Dental Care in Pregnancy

Today’s episode is a must listen, as Dr. Sarah Lea interviews dentists Dr. Brin MacMillan and Dr. Sabrina Ma, co-owners of South Island Dental, on the do's and don'ts of dental work in pregnancy. They discuss if and when to get dental care in pregnancy, which procedures patients might want to avoid, how the changes brought on by pregnancy may affect dental health, and share some facts about radiation, nutrition, and how hormonal changes affect both the pregnant person and newborn, from an oral health and development perspective.

Resources:

• MI Paste

Feedback:

Please take a moment to fill out this very short anonymous survey (>1 minute). We want to optimize Pregnancy for Professionals to suit your needs, so any feedback is very valuable and much appreciated!

Transcript

[00:00:50] Dr. Sarah Lea: All right. Brin and Sabrina, welcome to the podcast!

[00:00:53] Dr. Brin MacMillan: Thank you so much for having us. This is awesome.

[00:00:56] Dr. Sarah Lea: Oh my God, it's so awesome and it's about time. It's been a long time in [00:01:00] the making of scheduling, rescheduling. So I just wanted to start by saying thank you for joining us. And then maybe ask you to briefly introduce yourselves and tell our listeners a little bit about who you are and what we're gonna talk about today.

[00:01:14] Dr. Brin MacMillan: Beautiful.

[00:01:15] Dr. Sabrina Ma: So my name is Dr. Sabrina Ma. I'm a dentist in Victoria, and we, my husband and I, we own a practice together in Langford. Yeah, on South Island Dental.

[00:01:27] Dr. Brin MacMillan: I'm Dr. MacMillan, just like Sabrina said we met in dental school, which is the cute little thing. Moved from Windsor, Ontario to Victoria, British Columbia, and I was born and raised in Victoria, BC. This was a great spot for us to set up.

[00:01:39] Dr. Sarah Lea: Oh yeah. That's funny. I'm, I met my husband in residency who's also a physician. And he's the one who's from here and I'm from the east coast, so very similar.

[00:01:47] Dr. Sabrina Ma: It's funny how that works out.

[00:01:51] Dr. Sarah Lea: Okay, so we're talking about dental care in pregnancy and we have had so many questions.

[00:01:57] Dr. Brin MacMillan: Yeah. Which is awesome. This is great.

[00:01:59] Dr. Sarah Lea: Yeah.[00:02:00] So I thought we could just start by you guys diving in and do you mind sharing a little bit about what changes that you might see from a dentist perspective in pregnant people?

[00:02:10] Dr. Sabrina Ma: So pregnancy gingivitis is a very common thing that happens. So basically it's the peak of your pregnancy hormones. So estrogen, progesterone -pregnancy gingivitis typically peaks at month eight. So that's when you can start to develop very swollen gums, very sensitive. Even when you just touch it, brush it, floss it, you are just exhibiting a lot of bleeding. So that's probably the number one thing.

[00:02:36] Dr. Brin MacMillan: Yeah. With the progesterone and estrogen, you get the increased vascularity Yes. In the gums. And that actually also correlates with your periodontal ligaments. So we got millions of muscle ligaments that hold your teeth to the bone, and if they get inflamed, then your teeth tend to feel pretty loose. It also feels a little unstable. And with that being said [00:03:00] Essentially,

[00:03:01] Dr. Sabrina Ma: so yes, that it can cause a little bit of like tooth mobility. So we had a couple questions about that. People's tooth, teeth feeling a little bit loose in their mouth, so that is a thing.

[00:03:11] Dr. Sarah Lea: I have no idea that was a thing.

[00:03:13] Dr. Sabrina Ma: Yeah. Especially if you're a clincher and grinder as well, you're putting more forces on your teeth. Okay. Or if you have what we call diastema, like little spaces in between your teeth, right? So your teeth aren't really locked into place.

[00:03:24] Dr. Brin MacMillan: Yeah. There's no stability on either side of your teeth, so your teeth just feel loose.

[00:03:28] With that being said, the when people are clenching and grinding, I'm sure a lot of people have heard of night guards. The downfall with a night guard is it's a big chunk of something in your mouth. And unfortunately when you're pregnant, especially in the first trimester, I'm sure with morning sickness, it's not the greatest thing to happen.

[00:03:43] Dr. Sabrina Ma: Yeah. Your gag reflex just gets increased. Yeah. Yeah. So it's like a mixed...

