Pregnancy and dentist: free extra check-up and care per trimester

Pregnancy changes your body in ways you may not expect: your mouth changes too. At Tandarts West in Rotterdam West we see pregnant women weekly with the same questions. Can I still have regular dentistry? What about x-rays? And what are those red spots on my gums? In this article you'll find the answers, written by our dentists and based on the guidelines of the KNMT, NHG and the Dutch Healthcare Authority.

What changes to your teeth during pregnancy?

The hormonal fluctuations of your pregnancy don't only affect your skin and mood. Your gums respond too. Due to elevated progesterone and estrogen levels, your gums react much more strongly to dental plaque: an amount of bacteria that never gave you problems before pregnancy can now suddenly cause red, swollen and bleeding gums. This is called pregnancy gingivitis, and in more than half of women it develops sometime during the second trimester.

In addition, three other changes affect your teeth:

• Morning sickness and vomiting. Stomach acid erodes enamel. Many women brush immediately afterward and thereby damage softened enamel even more.
• Changed eating pattern. Small, frequent snacks (often sweet) give less rest to your teeth and increase cavity risk.
• Drier mouth in some women. Saliva protects teeth against acid. Less saliva means less protection.

The good news: all of this is temporary and preventable with adjusted oral hygiene. What is absolutely not true is the old saying "a child costs a tooth". A healthy mouth comes through pregnancy without damage, provided you pay good attention. More on this later.

Your mouth is an early sentinel of your pregnancy. What goes wrong here, you can fix before it becomes serious.

Free extra check-up via Dutch basisverzekering

Many pregnant women, especially expats new to the Dutch healthcare system, don't know they're entitled to extra dental care during pregnancy, covered via the basisverzekering. Here's how it works:

• The Dutch basisverzekering normally does not cover regular dental care for adults, only oral surgery and dentures.
• But: during pregnancy, health insurers recognise the mouth as an elevated-risk area. Many policies therefore cover an additional check-up and dental cleaning during these nine months, often without consequences for your eigen risico (deductible).
• NZa codes M01 (preventive education) and M40 (fluoride treatment) are applied more broadly for pregnant women.

What do you need to do to access this?

1. Call or email your insurer and ask whether pregnancy oral care is covered in your policy. Give them your due date.
2. Book an appointment at Tandarts West Rotterdam. Mention you're pregnant when scheduling, so we reserve more time and assign the right care provider (dentist or dental hygienist).
3. Keep your invoice. If your insurer asks for proof afterward, you'll have it ready.

Safe care per trimester

Not every phase of pregnancy is equally suited for every treatment. Here's an overview.

First trimester (weeks 1 to 13)

This is the phase in which the baby's organs are forming. We are most cautious here with treatments that aren't strictly necessary. We do and may:

• A routine check-up and dental cleaning.
• Acute pain treatment for infection or toothache, with local anesthesia (lidocaine is safe).
• Dietary advice for morning sickness to limit enamel erosion.

What we prefer to postpone to the second trimester: non-acute fillings, crowns, root canals and extensive x-rays.

Second trimester (weeks 14 to 27)

The safest window for regular dentistry. The baby is formed, you often feel better, and you can still lie comfortably in the chair. Here we typically perform:

• Fillings, crowns, root canals if needed.
• Professional dental cleaning against pregnancy gingivitis.
• When indicated: digital x-ray with lead apron.

Third trimester (week 28 to birth)

Lying flat on your back becomes uncomfortable toward the end and may even cause dizziness (vena cava syndrome). We adjust the chair position with a slight incline or a cushion under your right hip. Treatments remain possible, but:

• Short appointments are preferred over long ones.
• Cosmetic or non-urgent treatments we postpone until after birth.
• Acute complaints are of course always treated immediately.

Common complaints and what you can do

Bleeding gums

Almost all pregnant women notice this at some point. No reason to brush less, in fact more. Switch to an extra-soft toothbrush, brush twice daily for two minutes, and floss daily. A cleaning by the dental hygienist in the second trimester works wonders.

Enamel erosion from vomiting

Rinse immediately after vomiting with water or a fluoride mouthwash, but do not brush within 30 minutes. The enamel is soft and gets brushed away. A fluoride toothpaste with at least 1450 ppm helps your enamel recover.

Bump on the gum (pregnancy tumour)

Despite the scary name, this is a benign red lump, usually between two teeth. It almost always disappears on its own after birth. Does it bother you or bleed when eating? Call us, then we'll assess whether treatment is needed.

Toothache

Untreated toothache is more dangerous than a treatment. Call the same day: 010 846 6539. For pain relief until your appointment: paracetamol (max 4×500 mg per day) is safe. Avoid ibuprofen and aspirin during pregnancy.

Myths debunked

Persistent myths circulate around pregnancy and oral care. We set the three most-heard straight.

"A child costs a tooth"

Incorrect. Calcium from your teeth does not go to your baby. The baby gets calcium from your bones via diet. However: pregnancy does make gums more sensitive and the diet sweeter, so without good oral hygiene you can develop more cavities. That is not inevitable, that is prevention.

"You can never have an x-ray during pregnancy"

Incorrect. A digital dental x-ray with lead apron gives a dose lower than 1 percent of what you receive on a flight from Amsterdam to New York. The second trimester is the safest period. For acute complaints, an x-ray is absolutely justified and often necessary.

"Anesthesia is dangerous for the baby"

Incorrect. Local anesthesia with lidocaine (the standard in Dutch dental practices) is confirmed safe in every trimester by the KNMT, NHG and ACOG (American College of Obstetricians). Untreated pain and infection are statistically riskier for the baby than a properly performed treatment.

What Tandarts West does for pregnant patients

At Tandarts West Rotterdam we don't see pregnant women as "difficult patients" but as a vulnerable group that deserves extra care. Concretely, that means:

• More time per appointment. We schedule 30 to 60 minutes so there's never haste, especially with morning sickness.
• Adjusted chair position. From the third trimester, a flat lying position is uncomfortable. We work with an incline or cushions.
• Coordination with obstetrics. With Erasmus MC and Sophia Children's Hospital we arrange seamless information transfer for complex medical histories.
• Multilingual team for expat mothers. We speak English, Dutch, Arabic, Berber, Turkish, French and German. For many pregnant women in Rotterdam West, communication in their own language makes the difference between calm and stress.
• No waiting list. Register and you typically have your first appointment within a week. Pregnancy doesn't wait.

We see that women who navigate their pregnancy well in our chair also return afterwards with their baby for the first introduction. A familiar face for you becomes one for your child too. On this page you'll read more about our treatments, and our entire team is happy to introduce themselves.