口腔指南共识汇总

REVIEW ARTICLE

OPEN

Expert consensus on the treatment of oral diseases in pregnant

women and infants

Jun Zhang1, Chenchen Zhou

2, Liwei Zheng

2, Jun Wang3, Bin Xia4, Wei Zhao5, Xi Wei

6, Zhengwei Huang

7, Xu Chen

8,

Shaohua Ge

9, Fuhua Yan

10, Jian Zhou11, Kun Xuan12, Li-An Wu12, Zhengguo Cao13, Guohua Yuan

13, Jin Zhao14, Zhu Chen15,

Lei Zhang16, Yong You17, Jing Zou2✉and Weihua Guo

1✉

With the growing emphasis on maternal and child oral health, the significance of managing oral health across preconception,

pregnancy, and infancy stages has become increasingly apparent. Oral health challenges extend beyond affecting maternal well-

being, exerting profound influences on fetal and neonatal oral development as well as immune system maturation. This expert

consensus paper, developed using a modified Delphi method, reviews current research and provides recommendations on

maternal and child oral health management. It underscores the critical role of comprehensive oral assessments prior to conception,

diligent oral health management throughout pregnancy, and meticulous oral hygiene practices during infancy. Effective strategies

should be seamlessly integrated across the life course, encompassing preconception oral assessments, systematic dental care

during pregnancy, and routine infant oral hygiene. Collaborative efforts among pediatric dentists, maternal and child health

workers, and obstetricians are crucial to improving outcomes and fostering clinical research, contributing to evidence-based health

management strategies.

International Journal of Oral Science (2025) 17:62

; https://doi.org/10.1038/s41368-025-00395-3

INTRODUCTION

Maternal and child oral health, a pivotal yet often overlooked

component of maternal and infant health, has historically received

insufficient recognition.1,2 Emerging evidence underscores the

significant correlation between maternal oral health challenges

during

pregnancy,1,3

particularly

periodontal

diseases,

and

adverse outcomes such as preterm birth, low birth weight, and

gestational hypertension.4 Oral health issues in pregnant women

not only affect their own health but can also influence fetal

development through various mechanisms, potentially heighten-

ing the offspring’s susceptibility to oral diseases.5–7 Pregnant

women exhibit an incidence rate of dental caries 1.5–2 times

higher than the general population,8–10 a vulnerability linked to

hormonal changes, dietary shifts, and altered oral hygiene.11,12

This underscores the need for focused preventive dental care

during pregnancy.13,14 They are also more likely to develop

gingivitis, thus facing a greater risk to their oral health.11,12

Furthermore, oral health challenges during pregnancy not only

intensify maternal complications during delivery but also exert

lasting effects on fetal oral health, elevating the likelihood of

future oral pathologies.15–17 Therefore, establishing standardized

treatment protocols for maternal and child oral health is

essential.18 By creating uniform guidelines, these protocols can

provide guidance for the management of oral health in women

Received: 22 April 2025 Revised: 19 July 2025 Accepted: 21 July 2025

1Yunnan Key Laboratory of Stomatology & Department of Pediatric Dentistry, The Affiliated Stomatology Hospital, Kunming Medical University, Kunming, China; 2State Key

Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University,

Chengdu, China; 3Department of Pediatric Dentistry, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology,

Shanghai, China; 4Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; 5Department of Pediatric Dentistry, Guanghua School

of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China; 6Hospital of Stomatology, Guanghua School of Stomatology,

Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China; 7Department of Endodontics, Shanghai Ninth People’s Hospital, College of

Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai Key Laboratory of

Stomatology, Shanghai, China;

8Department of Pediatric Dentistry, School and Hospital of Stomatology, China Medical University, Shenyang, China;

9Department of

Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration, Shandong

Engineering Research Center of Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China; 10Department of

Periodontology,Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China; 11Department of VIP Dental

Service, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China; 12Department of Pediatric

Dentistry, School of Stomatology, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shanxi Key Laboratory of Military

Stomatology, Fourth Military Medical University, Xi’an, China; 13State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine

Ministry of Education, Hubei Key Laboratory of Stomatology, Department of Periodontology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; 14Department

of Cariology and Endodontics, The First Affiliated Hospital of Xinjiang Medical University (The Affiliated Stomatology Hospital of Xinjiang Medical University), Urumqi, China;

15School of Stomatology, Zunyi Medical University, Zunyi, China. Department of Endodontics, Guiyang Stomatological Hospital, Guiyang, China; 16Hohhot Stomatology Hospital