[00:03:48] Dr. Brin MacMillan: Yeah. It's a tough, it's a toughy one. Yeah. But at the end of the day, I guess take a big deep breath and just realize it's gonna happen. Yeah. The big thing to be on top of is to be on top of your oral hygiene, obviously at home. Mm-hmm. The big [00:04:00] myth is, a lot of the times we think, Hey if you're pregnant, do you go to the dental office?

[00:04:03] Dr. Sarah Lea: Yes.

[00:04:04] Dr. Brin MacMillan: I definitely say you should a hundred percent.

[00:04:07] Dr. Sabrina Ma: Like your oral health is a big component of your overall health and you wanna be the healthiest version of yourself for your baby. So there's a lot of consequences if you do have poor oral health and it can be passed on to your baby.

[00:04:23] Dr. Brin MacMillan: Or it could actually lead to you having some issues during pregnancy. During pregnancy or after pregnancy. Yeah. So yeah, so the big thing is be on top of your oral health. This actually stems a little bit before you're pregnant if you know you're trying. It's probably a really good idea to be on top of your overall health, and that includes going to see your dentist. Getting regular checkups. The moment that you are pregnant you try to want to, you really wanna stay away from x-rays as best you can.

[00:04:47] Dr. Sarah Lea: Okay. That was a question we had. Yeah.

[00:04:48] Dr. Brin MacMillan: Yeah. That was a question we had. And with that being said, it's nice if you are trying, and you aren't pregnant yet to come in for a routine checkup and get your x-rays so that you know in advance and be [00:05:00] proactive rather than reactive.

[00:05:01] Dr. Sabrina Ma: Because most cavities that we see are typically, they form in between, sorry, they form in between your teeth. Cause I'd say most people are really good at brushing, but most people aren't very good at flossing. So that's where a lot of interlock, small in between your teeth, those cavities develop and we diagnose those at an early stage with x-rays.

[00:05:20] Dr. Sarah Lea: Oh, okay. I was gonna ask, so with the X-rays, you're looking for cavities as well as, infections, abscesses.

[00:05:28] Dr. Brin MacMillan: Yep. Bone loss. Most of the time though, that would, you'd hope that someone would come in because when you have an infection or an abscess, you're in pain. You'd like to react to that.

[00:05:37] Dr. Sabrina Ma: But sometimes you can have an infection and you're not in pain. So some, it's still good to have your checkups with your x-rays beforehand.

[00:05:45] Dr. Sarah Lea: Okay. And my understanding is though, and this is a question we often get is, ' what, if I had an answer and I didn't know I was pregnant?' For those early pregnant people. Yes. Now you put lead on folks, right? Yes. When you...

[00:05:56] Dr. Brin MacMillan: Absolutely. Absolutely. Yeah. So it is a college guideline by our college that you [00:06:00] must have lead aprons as well as a thyroid collar. The thyroid collar is actually the key component. Obviously if you're unknown, it's usually the first trimester. And unfortunately that is when the major development of the baby is happening. And big component is thyroid hormones are hu huge when it comes to brain and nervous system development. And so you really need that thyroid collar to protect your thyroid.

[00:06:25] Dr. Sabrina Ma: So there's a lot of lead aprons that have a built-in thyroid collar, but sometimes they can be like just a lead apron that they throw on and then they slap on the thyroid collar.

[00:06:34] Dr. Sarah Lea: Yeah.

[00:06:35] Dr. Sabrina Ma: So most of the time that is used, so take all those precautions anyways, so it it should technically be fine. Yes. The only other thing is that for a new patient exam we typically take some intraoral x-rays where we'll use thy collar and lead apron, the normal lead apron. But we usually take a panoramic x-ray as well. So that one has a pan cape lead apron. So it doesn't really have the thyroid [00:07:00] collar aspect, but that's because we need to see those structures down there as well. Oh, okay. So blocking part of the image. But typ, we don't take those x-rays very often, it's usually every five years. Patients can decline those, those are totally fine. Yeah.

[00:07:11] Dr. Brin MacMillan: So if you're thinking you might be expecting at one point, maybe just decline that panoramic X-ray.

[00:07:16] Dr. Sarah Lea: Yeah. Okay. Now, I dunno if you know this answer, but people are just always concerned with x-rays in general. Yeah. And so I tell folks like a chest x-ray for example is similar radiation flying from like here to Calgary, which is like a long flight. Don't worry. I had a chest x-ray in pregnancy, I had a lead apron on. He's sitting on the couch playing Nintendo Switch cuz he is sick. Very intelligent. Yeah, exactly. Do you know the similar sort of like the radiation that...

