaccessible during a routine cleaning. Non-surgical periodontal therapy is generally considered safe and effective during pregnancy when proper precautions are taken and the treatment is strategically timed. Consultation with both your dentist and obstetrician is recommended to ensure the procedure is appropriate for your specific health needs and stage of pregnancy.
Pregnancy’s Effect on Gum Health
Pregnancy creates a unique environment in the mouth that can exacerbate existing gum issues or lead to new ones. Elevated levels of estrogen and progesterone are responsible for increased blood circulation and a heightened inflammatory response in the gum tissues. This exaggerated reaction to plaque bacteria is why 60% to 75% of expectant mothers develop gingivitis, often called “Pregnancy Gingivitis.”
The rise in progesterone promotes the growth of certain anaerobic bacteria, such as Porphyromonas gingivalis and Prevotella intermedia, which are associated with the progression of periodontitis. If gingivitis is not managed, it can advance to periodontitis, where the infection begins to destroy the bone and supporting tissue around the teeth. This progression creates a need for an SRP procedure.
Optimal Timing and General Safety
The timing of dental treatment is important for both patient comfort and fetal development considerations. The second trimester (roughly week 13 to week 26) is widely considered the optimal and safest period for non-emergency dental procedures like deep cleaning. By this stage, the critical period of organ development (organogenesis) in the first trimester has largely passed, minimizing potential concerns related to early fetal growth.
The first trimester is generally avoided for elective procedures due to the intense period of organ formation. Waiting until the second trimester also allows common discomforts of early pregnancy, such as morning sickness, to subside, making the patient more comfortable during the procedure.
The later stages of the third trimester present challenges primarily related to patient comfort. The increased size of the uterus can make it difficult to lie supine (flat on the back) for an extended period in the dental chair, making the middle trimester the ideal window for necessary treatment.
Procedural Adjustments for Patient Safety
Dental teams implement adjustments during a deep cleaning to ensure the safety and comfort of the pregnant patient.
Local Anesthesia
Local anesthesia is often necessary for SRP to ensure the patient remains comfortable throughout the procedure. Lidocaine, with or without a vasoconstrictor like epinephrine, is considered safe for use during pregnancy, as the amount administered is minimal and localized.
Patient Positioning
Patient positioning is an important adjustment, particularly in the second half of pregnancy, to prevent supine hypotensive syndrome. This occurs when the growing uterus compresses the inferior vena cava, potentially causing a sudden drop in blood pressure, dizziness, and nausea. To mitigate this, the dental chair is positioned with the patient lying on her left side, or with a wedge placed under the right hip, to relieve pressure on the vein.
Dental X-Rays
Dental X-rays are typically avoided during pregnancy unless required for treatment planning. When X-rays are necessary, a strict protocol is followed, including using a lead apron over the abdomen and a lead collar around the neck to shield the fetus and the thyroid gland. The minimal radiation exposure from modern digital X-rays, combined with this shielding, poses a negligible risk.
Risks Associated with Delaying Treatment
Delaying a necessary deep cleaning carries risks that often outweigh the minimal risks of receiving treatment during the optimal window. Untreated periodontitis represents a chronic infection and inflammation in the mother’s body. This sustained inflammation results in the release of chemical messengers, including prostaglandins, which circulate throughout the body.
These inflammatory chemicals have been implicated in adverse pregnancy outcomes because they can trigger uterine contractions, increasing the risk of preterm birth (delivery before 37 weeks of gestation) and low birth weight. Research suggests that mothers with periodontal disease may be at a higher risk of delivering a premature or low-birth-weight baby.
Treating the infection with SRP aims to reduce the overall bacterial load and systemic inflammation, which benefits the mother’s general health. The consensus is that the health benefits of treating active oral disease surpass the perceived risks associated with the treatment itself.