(Inner Mongolia Autonomous Stomatology Hospital), Hohhot, China and 17Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University,

Chengdu, China

Correspondence: Jing Zou (zoujing@scu.edu.cn) or Weihua Guo (guoweihua943019@163.com)

These authors contributed equally: Jun Zhang, Chenchen Zhou.

www.nature.com/ijos

International Journal of Oral Science

1234567890();,:

and

children,

promote

early

intervention,

and

reduce

the

pregnancy

complications

caused

by

oral

problems.19

This

consensus, developed through an iterative modified Delphi

process involving multidisciplinary experts, aims to guide oral

health professionally in the prevention and management of oral

diseases in women and children, while advocating for further

research into the interconnected impacts of maternal and

childhood oral health on overall maternal and infant well-being.

FETAL DEVELOPMENT AND ORAL HEALTH OF

PREGNANT WOMAN

Maxillofacial development

Maxillofacial

development

originates

primarily

from

the

first

pharyngeal

arch,

with

the merging

or

fusion

of the

facial

prominences occurring between the 6th and 7th week of embryonic

development. The facial structures begin to take form during the 7th

to 8th week, at which point the maxillofacial morphology is initially

established. Genes responsible for regulating the migration of

mesenchymal cells and neural crest cells initiate facial development

around day 28 of pregnancy.20 The maternal nutritional status,

overall health, and microbiome directly affect fetal craniofacial

development. Previous studies have shown that biological indicators

of craniofacial morphology—including nutritional status21 growth

factors and hormonal activity,22 physical stature,23,24 and bone

maturation processes25–28—play a pivotal role in shaping craniofacial

development. The development of the craniofacial complex is

fundamental for achieving harmonious relationships among the

teeth, jawbones, and associated facial structures integral to occlusion.

Disorders in craniofacial structure development can result in

malocclusion, necessitating orthodontic interventions and, in some

cases, orthognathic surger.29 Poor oral health during pregnancy,

particularly oral infections such as periodontal disease or caries, can

lead to systemic inflammatory responses via bacterial translocation

into the bloodstream, adversely affecting fetal craniofacial develop-

ment and increasing the risk of anomalies such as dental

development defects, facial deformities, and cleft lip and palate.30

Tooth development

Tooth development begins during fetal life, with the formation of

the primary tooth buds occurring between the 6th and 8th weeks

of embryonic development. This process lasts approximately 10

weeks. The initiation of permanent tooth development begins

around the 20th week of pregnancy, while mineralization starts

postnatally and may continue until early adulthood.31–33 The

development of the permanent molar tooth buds begins at the

20th week of pregnancy (for the first permanent molar) and

continues until the age of 5 (for the third permanent molar).

Disruptions in this process can lead to various tooth development

abnormalities. Maternal nutritional status, particularly the con-

sumption of critical elements like calcium, phosphorus, and

vitamin D, exerts a direct influence on the fetal tooth mineraliza-

tion process.34,35 Prenatal exposure to viruses, pharmaceuticals,

environmental contaminants, and ionizing radiation during early

pregnancy can adversely affect odontogenesis, particularly alter-

ing the number, size, and morphology of developing teeth.36

Maternal deficiencies in protein, vitamin A, D, or minerals such as

calcium, phosphorus, and iron can directly affect tooth develop-

ment, resulting in structural abnormalities in enamel or dentin.37

Maternal systemic diseases also influence fetal tooth develop-

ment. Seminal studies suggest a potential association between

maternal diabetes and developmental anomalies in infant primary

dentition.38–40 Maternal malnutrition during pregnancy is a

significant contributor to low birth weight in offspring and has

been strongly linked to the occurrence of enamel hypoplasia.

Enamel hypoplasia is significantly more prevalent in the primary

dentition of low birth weight infants than in those with normal

birth weight, indicating a link between birth weight and tooth

enamel development.41

Oral microbiota and fetal growth and development

Maternal and infant microbiota and oral health.

Maternal micro-

biota transmission is essential for the establishment of the infant’s

oral microbiota, influencing early microbial composition and

potentially impacting long-term oral health outcomes.

Placental microbiome and oral microbiota linkage.

A study by the

Aagaard team42 demonstrated that the placental microbiome mirrors

the bacterial species prevalent in the maternal oral cavity, suggesting

that oral microbiota may translocate via the maternal bloodstream to

the placenta, potentially influencing fetal development.

Maternal oral health impact on bacterial transfer.