[00:07:45] Dr. Brin MacMillan: It's we actually do. So for the panoramic one, it's very similar to the chest x-ray that you were talking about. Yes. For the intraoral images, it is extremely less than that. Oh. Yeah so it's not something we worry about now. It's so localized here. So when I said X-rays, we try to stay away [00:08:00] from that is a key component, but at the end of the day, if you have an emergency and emergencies can arise for whatever reason. An x-ray is something that you should do. Yeah. In order to diagnose a problem. Yeah. And figure out how we can solve it. Yeah. And I think so, yeah.

[00:08:16] Dr. Sarah Lea: Sorry. No, I was gonna say it's so important to understand like the context, right? Like it's not like you're getting like a jolt, full body dose of, oh gosh no, radiation.

[00:08:24] Dr. Brin MacMillan: Yeah. Yeah. And it's when you are protected with a lead apron and thyroid collar it's at the head and neck region. It's very far away. Yes. So not something to be too panicked about. Yes.

[00:08:33] Dr. Sarah Lea: Yes. So...

[00:08:33] Dr. Sabrina Ma: Did you ever hear about that study, I think it was in California or something, about the amount of radiation that you can get from eating a banana? Did you ever -this is a thing. Yes! So anyways I just have this little chart in, in front of me and I don't wanna freak people out about eating bananas, cuz obviously there's a lot of good things about eating bananas. But for instance, I think a chest x-ray is about like 50 microsievert something around here. Okay. And then a single dental x-ray is [00:09:00] 0.2. Oh my gosh. It's so minimal and your shielded, so it's like nothing. Yeah. Yeah. But then also eating a single banana is 0.1. So you can get, so there's this huge part, if you look at the study, if you actually want to like compare taking a flight from point A to B is the equivalent of eating like a truckload of bananas or something. Oh my gosh.

[00:09:23] Dr. Sarah Lea: The things that people in science do. That's, yeah. Ok. So I'm gonna summarize what we've talked about so far. Yeah. So really important to try and get dental care, pre-pregnancy preconception. So just routine care. Brush your teeth, floss your teeth, visit your dentist. Changes that we see in pregnancy are increases in estrogen and progesterone, and they cause that inflammation in the gums. As well as some of that. And is that from the increased vascularity, like the - that's what?

[00:09:52] Dr. Brin MacMillan: Yeah, exactly. Exactly.

[00:09:54] Dr. Sarah Lea: And then it's that vascularity and inflammation that also causes swelling in the ligaments, which makes your [00:10:00] teeth feel loose, which is bananas to me. Yeah. And very scary. That did not happen to me in my pregnancies.

[00:10:05] Dr. Brin MacMillan: Yeah. And so the big important to, to add on that is the periodontal ligaments or the muscle ligaments that hold your teeth to the bone that get inflamed and cause 'em to be loose they're actually a protective barrier for your roots that are under the gums.

[00:10:17] When you hear about people saying, oh, my gums have receded, or they've dropped those roots are exposed and they create a lot more sensitivity to hot and cold. So when you get inflamed muscle ligaments like that, it actually creates a bigger space for water, cold water or ice cream to shoot down your teeth and cause cold sensitivity.

[00:10:33] Dr. Sarah Lea: I hate that.

[00:10:33] Dr. Brin MacMillan: So it's it's unfortunately, it's just, it's par for the course.

[00:10:37] Dr. Sabrina Ma: Yeah. Yeah. Okay. But should return back to normal.

[00:10:39] Dr. Brin MacMillan: Yes. With that increased vascularity, the big thing is anything that's got a lot of blood flow in an area is unfortunately ready to bleed. Yes. So stay away from hard bristle toothbrushes. Okay. We've learned that out of all electric toothbrushes, not say you should switch your electric toothbrush, which, cuz they cost money. But if you have a Sonicare, it is usually the softest, the gentles, yeah, the [00:11:00] gentles per se. If that's a word. And those are kind of things that we recommend.

[00:11:03] Dr. Sarah Lea: Okay. Okay. Because that was one of the questions, so now we understand why it happens. And then somebody was wondering about how to reduce the gum bleeding during pregnancy. So soft toothbrush.

