Pregnancy is one of those times where there must be extra attention placed on good dental hygiene for the sake of the expecting mother, but also for the dental development of the foetus. Many pregnant women will ask about future dental needs for their child but are not fully educated on proper care for themselves, despite a high level of concern. Many expectant parents are unsure about the exact timing they should begin dental hygiene practices for their children, along with the proper cleaning and toothbrushing techniques.
Historically, it has been said that for every pregnancy there is a loss of one tooth. Of course this is not the case but there are some factors that make pregnancy a time where the dental health can become worse over the period of the pregnancy.
There is a hormonal alteration in the pregnant individual, and most of the changes are caused by a hormone called oestrogen. There is also a bacteria found in the mouth called Prevotella intermedia. In pregnancy, there is an increase in the number of hormones and bacteria, which causes the amount of inflammation to increase. Inflammation will occur to a greater extent when there is more plaque and calculus on the teeth, so even slightly poor dental hygiene could result in lots of bleeding gums, or gum disease due to inflammation.
Gum disease in pregnant individuals is also linked with preterm, low birth-weight neonates (newborns).
Another concern is that pregnant women will feel quite nauseous and may frequently vomit. This will make looking after teeth much harder, and will contribute to dental erosion due to the presence of stomach acids coming into the mouth. The effects of vomiting on the teeth can be minimised by consuming dairy products, rinsing with a bicarbonate rinse (warm water, half tablespoon of salt, and a tablespoon of bicarbonate soda), or purchasing CPP-ACP from a dentist.
For more information on milk products and teeth, see the Dairy Australia fact sheet on dental health. Pregnant individuals may also have cravings for sugar-rich foods, which will cause an increased chance of dental decay, as sugar is one of the main reasons for getting decay and needing fillings. This will consequently lead to an increase in dental visits, expenditure, and possible loss of teeth due to tooth decay.
The development of teeth starts around 6 weeks after the embryo starts to form. There is a lot of research going on at the moment to determine if anything affects the foetus' development of the teeth and jaws prenatally.
During the early phase of tooth growth, damage can occur to the teeth and jaws due to things like malnutrition. These can have irreversible changes on the teeth and jaws.
Poor maternal nutrition can have the following effects on the foetus:
Evidence from underdeveloped countries with poor nutrition shows that a defect in enamel called enamel hypoplasia is common. People with enamel hypoplasia have a much greater chance of developing tooth decay on those areas; andPoor prenatal nutrition is associated with a higher risk of mothers having tooth decay, and consequently are also more likely to transmit decay-causing bacteria to their children through oral contact e.g. kissing and sharing cutlery.A woman planning on a pregnancy should see a dentist prior to becoming pregnant if at all possible, to complete all dental treatment required and to assess what level of risk she is at. Pregnancy is a critical time to focus on preventing dental problems. Emphasis on the food pyramid, eating a well balanced diet, along with lots of calcium is of great importance. Sweets and low-nutrient foods should be minimised. It is important to concentrate on low fat, and low sugar snacks if at all possible i.e. celery sticks, carrot sticks, milk, cheese, other milk products as these will minimize the risk of dental decay.Reducing those bacteria that cause tooth decay via mouthwashes containing chlorhexidine gluconate has been shown to reduce both the transfer of decay-causing bacteria to their children and also tooth decay in the children.
Kindly written by Dr Akhil Chandra BDSc. (Hons UWA)
Dentist, Whitfords Dental Centre and Editorial Advisory Board Member of the Virtual Dental Centre
?For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see?Pregnancy.