Maternal oral

health has been shown to influence the transference of bacteria

from mother to child.43,44 Suboptimal maternal oral health is

associated with elevated microbial loads and increased frequency

of microbial transfer. Maternal health status, dietary patterns, and

antibiotic usage modulate: metabolites generated by the micro-

biota and transference of microbiota or metabolites to the fetus.44

Fetal exposure and microbiome development.

Maternal health

status, dietary patterns, and antibiotic usage can modulate the

metabolites generated by the microbiota and their transference to

the fetus; through the placenta, the fetus is exposed to maternal

microbiota and associated metabolites, which contribute to the

formation of the fetal microbiome.45,46

Paternal

microbiome

contribution.

Suboptimal

maternal

oral

health is commonly linked to elevated microbial loads and

increased frequency of microbial transfer. The paternal micro-

biome also plays a role, with the father not only being a genetic

donor but also influencing the health of the offspring through

their own microbiome, contributing to a mother-father-fetus

microbiome interaction system.47

Impact of birth mode on microbial succession.

The shift from

prenatal to postnatal life requires several critical adjustments in

neonatal respiratory, metabolic, and immune systems, alongside

initial exposure to antibiotics and maternal microbiota. The mode

of delivery significantly impacts these adaptations, playing a

significant role in shaping the infant’s oral microbiota.48 At birth,

vaginal delivery directly exposes the neonate to the maternal

vaginal and rectal microbiota, while cesarean delivery introduces

microorganisms from the maternal skin and hospital environment,

shaping the infant’s early microbial composition.

Early microbial composition differences.

Studies have shown that

within the first two days post-delivery, the salivary bacterial count

in

cesarean-born

infants

is

significantly

lower,

with

lower

detection rates of certain oral taxa such as Actinomyces viscosus,

Bifidobacterium dentium, and Streptococcus sanguinis.49 Post-

cesarean delivery, certain microbial communities show delayed

colonization and lower diversity.50 Infants born via vaginal delivery

exhibit higher oral microbiota richness, while those born via

cesarean delivery tend to have a more homogeneous microbiota,

which may impact immune system development.

Confounding effects of antibiotic exposure.

However, given that

antibiotics are routinely administered during cesarean delivery,51

evidence indicates that the infant’s microbiota is influenced by

both the mode of delivery and antibiotic exposure. Infants

exposed to antibiotics at birth show a reduced similarity between

their oral microbiota and that of the mother, with a higher

proportion of Firmicutes.52

Expert consensus on the treatment of oral diseases in pregnant women and. . .

Zhang et al.

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International Journal of Oral Science (2025) 17:62

Impact on breast milk composition.

Interestingly, the mode of

delivery also influences maternal breast milk, which serves as the

primary substrate for the infant’s microbiota. After vaginal

delivery, colostrum has a significantly higher total protein

content than in cesarean-delivered infants, and the microbial

composition of colostrum is similarly influenced by the mode of

delivery.53,54

Impact of breastfeeding on microbial succession.

Breastfeeding is

vital for the proper development of the infant’s oral microbiota.

Breast milk not only contains immune factors but is also rich in

beneficial prebiotics that support the establishment of a healthy

oral microbiome in newborns.

Early-Life Microbial Similarity Across Body Sites:

Shortly after

birth, the microbiota of the infant’s gut, mouth, nose, and skin is

similar.55–57 By the age of six months, the infant oral microbiota

closely resembles that of the mother’s oral cavity, breast milk, and

areolar microbiota.57

Maternal Microbial Transfer via Breastfeeding:

Certain bacterial

species are transferred from the mother to the infant through

breastfeeding,58 with the maternal microbial community naturally

colonizing the infant’s gastrointestinal tract.

Role of Human Milk Oligosaccharides (HMOs):

The primary

carbohydrate in breast milk that babies cannot digest, human milk

oligosaccharides, aid in nourishing the newly formed microbiota.59

Biochemical Synergy and Microbial Maturation:

An exceptional

biochemical synergy exists between the infant’s oral secretions

and the components of breast milk, influencing both the oral and

gut microbiota.60 Furthermore, breastfeeding is associated with a

delay in microbial maturation, which corresponds with the

findings in the infant gut microbiota.

Stability and Immune Protection:

Infants who are breastfed tend

to develop a more stable oral microbiota with better immune

protection.61,62

Factors Influencing Microbial Colonization:

Variations in micro-

bial colonization between individuals are influenced by multiple

factors, including maternal salivary microbial load, extent of close

interactions, nutritional sources, and the receptivity of the child’s

oral environment.63 Breast milk, along with its immune and

bioactive factors, may reduce particular germs from colonizing the

oral cavity.