[00:11:14] Dr. Brin MacMillan: Soft toothbrush and honestly keep up with regular cleanings. And that was also, the other thing is throughout your whole pregnancy, it's okay to have cleanings. Yeah. Yes.

[00:11:21] Dr. Sarah Lea: That was the question. And fluoride, yeah.

[00:11:23] Dr. Brin MacMillan: Yeah. And fluoride too. Yeah. The fluoride, obviously it's like anything, if you ingest too much of something, it's not good, so to a toxic level. So you don't wanna be swallowing fluoride. Now the big thing is too, is in the first trimester when you do have some morning sickness, fluoride's not a very fun thing. It makes you a little nauseous. I don't know if you've ever gotten nauseous of it before, but I have. We do have it in two different forms. One is to actually have a rinse where you swish around, downfall with the rinse is you do end up swallowing a bit of it. Even if you don't think you do. Yeah. It's not in a toxic level, so nothing to panic about at all. Yeah, okay. But but it is also something that could stimulate to maybe feel a little sick. Yeah. Okay. Um, So what we do [00:12:00] recommend is using more of the varnish. We use varnishes on kids. Okay. Because we don't want them swallowing it. So varnish is where you actually just painted on the teeth.

[00:12:08] Dr. Sarah Lea: Oh, yes. I've seen it.

[00:12:10] Dr. Brin MacMillan: Feels gross and dirty, but you know what, it's it's good for your teeth. Yeah.

[00:12:14] Dr. Sarah Lea: Okay. Okay. So fluoride is safe, maybe in the first trimester, or if you're having significant nausea throughout, then just ask for the varnish.

[00:12:24] Dr. Brin MacMillan: Or avoid, one of the two. Yeah. Yeah.

[00:12:26] Dr. Sarah Lea: Okay. No, that's great. And it's good, it's good to know. I know fluoride is, there's a lot of controversy. There's a lot of things. Yes. I know that I have great teeth cause I have fluoride in my water growing up. Exactly. Yeah. Where were you born and raised again?

[00:12:38] Prince Albert Island, Charlottetown. Oh, I, oh nice, okay. Yeah, yeah, Cavities, how do we manage cavities in pregnancy?

[00:12:46] Dr. Brin MacMillan: That's a tough question. Realistically speaking, if you keep up, your oral hygiene cavities usually are lower, not lower, they're, they should be the same as if you were not pregnant. Yeah. The only thing that we can state out there is unfortunately if you're not bringing [00:13:00] enough calcium, cuz your teeth are mineralized, they're harder than bone, the other enamel it is, that is if you're not bringing enough calcium, unfortunately the the baby or the fetus is actually gonna take it from you, which can prevent you from having enough minerals in your saliva, which then could correlate to getting more cavities per se. It's not very common, but -

[00:13:21] Dr. Sarah Lea: It's like a theoretical possibility. Very rare.

[00:13:24] Dr. Brin MacMillan: Yeah. So I wouldn't wanna say that you're more prone to cavities. Mm-hmm. You're definitely more prone to gingivitis or periodontal disease. Gingivitis is just a fancy word for saying inflammation to the gum, periodontitis inflammation to the bone.

[00:13:36] Dr. Sabrina Ma: And then with morning sickness, you're dropping the pH level in your mouth and that's typically the environment of how cavities are formed in general. So basically just, quickly how cavity is formed. Basically, you have something to eat. The leftover food in your mouth is eaten by the bacteria in your mouth, and the waste product of the bacteria is acidic. So that's what's eating your teeth. Ok. So if you have a very acidic [00:14:00] environment in your mouth, you're very prone to cavity. So if you have morning sickness so if you're trying to give advice to someone who has morning sickness after they vomit you, want to rinse with like a little solution with a cup of water and baking soda to help neutralize the acidity.

[00:14:17] Dr. Sarah Lea: Oh, that's so genius.

[00:14:19] Dr. Sabrina Ma: Yeah. And as you can do that and then wait at least 30 minutes before you brush. Because your teeth are in that softer, low pH state. So if you brush right away, that mechanical disruption will actually strip layers of your teeth away. Oh, so you wait 30 minutes for it to kind of, um Yeah. Yeah, neutralize the pH levels. Yeah. And then you can brush.

[00:14:40] Dr. Brin MacMillan: So if you're not around baking soda, just drink a lot of water.

[00:14:42] Dr. Sabrina Ma: Yeah. You don't always have that solution ready with you, but Yeah.