For more information on nutrition, including information on?types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.?Fitzsimons D, Dwyer JT, Palmer C, Boyd LD. Nutrition and oral health guidelines for pregnant women, infants, and children. J Am Diet Assoc. 1998 Feb;98(2):182-6.Tsamtsouris A, Stack A, Padamsee M. Dental education of expectant parents. J Pedod. 1986 Summer;10(4):309-22.Newman M, Takei H, Klokkevold P. Carranza's Clinical Periodontology. 10th ed. Carranza F, editor. St Louis: Saunders, Elsevier; 2006.Chiodo GT, Rosenstein DI. Dental treatment during pregnancy: a preventive approach. J Am Dent Assoc. 1985 Mar;110(3):365-8.Ferris GM. Alteration in female sex hormones: their effect on oral tissues and dental treatment. Compendium. 1993 Dec;14(12):1558-64, 66; quiz 71.Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol. 1996 Oct;67(10 Suppl):1103-13.Tinanoff N. Association of diet with dental caries in preschool children. Dent Clin North Am. 2005 Oct;49(4):725-37.Tinanoff N, Palmer CA. Dietary determinants of dental caries and dietary recommendations for preschool children. J Public Health Dent. 2000 Summer;60(3):197-206; discussion 7-9.Proffit W. Contemporary Orthodontics. 3rd ed. St Louis: Mosby, Inc; 2000.Davies GN. A comparative epidemiological study of the diet and dental caries in three isolated communities. Ala Dent Rev 1958;4:19-28.Johnsen D, Krejci C, Hack M, et al. Distribution of enamel defects and the association with respiratory distress in very low birth weight infants. J Dent Res 1984;63:59-64.Kohler B, Bratthall D. Intrafamilial levels of Streptococcus mutans and some aspects of the bacterial transmission. Scand J Dent Res 1978;86:35-42.Kohler B, Andreen I, Jonsson B. The effect of caries-preventive measures in mothers on dental caries and the oral presence of the bacteria Streptococcus mutans and lactobacilli in their children. Arch Oral Biol. 1984;29(11):879-83.Leverett DH, Adair SM, Vaughan BW, Proskin HM, Moss ME. Randomized clinical trial of the effect of prenatal fluoride supplements in preventing dental caries. Caries Res. 1997;31(3):174-9.
A regular exercise regime is essential for a healthy and happy lifestyle. Physical activity helps maintain a healthy weight range, improves body strength and fitness, and has positive psychological effects. People who exercise regularly generally live happier lives and are less stressed than those who do not. Often described as the cheaper non-pharmacotherapeutic treatment alternative, or "exercise therapy", the benefits of exercise are widespread throughout the body system.
The terms "Merry Christmas Coronary" and "Happy New Year Heart Attack" were coined after analysis found that there is a significant raise in cardiac events that has been observed during the festive season. Doctors have suggested that the accumulation of stress and overindulgence during the festive season is responsible for this incidence.
Still not motivated to engage in physical activity during the holiday period? It is not unusual to come to the end of the year and believe you need a well deserved break from all the hard work you have been doing all year, and this is understandable. But who says that you need to wake up at 6am and do weights at the gym? During the festive season it is wise to change our exercise goals. Not only will this help you to keep motivated but will expose different muscles to a work out. 
?For more information on fitness and exercise, including stretches, types of exercise, exercise recovery and exercise with health conditions, as well as some useful videos, see Fitness.
Whilst pregnant, women are at an increased risk of infection with the food-borne bacteria Listeria monocytogenes, found in raw meat and soft cheeses. This infection causes upper respiratory tract symptoms, septicaemia (blood infection) and encephalitis (inflammation in the brain) in infected individuals. Although it is relatively uncommon, infection of pregnant women with L. monocytogenes is of particular concern as it can cause miscarriage, stillbirth and premature birth and septicaemia (whole body infection) and pneumonia in newborn babies. Up to 50% of newborns with listeriosis who do not receive treatment die. The infection can also adversely affect a pregnant woman's health and may sometimes be fatal for pregnant women.
Salmonellosis is an infectious disease caused by the bacteria Salmonella. It is found in raw animal products (including eggs) and some plant foods (in particular sprouts). It causes nausea, vomiting, abdominal cramps, diarrhoea, fever and headache. While pregnant women are no more likely than those in the general population to experience salmonella infection, it has been linked to miscarriage, and therefore the consequences of infection are more serious for pregnant women. 
Pregnant women and women who are attempting to conceive should also take additional hygiene precautions when preparing food to reduce the risk of infection. These include:
Chilled ready-to-eat foods including; Cold cooked chicken;Processed meats;Prepared salads;Ready-cooked take-away foods;Leftovers which are more than 24 hours old or which have not been refrigerated <5°C; andAll types of sprouts including alfalfa, broccoli, onion, sunflower, clover, radish and snow pea sprouts and mung and soy beans.