MATERNAL SYSTEMIC HEALTH AND FETAL ORAL HEALTH

Maternal bacterial and viral infections

Infection with Treponema pallidum can result in “Hutchinson

teeth” in the fetus.64 Pathogens from infectious diseases (e.g.,

upper respiratory infections, rubella, mumps, viral flu, etc.) can

lead to enamel hypoplasia.

Maternal systemic diseases

Maternal diabetes may lead to abnormal development of infant

primary teeth.39,65 Oral diseases during pregnancy can cause

opportunistic pathogens to enter the placenta via the blood-

stream, increasing fetal susceptibility to dental caries or period-

ontal diseases.66

Maternal drug use and exposure to chemicals

Maternal exposure to certain drugs and environmental chemicals

during critical periods of pregnancy can lead to permanent dental

anomalies in the offspring.

Tetracyclines.

Bind to calcium ions in mineralizing tissues,

resulting in yellow-brown banding discoloration of teeth (“tetra-

cycline teeth”);67,68

Thalidomide.

Associated with supernumerary teeth or congenital

tooth agenesis due to its teratogenic effects on craniofacial

development.69

Antiepileptic drugs.

Impair ameloblast function, leading to enamel

hypoplasia with chalky white defects, especially in primary teeth.70

Co-exposure to lead, dioxins, or amoxicillin.

These agents can

exacerbate fluoride-related damage, worsening the extent of

enamel defects.71–73

Excess Vitamin A or retinoic acid.

Suppresses bone formation,

stimulates osteoclastic activity, and induces enamel hypominer-

alization by disrupting odontogenesis.74,75

Excessive fluoride.

Leads to dental fluorosis, characterized by

mottled, discolored, or pitted enamel depending on severity.76

Bisphenol A (BPA).

Perinatal exposure has been linked to enamel

developmental

defects,

likely

through

endocrine-disrupting

mechanisms affecting ameloblast differentiation.65,77

Pesticide exposure.

Prenatal exposure to pesticides(eg. Organo-

phosphates)may interfere with cellular signaling pathways during

tooth development, leading to enamel hypoplasia or malformed

crowns.78–81

Heavy metal exposure.

These toxicants can impair the function of

ameloblasts and odontoblasts, resulting in delayed tooth eruption,

enamel mineralization defects, and crown malformations.82

Maternal malnutrition

Maternal malnutrition during pregnancy, leading to low birth

weight, is associated with a significantly higher prevalence of

enamel hypoplasia in primary teeth compared to infants with

normal birth weight.41 It may also contribute to tooth morpho-

logical abnormalities such as microdontia and altered crown

shapes due to disrupted odontogenesis.83,84

ORAL HEALTH MANAGEMENT AND DISEASES DURING

PREGNANCY

Periodontal diseases

The uniqueness of oral health challenges during pregnancy is

primarily driven by hormonal fluctuations. Gingivitis is among the

most prevalent oral conditions during pregnancy, triggered by

changes in pregnancy hormones, leading to vascular dilation. This

allows oral microorganisms to enter the placenta directly or via

maternal immune cells, where microbial cells or fragments may be

retained in the placental tissue, presenting antigens to the fetal

immune system.85–89 Elevated progesterone levels during preg-

nancy alter the oral microbial environment, promoting the growth

of Prevotella intermedia, a key pathogenic bacterium in period-

ontal disease.90 Some pregnant women may develop localized

gum swelling, known as pregnancy granuloma or pyogenic

granuloma, which occurs in about 5% of women. This condition

may be due to higher hormone levels or a stronger inflammatory

response to bacteria or trauma, resulting in increased angiogen-

esis. A systematic review found that maternal periodontitis is

linked to a 1.6-fold increased risk of preterm birth, a 1.7-fold

increased risk of low birth weight infants, and a 2.2-fold increased

risk of preeclampsia. The combined likelihood of preterm birth

and low birth weight is elevated by 3.4 times.4

Expert consensus on the treatment of oral diseases in pregnant women and. . .

Zhang et al.