[00:14:47] Dr. Sarah Lea: It's good to know actually to not brush your teeth right away, especially even as a mom of kids who sometimes throw up.

[00:14:53] Dr. Sabrina Ma: Yes. So even, yeah, that does happen. But even not even relating to morning sickness. So even after eating, it's not[00:15:00] advised to brush right away. You still wanna wait at least 30 minutes

[00:15:03] Dr. Sarah Lea: To let your like, that environment go back to, yeah. Oh my God, I'm learning so much. And so if unfortunately someone does get a cavity or they get a cavity diagnosed in pregnancy, I would presume that you would recommend treating it the same way you would if the person was nonpregnant because pregnant people deserve care.

[00:15:22] Dr. Brin MacMillan: Absolutely. Yeah. I think it's very dependent on the severity though, because if it's in the first trimester and it's not something that's impeding their life and it's not gonna turn into an infection, yeah. Then you wanna postpone it. If you can postpone until after the birth, great. Yeah. There are certain times where you can, and second trimester is definitely the most important time, or the easiest time and the best time to be treated. Yeah. Yeah. Yeah. And then -

[00:15:44] Dr. Sabrina Ma: You can treat in third trimester, it's just a little bit more uncomfortable

[00:15:47] Dr. Brin MacMillan: and there's a small chance of inducing labor.

[00:15:51] Dr. Sarah Lea: Oh, with the treatment?

[00:15:52] Dr. Brin MacMillan: Yeah, with treatment if you're very close.

[00:15:55] Dr. Sarah Lea: Oh. And do you know the sort of path-

[00:15:57] Dr. Brin MacMillan: I don't know that at all.

[00:15:58] Dr. Sabrina Ma: Stress wise, [00:16:00] like with our local anesthetic, there's some of it does have epinephrine in it,

[00:16:04] Dr. Brin MacMillan: So I don't think that's gonna induce it though. I think its more the stress related. Yeah. Unfortunately, yeah, the dental office is not everyone's favorite place to be, which we all know.

[00:16:13] Dr. Sarah Lea: I love going, I love how my teeth feel post cleaning, but that's just me.

[00:16:18] Dr. Brin MacMillan: Yeah. I would say a good percentage love coming, and then there's the percentage that don't, and we get that. So yeah. But with that being said, going into that, I guess, per se, is uh, we do try to stay away from certain drugs and there are some drugs that are used commonly in dentistry for sedating or helping you feel comfortable.

[00:16:34] Dr. Sabrina Ma: Antibiotics.

[00:16:34] Dr. Brin MacMillan: Yeah. And any type of benzodiazepine I would say you try to stay away from. I know that it's safe in theory from your point of view. I bet, uh, normal, we do a loading dose. But yeah. In theory you wanna stay away from it.

[00:16:46] Dr. Sarah Lea: Yeah, that's fair. And you know, like, yeah, they're safe in moderation, but if you can avoid it, so my understanding is your recommendation is if you have a cavity and it's not, significantly impacting your day-to-day, you can yeah, [00:17:00] postpone treatment into the second trimester or even further, you know, beyond into postpartum if it's, a small minor cavity. But if it's causing discomfort or you've got an infection, it's important and appropriate to treat it.

[00:17:11] Dr. Brin MacMillan: Absolutely. And at that point it is appropriate to take an X-ray and go from there.

[00:17:16] Yeah. Yeah. And do you have safe, very safe local anesthetics in any dental office, for the most part, they should have multiple options of local anesthetics. There are certain ones that you wanna stay away from. Dunno if names matter, but articaine is one of them. Lidocaine is a most common local anesthetic.

[00:17:32] Dr. Sarah Lea: Yeah. I don't even know the first one that you just said, articaine?

[00:17:35] Dr. Brin MacMillan: Yeah, articaine it's a higher percentage and it's it's just used more for local infiltration. Yeah. But, but yeah, so lidocaine is super important. Very safe. Not across the board. If you are super concerned at all, in theory, the half-life of lidocaine is two hours. So sometimes if I do have a very concerned person, I do say, Hey, you know what, if you really wanna, for breastfeeding wise, that is after pregnancy. Yeah. If you're concerned you could [00:18:00] potentially pump and dump for 2 to 6 hours after procedure. Yeah. Yeah. On the safe side. But it's so minimal.

[00:18:06] So minimal. And they say that after one week of the baby being born, it should be fine.

