The Pregnancy & First Year Oral Health Guide

Claim your free NHS dental care

This is the single most valuable thing in this guide, and it is the one most people miss.

NHS dental treatment is free throughout pregnancy and for twelve months after your baby is born, in all four UK nations. It covers all NHS dental treatment, not just work related to your pregnancy. Check-ups, fillings, extractions, hygienist appointments under the NHS: all of it.

It is not automatic. You need a Maternity Exemption Certificate, usually shortened to MatEx.

What to expect

• If your healthcare professional applies online and you give an email address, the digital certificate usually arrives very quickly.
• A paper certificate applied for on form FW8 typically arrives within about ten working days.
• The certificate runs until twelve months after your due date. If your baby arrives later than expected, contact NHSBSA with a copy of the birth certificate and they will extend it.
• It does not cover private or cosmetic treatment. NHS treatment only.
• If you have already paid for NHS dental treatment while entitled, you can usually claim a refund, but there is a three month deadline from the date you paid.

One warning worth taking seriously: do not claim free treatment before your certificate has been issued. Claiming an exemption you cannot evidence can result in a penalty charge. Keep your receipt and reclaim instead.

Which treatments are fine now, and which can wait

The most common mistake is postponing something that is already a problem.

There is a widespread belief that you should avoid the dentist entirely while pregnant. That belief causes more harm than it prevents. An untreated problem does not pause for nine months; it gets larger, and treating it later is usually more involved.

Go ahead with

• Routine examinations and hygienist appointments, at any stage.
• Fillings and extractions where they are needed. Local anaesthetic is used routinely in pregnancy.
• Treatment of anything actively causing you trouble. Do not wait it out.

Discuss with your dentist

• X-rays. These are generally avoided in pregnancy unless they are needed to diagnose something, in which case modern doses are very low and shielding is used. Your dentist will weigh it up with you.
• Longer or more complex appointments. The second trimester is often the most comfortable window, since early sickness has usually settled and lying back for a while is easier than it becomes later on.

Leave until after

• Tooth whitening and elective cosmetic work. There is no urgency, so there is no reason to have the conversation now.

Morning sickness and your enamel

Brushing immediately afterwards is the instinct, and it is the wrong one.

Stomach acid is considerably more acidic than anything you eat or drink. When it reaches your teeth it temporarily softens the surface layer of enamel. That softening is reversible: saliva re-hardens the surface over the following hour or so.

Brushing during that window does not clean the softened surface. It removes it. Repeated over weeks of frequent sickness, that is how early pregnancy leaves permanent wear on the back of the upper front teeth.

• Sugar-free chewing gum afterwards encourages saliva flow, which is what does the repair work.
• If sickness is frequent, brush before you are likely to be sick rather than after.
• The same rule applies to reflux later in pregnancy, which is the same problem arriving at night.

Bleeding gums are a reason to brush more, not less

Common, expected, and made worse by the obvious response.

Pregnancy hormones increase how strongly your gums react to the plaque that is there anyway. The result is gums that look redder, feel puffier and bleed when you brush. It commonly starts in the second month and is often at its most noticeable around the eighth.

Bleeding feels like damage, so the instinctive response is to brush that area more gently or skip it. That leaves more plaque behind, which increases the inflammation, which increases the bleeding. It is a loop, and the way out of it is through.

What actually helps

• Brush twice a day, for two minutes, including the areas that bleed.
• Clean between the teeth daily, with floss or interdental brushes. This is where most of the inflammation lives.
• Expect it to improve over one to two weeks of consistent cleaning, not overnight.
• Mention it at your check-up. A hygienist appointment is free for you right now.

You may also notice a small lump appear on the gum between two teeth. This is usually a pregnancy epulis, a benign overgrowth that typically settles after the birth. It is worth having looked at so that someone can confirm what it is, but it is rarely anything sinister.

Research into whether gum inflammation during pregnancy affects birth outcomes is ongoing and the evidence is not settled. We are not going to tell you it is proven. What we will say is that there is no version of this where healthier gums is the worse option.

Cravings, reflux, and the pattern that does the damage

How often matters more than how much.

Every time you eat or drink something sugary or acidic, the environment in your mouth turns acidic and stays that way for a while afterwards while saliva brings it back to normal. Your teeth are fine with that happening a few times a day. They are not fine with it happening continuously.

Which means a whole dessert eaten in one sitting is gentler on your teeth than the same amount of sugar grazed across an afternoon. If pregnancy has you eating little and often, and it often does, the frequency is the thing to manage rather than the quantity.

