Your Dentist Wants to See You—Before and During Pregnancy

If you’re thinking about having a baby, here’s something that probably isn’t on your checklist: a trip to the dentist. It should be.

And if you’re already pregnant? That appointment is just as important—maybe more so.

Yet despite clear guidance from both the American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA) that oral health care, including having dental radiographs taken and being given local anesthesia, is safe at any point during pregnancy, American Dental Association too many pregnant women skip the dentist—and too many providers hesitate to refer them.

This needs to change.

Start Before the Stick Turns Pink

Preconception is the ideal time to address dental problems. Cavities, gum disease, that wisdom tooth that’s been bothering you—take care of it now.

Why? Because once you’re pregnant, your mouth becomes a harder environment to manage. Hormonal changes will work against you. And while dental care during pregnancy is completely safe, it’s much easier to start from a healthy baseline than to play catch-up while dealing with morning sickness, fatigue, and everything else pregnancy throws at you.

Think of it like this: you’d get your car serviced before a long road trip. Your mouth deserves the same consideration before the nine-month journey ahead.

What Pregnancy Does to Your Mouth

Pregnancy hormones don’t just cause morning sickness and mood swings. They fundamentally alter what’s happening in your gums.

Rising levels of estrogen and progesterone increase blood flow to gingival tissue and change how the immune system responds to oral bacteria. These hormones are supposed to be responsible for gingivitis progression PubMed Central through multiple mechanisms: they stimulate bacterial growth in the mouth, resulting in a shift in bacteria flora, PubMed alter cytokine production involved in inflammatory responses, and change the rate and pattern of collagen production in gingiva, thereby reducing the body’s ability to repair and maintain PubMed healthy tissue.

The result? Gums that swell, bleed easily, and become inflamed.

This is called pregnancy gingivitis, and it’s incredibly common. Gingivitis is common and affects 60% to 75% of all pregnancies in the U.S. Cleveland Clinic Interestingly, research suggests that its incidence is only 0.03% if pregnant women are plaque-free at the beginning of pregnancy and practice good oral hygiene during pregnancy PubMed—underscoring why preconception dental care matters so much.

For most women, pregnancy gingivitis is a nuisance. Gums that bleed when you brush. Some tenderness. Symptoms often start to become evident in the second trimester and peak in the third trimester. Delta Dental Institute But for some women, gingivitis can progress to periodontitis—a more serious infection that damages the bone and tissue supporting the teeth.

Why This Matters for Your Baby

Here’s where it gets serious.

A growing body of research has examined the relationship between maternal periodontal disease and adverse pregnancy outcomes. The evidence is compelling, though not yet definitive.

A 2020 meta-analysis of cohort studies found statistically significant values were obtained regarding the risk of preterm birth in pregnant women with periodontitis (RR = 1.67, 95% CI 1.17-2.38), and low birth weight (RR = 2.53, 95% CI 1.61-3.98). PubMed

Case-control studies have shown similar associations. One systematic review reported the estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 2.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. PubMed

A large population-based cohort study from Taiwan found that the advanced periodontal disease group had OR of 1.09 (95% CI 1.07–1.11) for preterm birth, Nature with increased severity correlating with higher risk.

What about treatment? A 2019 meta-analysis of 20 randomized controlled trials involving over 8,000 participants found that periodontal treatment during pregnancy was associated with significantly decreased risk of perinatal mortality (RR = 0.53, 95% CI 0.30-0.93) PubMed and reduced risks of preterm birth (RR = 0.78, 95% CI 0.62-0.98). PubMed Treatment also significantly increased birthweight PubMed by an average of 200 grams.

However, not all studies agree. Some meta-analyses have shown a non-significant reduction in preterm births PubMed with treatment. The heterogeneity in findings likely reflects great variety in the definitions of periodontal disease, type and extent of periodontal examination, inclusion criteria, sample selection, and other factors. PubMed Central

The proposed biological mechanism involves hematogenous pathways or the presence and intervention of inflammatory mediators PubMed Central—essentially, bacteria and inflammatory cytokines from infected gums may enter the bloodstream and trigger responses that affect the uterus.

The Bottom Line on Evidence

Is the causal link proven? No. But ACOG acknowledges that oral health disorders, such as periodontitis, are associated with many disease processes, ACOG and approximately 40% of pregnant women in the US have some form of periodontal disease. Preeclampsia Foundation

More importantly, the American Dental Association and the American College of Obstetricians and Gynecologists agree that emergency treatments, such as extractions, root canals or restorations can be safely performed during pregnancy and that delaying treatment may result in more complex problems. American Dental Association

The absence of definitive proof that treatment prevents preterm birth shouldn’t be confused with absence of benefit. Treating maternal periodontal disease improves maternal oral health—and may reduce transmission of cariogenic bacteria to infants.

The Myth That Keeps Women Away

So why do so many pregnant women skip the dentist?

Because somewhere along the way, they were told—or assumed—that dental care isn’t safe during pregnancy. That X-rays could harm the baby. That anesthesia is off-limits. That it’s better to just wait.

None of this is true.

Dental cleanings are safe throughout pregnancy—and especially important given what hormones are doing to your gums.

Dental X-rays are safe. According to the American College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus. American Pregnancy Association In fact, the ADA now states that radiographs are considered safe for the pregnant patient, at any stage during pregnancy; shielding (abdominal or thyroid) is no longer recommended. American Dental Association (Though if a patient prefers shielding for peace of mind, there’s no harm in offering it.)