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International Journal of Oral Science (2025) 17:62

Pulpal diseases

Frequent vomiting during early pregnancy can increase the oral

acidic environment, thereby raising the risk of dental caries. Over

43% of expectant mothers experience oral health issues, such as

dental infections and discomfort, according to a new study.91 Most

odontogenic infections may quickly develop into deep infections

that threaten the oral-pharyngeal airway.92 Additionally, odonto-

genic infections often present with oral pain and swelling.93 Drug

abuse in place of appropriate dental care can be detrimental to

both the fetus and the pregnant woman. Therefore, prompt

treatment of odontogenic infections during pregnancy is essential

to minimize risks.94

Pericoronitis of the third molars

Pericoronitis of the third molars is more prevalent during

pregnancy, causing significant discomfort for the pregnant

woman and potentially leading to anemia and malnutrition.95

The third molar may be partially or fully covered by a gingival flap,

which forms a deep pocket between the gum and tooth, where

food and bacteria can easily become trapped.96 When systemic

immunity declines, pericoronitis becomes more likely, causing

difficulties with eating, chewing, swallowing, and limited mouth

opening.97 In severe cases, it can lead to infections of adjacent

tissues, organs, or spaces. The risk of pericoronitis is increased by

hormonal changes during pregnancy, poor dental hygiene, and

rapid fetal growth in the latter stages of pregnancy.66

Timing of treatment

●

Early Pregnancy: The most crucial time for fetal growth is

during the first trimester. If acute dental pain occurs in

pregnant patients, symptomatic emergency management can

be performed, such as removing inflamed pulp or draining

pus to alleviate pain.

●

Mid-Pregnancy: The safest time to have surgery or dental

work done is during the second trimester. Emotional stability,

reduced stress, and lower anxiety levels make it an ideal time

for selective and necessary dental treatments, including

professional

plaque

removal,

periodontal

surgery,

tooth

extractions, and root canal therapy.98–102

●

Late Pregnancy: In case of dental pain, emergency treatment

can be performed; however, it is advised to postpone

treatment if possible, until after delivery.103,104 The American

Dental Association underscores the importance of timely

dental care during pregnancy.Controlling and treating odon-

togenic infections is essential for a healthy pregnancy.105 It is

crucial to note that infections pose risks to both the mother

and the fetus.

Oral radiographic examinations and medication during pregnancy

Radiographic examinations.

Guidelines from the United States

(2003) and the European Union (2004) indicate that indications for

X-ray examinations are the same for pregnant patients as for the

general population.106,107 For elective dental procedures, radio-

graphic examinations should be postponed until after pregnancy.

However, in urgent cases, the lowest possible radiation dose

should be used to meet diagnostic needs.108 Although evidence

suggests that the radiation dose received by the fetus during oral

X-rays is minimal and can be considered negligible,106,107,109–111

due to psychological concerns, X-ray examinations should be

avoided during pregnancy whenever possible.110,112 It should be

emphasized that the most appropriate imaging examination

should be selected based on the diagnostic and therapeutic needs

of the patient, adhering to the ALADAIP principle.113

In pediatric patients, radiographic examinations play a key role

in early diagnosis and treatment planning for malocclusion.

According to the latest expert consensus,114 age-specific imaging

is recommended.115 Panoramic radiographs are generally pre-

ferred for initial screening, while lateral cephalometric radiographs

are recommended for detailed assessment in early orthodontic

planning. Cone-beam computed tomography (CBCT) should be

reserved for cases where additional three-dimensional evaluation

is necessary.116

Local anesthesia.

Local anesthetics are commonly used in dental

procedures to control pain, often combined with epinephrine to

increase anesthetic depth and duration, improving pain relief.

However, intravenous epinephrine administration can cause

uterine artery constriction, leading to reduced uterine blood flow

and potentially affecting fetal oxygen and nutrient supply. Studies

indicate that using a 100 000 concentration of epinephrine is

considered safe for healthy pregnant women in dental treat-

ments.117,118 When administering local anesthetics containing

epinephrine

or

other

vasoconstrictors,

the

lowest

possible

concentration should be employed, and aspiration techniques

should be used to avoid accidental intravascular injection.119

Current studies affirm that lidocaine is safe for use as a local

anesthetic in pregnant women, with minimal risk to maternal and

fetal health when administered properly.105

Infection-control medications.