Practical version

• Group snacks with meals where you can, rather than spreading them out.
• Plain water and milk are the two drinks that do not start the clock. Everything else does.
• Fruit squash, fizzy drinks, fruit teas and flavoured sparkling water are all acidic, including the sugar-free ones.
• If you are sipping something acidic slowly over an hour, that is one long acid exposure rather than one short one.
• Reflux at night is worth mentioning to your midwife or GP, both for your comfort and for your teeth.

Before the first tooth

There is one habit worth forming now, and one worth never starting.

Babies are not born with the bacteria that cause tooth decay. Those bacteria are transmitted, most often from a parent or primary carer, through shared saliva. Which is why the following matters more than it sounds like it should.

This is also a practical argument for looking after your own mouth during pregnancy, and for using that free NHS treatment. Your oral health and your baby’s are more connected than they appear.

Gums, before there is anything to brush

• You do not have to do anything to bare gums, and nothing bad happens if you do not.
• That said, wiping them with a clean damp cloth after the last feed of the day gets both of you used to the routine before it actually matters.
• Babies who are used to something going in their mouth at bedtime tend to accept a toothbrush with less resistance later.

The first tooth: when, in what order, and what is normal

The range of normal is much wider than the average suggests.

On average, the first tooth appears between six and twelve months. Anything from around three months to fifteen months falls within normal. A late first tooth is almost always just a late first tooth.

They usually arrive in a fairly predictable order, in pairs, working outwards from the front. The full set of twenty is typically complete somewhere between two and a half and three years.

What you might notice as a tooth comes through

• More drooling than usual, and chewing on everything within reach.
• One flushed cheek.
• Being generally unsettled, and disrupted sleep for a few days around each tooth.
• Gums that look swollen just before a tooth breaks through.

Brushing: when to start and how much toothpaste

Start the day the first tooth appears, not once there are a few of them.

NHS guidance is to begin brushing as soon as the first tooth comes through, twice a day: last thing at night and on one other occasion. The night-time brush is the one that matters most, because saliva flow drops during sleep.

How much

• Under three years: a smear, roughly the size of a grain of rice.
• Three to six years: a pea-sized amount.
• NHS guidance is to use a toothpaste containing at least 1,000 parts per million fluoride. Some parents prefer fluoride-free alternatives, such as hydroxyapatite-based toothpastes. Both approaches have advocates, and it is a reasonable conversation to have with your own dentist rather than a decision to make from a leaflet.
• Spit out afterwards, do not rinse. Rinsing washes away the part that is still working.

Technique, such as it is

• A small brush head with soft bristles. Any brand.
• You do the brushing, not them. Children generally do not have the dexterity to do it properly until around seven, and even then it is worth supervising.
• Sit them on your lap facing away from you, with their head resting back against your chest. You can see what you are doing and they are more settled than they are face on.
• Some days it will be a fight and you will get ten seconds. Ten seconds twice a day beats two minutes on the days it goes well and nothing on the days it does not.

Night feeds and new teeth

Not a reason to stop night feeding. A reason to change one small thing.

Once teeth are through, the concern with overnight feeding is that milk sits around the teeth for hours while saliva flow is at its lowest. Saliva is what neutralises and repairs, and during sleep there is very little of it.

To be clear, this is not an argument for night weaning, and it is not a reason to feel guilty about feeding your baby in the night. It is an argument for one adjustment.

• Where you can, make brushing the last thing that happens before sleep rather than the last feed.
• If that is not realistic, and often it is not, wipe the teeth with a clean cloth after the last feed.
• Never put juice, squash or sweetened milk in a bottle in the cot. This is the one hard rule.
• Introduce a free-flow open cup from around six months, and aim to be away from bottles by about twelve months.
• Sipping from a bottle throughout the day is the daytime version of the same problem.

The first dental visit

Earlier than most people think, and much less eventful.

Take your baby to the dentist as soon as their first tooth appears, or by their first birthday, whichever comes first. NHS dental care is free for children.

Parents often delay because they assume there is nothing to do yet, or because they expect it to be traumatic. Neither is true. A first visit is usually about five minutes: a look in the mouth, a lift-the-lip check, a conversation with you about brushing and feeding, and the beginning of your child being comfortable in a dental chair.

The point is familiarity. A child whose first six visits involve nothing more than sitting in a chair and being counted is a child who is not frightened if they ever do need something done.