To avoid mercury toxicity, pregnant women should limit their consumption of fish, as all types of fish contain traces of mercury. Specific types of fish which usually contain high levels of mercury should be avoided or eaten only in small quantities. While Australian fish have relatively low levels of mercury, it is still recommended that women restrict their intake whilst pregnant. The NSW Food Authority recommends that women eat no more than: 
It is recommended that pregnant women limit their daily intake of caffeine to 200mg per day which is equivalent to:
Consuming excessive caffeine during pregnancy is associated with a range of adverse health outcomes for the woman and her foetus.
The extent to which a woman bonds with her foetus during pregnancy is an important determinant of the extent to which she bonds with her newborn baby after childbirth. Women who bond more during pregnancy, also develop a greater bond with their baby during infancy.
Women from ethnic minorities are more likely than Caucasian women to have low socioeconomic and health status and thus it would be expected that they would also experience lower levels of prenatal attachment. However scientists have not yet produced strong evidence to determine whether or not race or ethnicity is associated with greater or lesser maternal-foetal bonding.
As a woman's pregnancy progresses, she becomes more aware of her foetus, and the foetus starts to grow and move. It would therefore be expected that a woman would become more attached to her foetus as her pregnancy progresses and her awareness of the foetus increased. 
Ultrasound technology enables women to view their foetus growing in their womb. It has been argued that ultrasound is likely to allow a woman to bond with the foetus earlier in the pregnancy than she otherwise would (e.g. women may otherwise only begin to feel attachment once they feel the foetus moving).
Bonding with a foetus during pregnancy enhances the bond between the woman and baby after childbirth and has ongoing positive implications for the child's development. Thus increasing the extent to which women bond with their foetuses would be expected to improve child development outcomes. 
For more information on various aspects of parenting, see Parenting.Alhusen, J.L. A literature update on maternal-fetal attachment. J Obstet Gyneacol Neonate Nurs. 2008;37:315-28.Cranley, M. Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 1981;30:281-4.Muller, M.E. Development of the prenatal attachment scale. West J Nurs Res. 1993;15(2):199-215.Yarcheski, A. Mahon, N. Yarcheski, T. et al. A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Studies. 2009;46:708-15.Canella, B.L. Maternal-fetal attachment: an integrative review. J Adv Nurs. 2005;50(1):60-8.Armstrong, D. Emotional distress and prenatal attachment in pregnancy after perinatal loss. J Nurs Scholarship. 2004;34(4):339-45.Tsartsara, E. Johnson, M.P. The impact of miscarriage on women's pregnancy specific anxiety and feelings of prenatal maternal-fetal attachment score during the course of a subsequent pregnancy: an exploratory follow-up study. J psychosom Obstet Gynaecol. 2006;27(3):173-82.Hedrick, J. The lived experience of pregnancy while carrying a child with a known, nonlethal congenital abnormality. J Obstet Gynecol Neonatal Nurs. 2005;34(6):732-40.Hjelmstedt, A. Widstrom, A. Collins, A. Psychological correlates of prenatal attachment in women who conceived after in vitro fertilization and women who conceived naturally. Birth. 2006;33(4):303-10.Damato, E.G. Predictors of prenatal attachment in mothers of twins. J Obstet Gynecol Neonatal Nurs. 2004;33(4):436-45.Freeman, A. The influences of ultrasound stimulates paternal fetal bonding and gender identification. J Doiagnost Med Sonog. 2000;16(6):237-41.Lawson, K.L. Turriff-Janasson, S.I. Maternal serum screening and psychosocial attachment to pregnancy. J Psychosomat Res. 2006;60:371-8.Nelson, L.J. Fazio, A.F. Emotional content of talk to the fetus and coping behaviours during pregnancy. J Infant Mental Health. 1995;16(3):179-91
The World Health Organisation recommends that women delay conception (getting pregnant) for at least two years after they give birth. Delaying a second pregnancy for at least two years after childbirth is known as birth spacing. It has important health benefits, both for pregnant women and the babies they bear. It provides time for the woman's body to recuperate from the additional demands of pregnancy and childbirth. Scientists have found this also benefits the health of her growing foetus during subsequent pregnancy and the newborn baby after childbirth.