[00:18:12] Dr. Sarah Lea: Oh yeah. Well here's the newsflash. We use local anesthetic when we're repairing the perineum while there you go. While the mom is actively breastfeeding. Yes. Ok.

[00:18:23] Dr. Brin MacMillan: There's a, all the time. And it's funny because in our world of dentistry, even nitrous oxide, laughing gas, yeah, is. airquote "unsafe," and you use it during the labor so, no. I mean, In theory you can avoid it while you're pregnant, but afterwards with breastfeeding, nitrous oxides great too. And that's a really good sedative very, it's right outta your system right away. It's usually the one that we recommend the most. Yeah.

[00:18:46] Dr. Sarah Lea: It's so interesting, hey, how there's this like risk perception because it's here and not- yeah. Cause that was one of our questions about local anesthetic while [00:19:00] breastfeeding and yeah.

[00:19:01] Dr. Brin MacMillan: No, no issues really overall. And just if you wanna be safe, you just pump and dump as long as you're able to bottle feed.

[00:19:08] Dr. Sarah Lea: Yeah. You alluded to at the beginning and I thought maybe we could just talk a bit more about the, like how dental care and dental hygiene relates to like general health as well as pregnancy health. Yes. And yeah, I wonder if you can just talk a bit more about that so people can understand, yeah, why

[00:19:26] Dr. Brin MacMillan: So there's a lot of studies that can, obviously there's certain things out there that can prove something exactly, but then there's other studies that show a correlation. Yeah. And when it comes to periodontal disease, which classified as gingivitis and periodontitis, which is bone loss it shows that actually there is a potential for low birth weight in your child. Also that there's also premature birth and even for the mother, preeclampsia as well. Yeah, which is interesting. So it is actually really important around this, with the premature birth step too, there's, the big one is [00:20:00] hypoplastic enamel. So the outer shell of your tooth, which is the hard part, it becomes really soft in the child when when they have their baby teeth. Baby teeth are super important. I know we think, oh, okay, we're gonna get our adult teeth and whatever their baby teeth, but they're actually really important for nutrition for your baby. They're also important too, to hold the space for when your adult teeth come through and you always hear people going, oh gosh, I don't wanna have to pay for braces, this, that, this is the most important way, is just be proactive. And that way you won't hopefully need braces.

[00:20:31] Dr. Sarah Lea: No. Fascinating. And as you're saying all this, I'm thinking like, if you've got, inflammation and infection that's causing a lot of, like immune reaction and cytokines, and that's probably like they're floating around in your blood. They're potentially crossing into the placenta. So I can see now that we're diving deeper. Yeah. Some of the, what we would say, like the pathophysiology behind it, which. Totally. Yeah. And you know what's really interesting? I can't, I have to, I always have to pull in a personal anecdote, but one of my kids [00:21:00] one of his baby teeth was very discolored. Okay. And our dentist, I think he's like, you probably had some kind of something probably happened at some stage in your pregnancy.

[00:21:07] Dr. Brin MacMillan: Yeah. There's, there was something, cuz we were reading into that a little bit. There's tooth discoloration due to increased bilirubin. Interesting. Any of that. But that's all we read and I didn't wanna dive further -

[00:21:17] Dr. Sarah Lea: Right? Yeah. But it could have been like some kind of minute because I think it had something to do with the enamel on that tooth.

[00:21:22] Dr. Brin MacMillan: Absolutely. Yeah, there's a lot of things actually.

[00:21:25] Dr. Sabrina Ma: Was it baby tooth or permanent tooth?

[00:21:26] Dr. Sarah Lea: Baby. Baby tooth.

[00:21:27] Dr. Brin MacMillan: Baby tooth. Yeah. Okay. Yeah, definitely. Yeah. The other few too is cuz like with the preterm births as well, when they're in NICU and they're on the side of their face, unfortunately they're lied on their side. Oh yeah. It actually causes them to get what you call a dolichofacial facial pattern, which is a elongated face. Um, which then can correlate with a narrow pallet. Oh. And then you're kinda diving into, you need to interrupt all of this at an early age before usually six years of age, before like expanders, expanders, and headgear and all that. So it does make a difference. [00:22:00] Yeah. Yeah. Not say that's always the case, but not to scare yet. Yeah.

[00:22:05] Dr. Sarah Lea: It's just important to be informed. That's the whole purpose of like why we are doing this work is to inform people and educate people so that they can advocate for themselves and their children. Yes.