Irrigants such as sodium hypo-

chlorite and root canal filling materials are not considered harmful

to the fetus.92 In cases of severe odontogenic infections,

antibiotics such as amoxicillin and metronidazole may be used.

established by the American Dental Association and obstetricians,

certain antibiotics are permissible during pregnancy and can be

used safely. Some antibiotics may have teratogenic effects during

pregnancy, and evidence suggests that amoxicillin use during

pregnancy may lead to congenital defects such as cleft lip/palate

and

enamel

hypomineralization.120–122

The

combination

of

amoxicillin and clavulanic acid has been shown to be effective

in managing severe odontogenic infections, with no evidence

indicating an elevated risk of fetal or congenital abnormalities.105

However, it has been observed that the use of this combination

during the later stages of pregnancy may elevate the risk of

necrotizing enterocolitis in newborns.123 Therefore, its use should

be avoided during the third trimester.105 Metronidazole, com-

monly used to target anaerobic bacteria, is often combined with

penicillin to treat odontogenic infections. Research indicates that

metronidazole use during pregnancy is not significantly linked to

fetal defects or adverse pregnancy outcomes.124–129 In contrast,

tetracycline antibiotics have been shown to cause staining and

discoloration of permanent teeth,67,68 and it is recommended to

avoid their use during pregnancy. Medications used during

breastfeeding can severely impact infant health. Therefore,

antibiotic use for odontogenic infections should be considered

carefully during pregnancy and breastfeeding, with consultation

from obstetricians.

Nutritional intake and oral health during pregnancy

Research indicates that adequate intake of calcium, phosphorus,

and vitamin D intake is crucial for the healthy formation and

mineralization of teeth and jawbones.

Consequences of Vitamin D deficiency.

Vitamin D deficiency

impacts the oral cavity, leading to enamel hypoplasia, dentin

changes, and ectodermal dysplasia, particularly affecting primary

teeth and potentially resulting in defects in permanent dentition.

This condition affects both esthetics and increases sensitivity,

along with elevating the risk of caries, and may lead to reduced

bone mineral density, resulting in jawbone resorption.130

Role in fetal dental development.

Fetal tooth development

depends on vitamin D, and maternal vitamin D during pregnancy

Expert consensus on the treatment of oral diseases in pregnant women and. . .

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International Journal of Oral Science (2025) 17:62

is essential for proper tooth mineralization and the development

of healthy dental structures in the fetus.131 Studies indicate that

optimal vitamin D levels are linked to a reduced incidence of

dental caries,132–134 with supplementation preventing both its

onset and progression.135–138 High levels supplementation during

pregnancy

may

mitigate

the

risk

of

enamel

defects

in

newborns.136

Critical

periods

in

tooth

development.

Early

pregnancy

(1–3 months) sees primary tooth bud initiation, mid-pregnancy

(4–6 months) involves primary tooth mineralization, and late

pregnancy (7–9 months) continues primary tooth development/

mineralization and permanent tooth bud formation. Pregnant

women should ensure sufficient intake of high-quality proteins,

calcium, phosphorus, vitamin D, and essential minerals to support

the formation of teeth and jawbones.135,136

Oral hygiene care during pregnancy

The incidence of dental caries may increase during pregnancy,

owing not only to physiological changes but also to heightened

cravings for sugary foods, challenges in maintaining adequate oral

hygiene, and pregnancy-related nausea and vomiting.139 Addi-

tionally, dental caries can lead to periapical periodontitis, which,

akin to periodontal disease, may be linked to adverse pregnancy

outcomes.140 Due to the heightened vulnerability to oral health

issues during pregnancy, preventive strategies are essential to

manage the increased risk of conditions like gingivitis and

periodontitis.

Pregnant

women

should

maintain

good

oral

A lifelong

continuum

Preconception

phase

Infant

phase

Pregnancy phase

Preconception oral

examination

Untreated caries

Periodontitis

Impacted third molars

Risk factors

A. Birth & early colonization:

Delivery mode:

Vaginal vs. C-section.

Immune factors + oligosaccharides

B. Oral health risks:

Early childhood caries

C. Preventive measures:

First tooth eruption:

Toothbrush + Clean gums nightly

WHO guideline:

Exclusive breastfeeding for 6 months

A. Fetal development risks

Oral-

systemic

links

Maternal

periodontitis

Preterm birth/

low birth weight

Enamel hypoplasia

Microbiome

transfer

Oral

Placenta

Fetus

C. Safe interventions

2nd Trimester for

dental procedures

(tooth extraction/RCT).

Gingivitis/pregnancy granuloma

Pericoronitis

For Mothers:

Preconception screening

Limit sugary snacks

Trimester-specific dental care

For Infants:

DAYS

2 4 6 8 10 12 14 16 18 20 22 24 26 28

Estrogen

Estrogen

Progesterone

Testosterone

Progesterone

Follicular phase

Ovulation

ovulatory phase

Luteal phase

Nutritional

deficiencies

(Ca, Vit D)

B. Pregnancy-specific Oral

conditions

X-rays/medications:

shielded X-ray + lidocaine

Avoid prolonged bottle use

Pacifer weaning by 12 months

Early treatment (scaling, fillings,

extractions) to reduce pregnancy

complications.