Lactational amenorrhoea is a contraceptive method which capitalises on the natural contraceptive effect of lactation (breastfeeding). While a woman is lactating (producing breast milk), the levels of a hormone in her body, called prolactin, increase significantly. This rise in prolactin suppresses ovulation (the release of an egg from the ovaries) and in doing so prevents pregnancy. Women who breastfeed exclusively (feed their infant only breast milk and do not substitute with other foods) do not usually ovulate for at least 6 months after childbirth and 94% of women who continue breastfeeding for 12 months after childbirth, do not return to ovulation (and are therefore protected from pregnancy) in this time.
Copper bearing intrauterine devices are contraceptive devices which are inserted into the uterus by a health professional. They provide long term contraceptive protection, because while an IUD is in place, the uterus undergoes changes in response to the presence of a foreign body (i.e. the IUD). The changes in the uterus make it more difficult for sperm and eggs to survive and fertilise each other, or to implant into the lining of the uterus and form a pregnancy if fertilisation occurs. IUDs are safe for use in the postpartum period and during lactation. Studies have shown that copper IUDs do not affect breast milk production or increase the concentration of copper in the breast milk. An IUD can be inserted as soon as 10 minutes after childbirth.
Barrier methods are methods which work by creating a barrier that prevents the sperm and egg meeting following ejaculation. They are methods which are applied just before sexual intercourse and therefore only need to be used at times when the woman is sexually active. Effectiveness varies depending on the method, with male and female condoms being the most effective barrier methods and cervical caps being the least effective.
For more information on different types of contraception, male and female anatomy and?related health issues, see?Contraception.
All exercise should begin with a warm up and cool down period. The hormones produced during pregnancy make women especially flexible in preparation for childbirth but this can lead to excessive stretching and pulling which can cause injury. Stretching should be done very gently, especially after the first trimester.
Studies to date on light to moderate resistance training using free weights and weight machines during pregnancy have found no adverse findings in patients that regularly engaged in the activity before pregnancy. Women who have never engaged in weight training prior to their pregnancy should not begin once they have conceived.
Heavy weight training lifts that involve maximal isometric muscle contractions are thought to put too much stress on the cardiovascular and musculoskeletal system;Holding your breath during difficult positions during yoga or while weight training. If you are ever not breathing during any exercise this is a clear indication you are over-exerting yourself and you need to stop immediately;Exercises lying on your back after the first trimester of pregnancy should be avoided to reduce the risk of affecting blood flow to the foetus and hypotension from vena cava?compression by the uterus;Exercises which involve lying on the stomach;Some abdominal strengthening exercises will be very uncomfortable due to muscle weakness and the development of abdominal seperation, a?condition where?called diastasis recti.?This occurs as a result of the growing uterus;Standing still for long periods of time is not recommended;Contact sports and high-impact sports such as ice hockey, soccer and basketball can risk abdominal trauma, excessive joint stress and falls;Scuba diving should be avoided as the pressure can result in birth defects and foetal decompression sickness;Any activities that increase the risk of falls should be avoided in order to reduce the risk of injury to you and your foetus. This includes sports such as gymnastics, horseback riding and water skiing;Any activities which require changes to the centre of gravity should be avoided as this can cause balance problems. This includes vigorous racquet sports such as squash and tennis;Any sports at altitude may induce altitude sickness which in turn can reduce the oxygen supply to the foetus. This does not appear to be the case for moderate intensity exercise at altitudes anywhere up to 2,500m but if you want to exercise at altitudes above this upper limit you should be guided through appropriate acclimatisation and make modifications to you activities as guided by your doctor. If you experience symptoms of altitude sickness including excessive shortness of breath, chest pain and light-headedness and weakness, you must stop exercising immediately and seek medical aid.
?For more information about pregnancy and exercise, including pre-pregnancy exercise, suitable types of exercise, risks and benefits of exercise and exercise myths, see Pregnancy and Exercise.