[00:22:16] Dr. Brin MacMillan: And with that being said, too make sure to still take your vitamins and such, supplements like folic acid because there's a big correlation between folic acid and cleft palates.

[00:22:24] Dr. Sarah Lea: Yes. Yeah. Yeah. It's so interesting. Okay. So I've learned so much. So basically take care of your teeth during Yes, before and during pregnancy. Go for routine care, routine visits, x-rays if you can avoid them, especially in the first trimester. That's great, but if you need an x-ray because of concern around infection or inflammation, it's totally safe and appropriate.

[00:22:48] If you need any treatments, again, if they can be avoided, you can wait. But if you need a treatment, it's important and safe. And then we just talked a little bit about the changes and what were the consequences of infection or, [00:23:00] chronic inflammation can be in terms of the pregnancy. That is crazy. I didn't know any of this stuff.

[00:23:04] Dr. Brin MacMillan: Yeah. Yeah. It's really cool. Yeah.

[00:23:08] Dr. Sarah Lea: So anything else that we didn't talk about that you guys think we should cover?

[00:23:13] Dr. Sabrina Ma: When I made a whole bunch of notes here, lemme just, yeah.

[00:23:16] Dr. Brin MacMillan: Some random ones too is, these are really out there, per se, but if you are gonna come in for treatment second trimester, like we mentioned, is usually best. Big one too is ask to, or bring your own, but hopefully a dental office has it, but try to ask for a pillow and try to get a pillow on your right side.

[00:23:32] Dr. Sabrina Ma: Or even like a rolled up towel. Yeah, just.

[00:23:34] Dr. Brin MacMillan: Yeah, that was like the big one cuz supine hypertensive syndrome, right? Which is when you get too much pressure from the fetus on your inferior vena cava, yeah. It can relate to not syncope per shape per se, but, making you feel sweaty, not feel good. Yeah.

[00:23:50] Dr. Sarah Lea: Yeah.

[00:23:51] Dr. Sabrina Ma: And maybe another recommendation for people who are experiencing pregnancy gingivitis or want to prevent it from happening. Different types of [00:24:00] toothpaste that can maybe be, yes. Yeah. So if, if you're using a whitening toothpaste, I'd probably avoid it because usually whitening toothpaste don't actually have a whitening agent in it. It's just more abrasive.

[00:24:12] Dr. Sarah Lea: Oh, interesting.

[00:24:13] Dr. Sabrina Ma: Like kinda scratching off a layer of your tooth. So eventually your teeth probably won't look white anymore cause you don't, you're stripping your enamel. So in general we don't even, we don't really even suggest people to use whitening toothpaste. There's other ways to whiten your teeth, but also I would suggest using a toothpaste that doesn't have SLS in it, cuz that is a bit of an irritant. Ok. So one toothpaste we know for sure doesn't have it is Sensodyne Pronamel. That doesn't have SLS in it. There are a lot of patients or people that are sensitive to that too.

[00:24:43] Dr. Brin MacMillan: So I, we have no steak in on. No.

[00:24:50] Dr. Sarah Lea: Actually and that brings up another question. I dunno if we had it in that little question box I put up, but I've had people ask about, are teeth whitening treatment safe in pregnancy?

[00:24:59] Dr. Sabrina Ma: So we [00:25:00] wouldn't advise to get whitening at the time. Yeah.

[00:25:03] Dr. Brin MacMillan: And then, yeah I from what we gathered, it's really not the safest thing to be doing. So I would avoid that. Cosmetic work too, which is completely, it's so elective. Elective. Yeah. I would avoid at all costs if I was you.

[00:25:15] Dr. Sabrina Ma: With that being said, if there's patients who have like demineralized teeth, hypocalcified, and they have little like chalky, blotches on their teeth, then that can actually be remineralized in office or even at home just by switching their toothpaste to something called MI Paste. I dunno if you've heard of MI Paste before. Yeah. But it's basically a mineral toothpaste, so you can get it with fluoride or without fluoride. So if you get the patients that don't like fluoride or they don't believe it, or they try to avoid it, that's a really good alternative. Alternative and you can use it pregnant. In kids, they can accidentally swallow it. It's totally safe. MI paste MI so a lot of dentists might sell it?