Local anesthesia (lidocaine with or without epinephrine) is safe. ACOG confirms that prevention, diagnosis, and treatment of oral conditions, including dental X-rays and local anesthesia (lidocaine with or without epinephrine), are safe during pregnancy. California Dental Association

Necessary procedures—fillings, root canals, extractions—can and should be done during pregnancy if needed. Conditions that require immediate treatment, such as extractions, root canals, and restoration of untreated caries, may be managed at any time during pregnancy. California Dental Association

The second trimester is often the most comfortable time for dental work, but there’s no trimester when routine care is off-limits.

The Elephant in the Room: Medicaid and the Two-Tiered System

Here’s what we don’t talk about enough.

Everything I’ve written above assumes a pregnant woman can actually get dental care. For millions of women in America, she can’t.

Medicaid covered 1.5 million births in 2023—representing 41% of all U.S. births—and financed nearly half (47%) of births in rural areas. KFF In some states, like Louisiana, Medicaid covered nearly two in three (64% of) births. KFF

The numbers are even more striking when you look at race. Among Black and Hispanic mothers, 64.0% and 58.1% of deliveries, respectively, were covered by Medicaid in 2021. CDC

So when we tell pregnant women that dental care is safe and important, we need to ask: for whom is it actually accessible?

Here’s the ugly truth: Medicaid dental coverage for adults is not required by federal law, so each state decides whether to offer it. GoodRx As of late 2024, one state, Alabama, offered no adult dental benefits unless the enrollee was pregnant or postpartum. Seven states offered emergency-only coverage. HealthInsurance.org

But even in states that offer coverage, finding a dentist willing to accept Medicaid is another matter entirely.

For all dentists, the top barrier was reimbursement—more than nine out of ten dentists cited it as a very or extremely important factor American Dental Association for not participating in Medicaid. According to a study by the Department of Health and Human Services, states report that inadequate reimbursement is the most significant reason dentists do not accept Medicaid patients. Mchoralhealth

The result? The majority of dentists (67%) had zero Medicaid patients. Sage Journals

Let that sink in. Two-thirds of dentists see zero patients on Medicaid.

The data on dental visits during pregnancy tells the story. Medicaid-enrolled women in states with no dental coverage were less likely to visit dentists for cleaning during pregnancy (26.7%) compared with women in states with either limited dental coverage (36.6%) or extended dental coverage (44.9%). PubMed

Only about a quarter of Medicaid-enrolled pregnant women in states without dental coverage get their teeth cleaned during pregnancy. Meanwhile, we publish guidelines telling them it’s important.

This is not a knowledge gap. This is a justice gap.

A Moral Reckoning for Two Professions

I’m going to be direct here—to both my colleagues in obstetrics and our colleagues in dentistry.

To obstetricians: We cannot keep counseling patients about the importance of dental care while failing to acknowledge the systemic barriers that make that care inaccessible for nearly half of pregnant women. 80% of obstetricians did not use oral health screening questions in their prenatal visits, and 94% did not routinely refer all patients to a dentist. ACOG And even when we do refer, we’re often sending women on a frustrating quest to find a provider who will actually see them.

We need to know which dental providers in our communities accept Medicaid. We need to advocate for expanded dental coverage in our states. We need to stop pretending this is someone else’s problem.

To dentists: I understand that Medicaid reimbursement rates are often below the cost of providing care. I understand the administrative burdens. But two previously unreported barriers to participation in Medicaid emerged: dentists’ perception of social stigma from other dentists for participating in Medicaid, and the lack of specialists to whom Medicaid patients can be referred. PubMed Central

Social stigma. From other dentists. For treating low-income patients.

When we talk about professionalism and ethics in medicine and dentistry, this is where the rubber meets the road. We cannot celebrate the safety of dental care in pregnancy while maintaining a system where the women at highest risk for poor outcomes—disproportionately Black, Hispanic, rural, and low-income—have the least access to that care.

Black pregnant women are 27% more likely to experience severe pregnancy complications than white women. CareQuest Institute for Oral Health They’re also more likely to be on Medicaid. And they’re more likely to be turned away from dental offices.

This is a structural injustice. And both professions bear responsibility for it.

What Needs to Change

For patients: Know your rights. If you’re pregnant and on Medicaid, dental coverage varies by state—but it’s worth checking what’s available. Community health centers (FQHCs) are more likely to accept Medicaid and may be a resource. Dental schools often provide care at reduced costs.

For clinicians: Screen every pregnant patient for oral health needs. Know which dentists in your area accept Medicaid. Advocate for expanded coverage in your state. And if you’re a dentist who doesn’t see Medicaid patients—ask yourself why.

For policymakers: Medicaid is the largest single payer of maternity care in the U.S., covering more than 40% of U.S. births. ACOG Comprehensive dental benefits during pregnancy should not be optional. Reimbursement rates need to reflect the actual cost of providing care.

The Bottom Line

Your mouth is part of your body. Ignoring it—before or during pregnancy—doesn’t protect your baby. It may do the opposite.

If you’re planning to conceive, put the dentist on your preconception checklist. If you’re already pregnant, schedule that appointment now. Get the cleaning. Address any problems.

And if you can’t find a dentist who will see you—know that this is not your failure. It’s ours.

Your gums—and possibly your pregnancy—deserve better.

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Dental care isn’t just safe before and during pregnancy. It’s recommended. The question is whether we’re willing to make it accessible to everyone who needs it.