Inequities in Maternal Oral Health and Their Impact from Postpartum to Early Childhood

Viviana Filangeri, Humera Rohail, Sokuntheary Prak

Project Smile Global

31 May 2025

Pregnant women are vulnerable to oral health conditions that can affect both their own well-being and that of their baby. During pregnancy, the placenta produces higher levels of estrogen and progesterone, which leads to increased susceptibility to gingivitis and periodontitis (Yenen and Ataçağ 264). These oral conditions, along with other issues such as gingival tissue ulcerations, low birth weight, and preeclampsia, can negatively impact birth outcomes (Yenen and Ataçağ 264). While maintaining good oral hygiene during pregnancy is important, not all mothers have equal access to dental care. Barriers to oral healthcare such as race, ethnicity, age, income, insurance coverage, and other sociodemographic factors limit access to necessary resources (Hartnett et al. 566–567). Poor maternal oral health not only has the potential to negatively impact birth outcomes, but it also may present concerns after childbirth, often resulting from a lack of education and access to services. These issues are a result of structural inequities in oral health care, which are heavily influenced by socioeconomic status and health care disparities. 

Due to the hormonal imbalances that pregnant women undergo, an excessive sensitivity to irritations occurs in the gingiva, or the gums (Yenen and Ataçağ 264). Gingivitis usually starts at the second month of gestation and is highest in the eighth month. Bleeding and pain in the gums occurs as long as the issue is not resolved (Yenen and Ataçağ 264). Another consequence of poor oral health is tooth decay, which can eventually lead to tooth loss. This risk is increased during early pregnancy, as frequent vomiting can erode tooth enamel and worsen oral health, contributing to decay (Yenen and Ataçağ 265). This highlights the need for improved oral health education among pregnant women, as neglecting oral care increases the risk of dental disease. 

In addition to hormonal changes, various lifestyle and behavioral factors during pregnancy can significantly affect oral health, requiring the need for targeted care strategies to maintain healthy teeth and gums. A healthy diet, adequate dental cleanliness, and proper use of fluoride can help pregnant women maintain their oral health (Fitzsimons et al. 182). Preventive dental care practices are especially important, as pregnancy can introduce challenges such as frequent vomiting. This action exposes teeth to stomach acid, which increases the risk of dental enamel erosion (Fitzsimons et al. 183). Additionally, pregnancy cravings and changes in eating habits may lead to frequent snacking on sugary foods, which raise the risk of tooth decay and cavities. Despite the known risks, many women receive little support or guidance when it comes to oral health—from pregnancy through their child’s first three years. 

This gap in access to preventive dental care and oral health education makes it especially difficult for pregnant women in marginalized communities to access dental services (Fitzsimons et al. 182). Even though preventive steps like using fluoride toothpaste, brushing with a soft toothbrush, and flossing daily are important, access to these basic measures is often limited. Dental treatments are rarely covered by welfare programs, meaning many low-income women are left without insurance and have to pay out of pocket (Fitzsimons et al. 183). The lack of resources and education continues to allow these problems to persist, displaying how poor maternal oral health is closely linked to inequalities in dental care.

Poor maternal oral health can have lasting effects beyond pregnancy. A 2015 birth cohort study conducted in Brazil examined how a mother’s view of her own oral health could influence her child’s dental health. It found that mothers who viewed their own oral health negatively were more likely to have children with dental caries, while those with a positive view tended to have children with fewer oral health issues. One of the main reasons behind this connection is that many mothers did not have access to the education, health information, or dental care needed to support good oral health (Karam et al. 875). To improve children’s oral health and reduce these gaps, it is essential to expand health promotion and education through public oral health services. In addition, policies should be implemented that are tailored to providing health information and treatment to mothers in marginalized communities (Karam et al. 877). 

Pregnant women also face an increased risk of periodontal disease, a condition that has been linked to adverse outcomes such as preterm birth and low birth weight (Centers for Disease Control and Prevention). Furthermore, untreated cavities can lead to high levels of cavity-causing bacteria, which mothers may transmit to their infants. Research shows that mothers with high levels of cavity-causing bacteria are more likely to transmit them to their newborns, making infants more vulnerable to early dental infections (Ludovichetti et al.). While pregnancy can lead to increased risks in oral diseases, socioeconomic factors play a crucial role as well. Prevention of oral health diseases during pregnancy is crucial for keeping both the mother and child healthy.