[00:25:53] Dr. Brin MacMillan: Yeah it's we get it ordered in and then we sell it for no extra charge. We just sell it for the, yeah, I think

[00:25:58] Dr. Sabrina Ma: Amazon sells it, but I [00:26:00] think they upcharge by $15 or something. Yeah, they sell it for $35 or whatever.

[00:26:05] Dr. Sarah Lea: Oh, interesting. Anyway, that's the good stuff. Yeah. Yeah. And on the same line, I'm gonna guess I know the answer, but I see a lot of this is just me asking of curiosity. I see a lot of people with Invisalign lately. Yep. Would you want that during pregnancy with your teeth being loose? What would you say there?

[00:26:21] Dr. Brin MacMillan: That's a good question. We are both general dentists. We don't really do a lot of orthodontics per se. Yeah. From the theoretical side of it, it doesn't make sense.

[00:26:29] Dr. Sarah Lea: Yeah, that's what I was thinking. If your teeth are loose.

[00:26:31] Dr. Sabrina Ma: Yeah. So if you're in the middle of it and you're like, oh my gosh, I just got pregnant. Should I just continue with this? I'd probably just stick with the tray that you have right now and try not to move your teeth any further. Yeah. Because moving your teeth is an inflammatory process.

[00:26:44] Dr. Sarah Lea: Yeah, that's a good point. It's all so interesting you guys!

[00:26:48] Dr. Brin MacMillan: Yeah. The other big one too, also out there is unfortunately, with this whole inflammation of the gums, there is a chance that when if you irritate them too much, you can get something called a pyogenic granuloma.

[00:26:59] Dr. Sarah Lea: Oh [00:27:00] yeah. And those are common in pregnancy.

[00:27:01] Dr. Sabrina Ma: They're very common, common.

[00:27:02] Dr. Brin MacMillan: Unfortunately. Very common. And they look, without something better words, they look scary. Yeah. Yeah.

[00:27:08] Dr. Sabrina Ma: The nickname for it is pregnancy tumor, which sounds awful. Yeah.

[00:27:11] Dr. Sarah Lea: Yeah, it's these like red vascular,

[00:27:14] Dr. Brin MacMillan: Massive kinda thing. It's usually on your gums, purely on your gums. Sometimes it can get on the pallet. It looks awful. If you see something like this, go and see your dentist and hopefully get reassured. It's not something to be worried about. Yeah. What, there are studies out there showing that, you can have it excised off or removed but it's not actually a good thing to do while you're pregnant. And they, they usually resolve on their own most of the time, but if they don't after your pregnancy, you can get it removed. With that being said, because you're cutting it out, the irritation of cutting it out is actually gonna cause it to reoccur. Yeah. Yeah. Yeah. The big thing though out of this is if you feel like there's this big bump on your gums, to go your dentist and be reassured that it's not a big deal. Yeah. [00:28:00] Yeah. All these funny things that can happen, unfortunately.

[00:28:02] Dr. Sarah Lea: It's so interesting, hey? And it just shows you like how pregnancy is like a whole body - like it affects everything in your body. And also how your oral hygiene can affect your entire health because of like the, I like all your blood flows through your mouth.

[00:28:17] Dr. Brin MacMillan: Yes. Yeah. It's crazy. Yeah. Even like without being pregnant periodontitis and gingivitis in correlation with diabetes and heart disease. Heart disease, there's a lot.

[00:28:26] Dr. Sabrina Ma: So yeah. Dementia. Yeah. Yeah. Lots of -

[00:28:29] Dr. Sarah Lea: Oh, interesting. Amazing. I'm super stoked that we finally got together and had this conversation.

[00:28:35] Dr. Brin MacMillan: Yeah. Yeah. That was awesome.

[00:28:37] Dr. Sarah Lea: Yeah. We'll put together some show notes for folks. And then maybe I will get you to email me your clinic address or name or just whatever, and the MI Paste. Cause that's, yeah. Yeah. We're in BC we got a lot of people who don't like fluoride.

[00:28:52] Dr. Brin MacMillan: Yeah, I know, right?

[00:28:53] Dr. Sarah Lea: Having safe alternatives. Cause that's their choice. It's great. Yes. Amazing. Thanks so much for your time today guys. No worries. [00:29:00] Yeah, that was awesome. Yeah, it was really fun. Amazing. Thanks so much for you both.

[00:29:04] Dr. Brin MacMillan: Yeah. It was nice to meet you.

[00:29:05] Dr. Sarah Lea: It was fun. Have a great day. You too. Thank you. Bye-bye. Bye.