Breastfeeding benefits:

Bottle feeding/pacifiers

Malocclusion

Fig. 1

This schematic illustrates the critical pathways linking maternal oral health to fetal development and infant oral health outcomes, as

established in this expert consensus. Key components include: Preconception Phase (Left Panel):Highlights the importance of pre-pregnancy

oral screening (e.g., caries, periodontitis) and early interventions to mitigate gestational risks. Pregnancy Phase (Center Panel): Demonstrates

bidirectional relationships between maternal oral diseases (gingivitis, periodontitis, caries) and adverse pregnancy outcomes (preterm birth,

low birth weight), mediated by systemic inflammation and microbial translocation.Identifies the second trimester as the optimal period for

dental treatments, with cautionary notes on radiation/medication safety.Infant Phase (Right Panel): Shows how delivery mode (vaginal vs.

cesarean) and feeding practices (breastfeeding vs. formula) shape the infant’s oral microbiome and occlusal development, influencing lifelong

caries and malocclusion risks. The image was created using BioRender.com (accessed on 6 April 2025). RCT, root canal therapy

Expert consensus on the treatment of oral diseases in pregnant women and. . .

Zhang et al.

5

International Journal of Oral Science (2025) 17:62

hygiene, reduce sugar intake, avoid carbonated drinks and acidic

foods, and undergo regular dental check-ups with timely plaque

removal. Maintaining optimal oral hygiene during pregnancy aids

in reducing the transmission of cariogenic bacteria, giving high-

risk mothers the opportunity to implement preventive measures

against caries transmission to their children.141

PRECONCEPTION ORAL HEALTH MANAGEMENT

A comprehensive oral examination before conception is crucial

for improving oral health during pregnancy. Studies have shown

that elevated progesterone and estrogen during pregnancy

increase vascularization in the periodontium, alter collagen

production,

and

enhance

biofilm

accumulation,

potentially

worsening

existing

gum

inflammation

or

periodontal

dis-

ease.142,143 A preconception oral check-up can effectively identify

potential oral health issues, including dental caries, periodontal

disease, and impacted third molars. It is recommended that

women undergo an oral examination before conception to assess

the eruption status of the third molars and, if necessary, extract

impacted third molars that meet the indications for removal.

Timely treatment of these oral issues can reduce the risk of

complications during pregnancy. Performing an oral examination

six months before conception and addressing any identified oral

issues, such as caries treatment and periodontal cleaning, can

effectively prevent oral health problems during pregnancy. The

American Academy of Periodontology, the American Dental

Association, and the European Federation of Periodontology

emphasize the importance of oral health interventions prior to

pregnancy to reduce the risk of adverse pregnancy out-

comes.98–100 Oral health is intricately linked to the oral micro-

biome. While the maternal microbiome is not directly transferred

to the fetus, it plays a vital role in priming the fetal immune

system for post-birth microbial exposure, through modulation

and training. Therefore, maintaining optimal maternal oral health

and a balanced oral microbiome is essential for the child’s overall

health and well-being.47 Oral health management during the

preconception period is vital for maintaining a proper microbial

balance and reducing the risk of bacterial infections.

ORAL HEALTH MANAGEMENT IN INFANCY AND EARLY

CHILDHOOD

The eruption of the first primary teeth creates stable surfaces

promoting microbial attachment and proliferation, increasing

diversity.144 From the first tooth eruption, parents should be

educated about caries risk. Parents should clean the infant’s oral

cavity nightly from birth to remove milk residue and facilitate

learning proper hygiene habits. Research demonstrates prolonged

breastfeeding is associated with an elevated risk of early

childhood caries. If breastfeeding is frequent, especially nightly,

without adequate hygiene, multiple caries may develop, hindering

growth.146 Some studies145 suggest infant formula and bottle-

feeding are linked to increased risks of mouth breathing,

malocclusions, and caries. Exclusive breastfeeding for the first six

months is linked to a reduced risk of malocclusion (e.g., open bite,

crossbite)146,147 and lower incidence of developmental abnorm-

alities in primary teeth.150 Children exclusively breastfed over six

months exhibit greater intercanine and intermolar width.148 The

World

Health

Organization

(WHO)

advocates

for

exclusive

breastfeeding during the first six months.149,150

Sucking is an innate reflex. The muscle activity in breastfeeding

helps develop oral motor skills,151 enhancing tone and ensuring

optimal function.152 Habits like pacifier use introduce unique

stimuli affecting development.153,154 Early pacifier use may

interfere with suckling and cause nipple confusion.155 Further-

more, pacifier use is associated with higher oral candidiasis

incidence.156,157 Non-nutritive sucking behaviors correlate with

primary dentition malocclusion.153,155 If breastfeeding lasts less

than six months, thumb-sucking frequency may increase.158

Table 1.