Poor maternal oral health is an important public health concern, particularly among women of lower socioeconomic status (SES). Socioeconomic status plays a major role in oral health, as the risk of oral diseases tends to increase as SES decreases (Almajed et al. 3). A study by Almajed et al. also found a correlation between low socioeconomic status and poor oral health, noting that individuals with limited oral health knowledge were at higher risk of developing dental caries. This is especially important during pregnancy, when changes in habits and hormone levels can increase the chances of gum inflammation, periodontal disease, and cavities if oral health is not maintained (Kamalabadi et al. 525). A 2024 study also showed that women facing socioeconomic challenges often have less awareness about oral health, which affects their daily care routines. It also found  that women with dental insurance are five times more likely to visit the dentist than those without (Kamalabadi et al. 533). 

Education and community-based interventions are vital for improving maternal oral health, particularly in underserved communities. According to a survey, OB/GYN residents reported that oral health is rarely discussed, as mothers were uncomfortable discussing oral health  due to their limited knowledge on the topic (Radwan-Oczko et al.). By educating pregnant women and prenatal providers and integrating oral health into prenatal care, inequities in maternal oral health can subside. A study conducted by Deghatipour showed that when mothers were exposed to educational interventions during and after pregnancy, the frequency of daily brushing increased from 64% to 85.6% (2022). This increase in brushing has the potential to enhance oral health outcomes in pregnant mothers, decreasing their risk of contracting dental diseases and negatively impacting the child’s oral health.

In the U.S., community-based programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Early Head Start (EHS) provide counseling, risk assessments, and dental referrals to support pregnant women (USDA). These programs provide educational resources on oral health and provide assistance, especially for women in underserved communities, but greater efforts are needed to raise awareness about their availability and benefits. Additionally, initiatives like the Oral Health Nursing Education and Practice program at NYU train nurses and healthcare providers to incorporate oral health into routine care. This is especially important as it is estimated that 108 million Americans visit a physician each year but do not see a dentist (Atchison et al. 118). By integrating oral health assessments, such as oral health evaluations and preventive interventions, into primary care practices is an important step toward reducing maternal oral health disparities. 

The oral health of pregnant women is a critical but often overlooked aspect of maternal and young child health and well-being. It has been shown through studies and research that structural inequities - rather than personal choices - significantly affect maternal oral health during pregnancy, birth outcomes, and the child’s oral health up to 36 months of age. Systemic improvements in public health policy, education, and access to care are necessary to address these discrepancies, particularly among underserved communities. 

Works Cited 

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Atchison, Kathryn A., et al. “Integration of Oral Health and Primary Care: Communication, Coordination and Referral.” NAM Perspectives, vol. 8, no. 10, 2018, https://doi.org/10.31478/201810e.

Deghatipour, Marzie, et al. “Effect of Oral Health Promotion Interventions on Pregnant Women Dental Caries: A Field Trial.” BMC Oral Health, vol. 22, no. 1, 2022, https://doi.org/10.1186/s12903-022-02292-1.

Fitzsimons, Dina, et al. “Nutrition and Oral Health Guidelines for Pregnant Women, Infants, and Children.” Journal of the American Dietetic Association, vol. 98, no. 2, 1998, pp. 182–89, https://doi.org/10.1016/S0002-8223(98)00044-3.

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Kamalabadi, Yasaman Mohammadi, et al. “Oral Health Status and Dental Services Utilisation Among a Vulnerable Sample of Pregnant Women.” International Dental Journal, vol. 75, no. 2, 2025, pp. 524–36, https://doi.org/10.1016/j.identj.2024.07.009. 

Karam, Sarah Arangurem, et al. “Socioeconomic Inequalities Related to Maternal Perception of Children’s Oral Health at Age 4: Results of a Birth Cohort.” Community Dentistry and Oral Epidemiology, vol 51, no. 5, 2023, pp. 872–878, https://doi.org/10.1111/cdoe.12779.

Ludovichetti, Francesco Saverio et al. “Mothers' Awareness of the Correlation between Their Own and Their Children's Oral Health.” International Journal of Environmental Research and Public Health, vol. 19, no. 22, 2022, https://doi.org/10.3390/ijerph192214967.

“Pregnant woman visiting a dentist stock photo.” iStock, 1 Nov. 2022, istockphoto.com/photo/pregnant-woman-visiting-a-dentist-gm1437836008-478513648 Radwan-Oczko, Małgorzata, et al. “How Much Do Pregnant Women Know about the Importance of Oral Health in Pregnancy? Questionnaire-Based Survey.” BMC Pregnancy and Childbirth, vol. 23, no. 1, 2023, pp. 348–348, https://doi.org/10.1186/s12884-023-05677-4.

“WIC: USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children.” USDA Food and Nutrition Service, www.fns.usda.gov/wic. Accessed 25 May 2025. 

Yenen, Zeynep, and Tijen Ataçağ. “Oral Care in Pregnancy.” Journal of the Turkish German Gynecological Association, vol. 20, no. 4, 2019, pp. 264–68, https://doi.org/10.4274/jtgga.galenos.2018.2018.0139.