Evidence-based Recommendations for Maternal and Child Oral Health

Domain

Key Findings/Recommendations

Evidence/Support

Significance

Maternal-fetal link

Periodontitis ↑risk of PTB (1.6×), LBW (1.7×),

preeclampsia (2.2×)4

Systematic review; microbial

translocation →systemic inflammation

Mandates prenatal oral screening

& intervention

Fetal development

- Maxillofacial: Oral infections/malnutrition

disrupt W6-8 development →malocclusion29,30

- Tooth: Vit D/Ca/P deficiency →enamel

hypoplasia ↑in LBW infants34,35,41

Critical windows: tooth bud (W6-8),

mineralization (prenatal-postnatal)31–33

Highlights developmental

vulnerability to nutritional deficits

Microbiome

dynamics

Maternal oral microbiota transfers via placenta.42

and vertical transmission43,44

Vaginal delivery →richer infant microbiota vs.

C-section48–50

Placental microbiome mirrors oral

cavity42; breastfeeding stabilizes via

HMOs/immune factors59–62

Supports pre-conception oral

hygiene & vaginal delivery

Clinical

management

Trimester-specific:

- T1: Emergencies only

- T2: Optimal for treatment

- T3: Defer elective care

Imaging: ALADAIP principle107–114

Anesthesia: Lidocaine + 1:105 epinephrine

safe118–120

Hormonal changes ↑P. intermedia

growth91; pericoronitis ↑malnutrition

risk96–98

Validates safety protocols for

essential interventions

Interventions

Nutrition: Vit D supplementation ↓caries risk &

enamel defects131–139 (Grade B)

Preconception: Screening ↓pregnancy

complications99–101,143,144

High-dose prenatal Vit D ↓enamel

defects137; maternal microbiome primes

fetal immunity47

Guides supplementation & early

care coordination

Infant health

Exclusive breastfeeding ≥6 months ↓

malocclusion147–149

Pacifier use ↑candidiasis/malocclusion154–158

Breastfeeding ↑intercanine width150;

nocturnal feeding + poor hygiene →

ECC150

Reinforces WHO breastfeeding

guidelines & early oral hygiene151

PTB Preterm birth, LBW Low birth weight, HMOs Human milk oligosaccharides, ECC Early childhood caries, WHO World Health Organization, T1/T2/T3 Trimester

1/2/3

Expert consensus on the treatment of oral diseases in pregnant women and. . .

Zhang et al.

6

International Journal of Oral Science (2025) 17:62

CONCLUSION

The management of maternal and infant oral health is a

continuous, lifelong process that begins before conception,

extends throughout pregnancy, and persists into infancy and

early childhood. As illustrated in Fig. 1 and Table 1, this continuum

underscores the profound interconnections between maternal

oral health, fetal development, and long-term infant well-being.

Timely intervention and scientific management are essential at

each stage. Maternal oral health during pregnancy has a direct

impact on the overall well-being of both the mother and the child.

Therefore, both dental professionals and obstetricians should

strengthen oral health education and prevention during preg-

nancy. Future research should further investigate the long-term

effects of oral health on maternal and child health, and rigorously

validate existing management protocols in clinical practice.

ACKNOWLEDGEMENTS

This work was supported by grants from the National Natural Science Foundation of

China (82270958), the Major Science and Technology Projects in Yunnan Province

(202302AA310038) and the National Key Clinical Specialty Development Project of

Pediatric Dentistry Division of China (20230610).

AUTHOR CONTRIBUTIONS

Conceptualization and Investigation, W.H.G. and Jing.Zou.; Supervision, W.H.G. and

Jing.Zou.; Original draft, J.Zhang and C.C.Z.; Review and editing, L.W.Z., J.W., B.X., W.Z.,

X.W., Z.Q.H., X.C., S.H.G.,F.H.Y., Jn.Zhao., K.X. L.A.W., Z.G.C., G.H.Y., J.Zhang., Z.C., L.Z.

and Y.Y.

ADDITIONAL INFORMATION

Competing interests: The authors declare no competing interests.

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Expert consensus on the treatment of oral diseases in pregnant women and. . .

Zhang et al.

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International Journal of Oral Science (2025) 17:62