Nausea and gagging when brushing your teeth during pregnancy

By trimester

Weeks 1–13

1st trimester

Morning brushing is usually the worst of it, since nausea peaks between 7 and 12 weeks and often sits heaviest early in the day. Shift brushing to mid-morning or afternoon, use a smaller brush head, and try a mild or unflavored paste. If you have vomited, rinse with a teaspoon of baking soda in a cup of water to neutralize the acid.

Weeks 14–27

2nd trimester

As nausea eases, book the dental visit you may have put off. The studies ACOG reviewed did not raise concerns about the safety of dental services during pregnancy, and a cleaning is far easier to sit through now than it was at ten weeks.

Weeks 28–birth

3rd trimester

A bigger bump makes leaning over the sink less comfortable and gagging more likely. Brush sitting down if that helps, keep the brush head toward the front of your mouth, and breathe through your nose rather than holding your breath.

What does the evidence show for nausea and gagging when brushing your teeth?

• Frequent vomiting wears away tooth enamel because of stomach acid, and rinsing with a teaspoon of baking soda dissolved in a cup of water helps neutralize the acid and protect your teeth. 1
• Self-reported difficulty keeping up oral hygiene appeared in six of the ten studies in a scoping review of hyperemesis gravidarum and oral health, and one study found significantly worse periodontal measures than in controls. 2
• Studies of dental care during pregnancy have not raised concerns about the safety of dental services, and ACOG advises counselling women on both the safety and the importance of oral health care while pregnant. 3
• The belief that dental care is unsafe and harms the fetus was among the most frequently reported misconceptions in a systematic review of 45 studies of pregnant women and new mothers. 4
• Nausea and vomiting affects roughly 80% of pregnant women, usually starting between 4 and 9 weeks and peaking between 7 and 12 weeks, which is the same window when brushing tends to become hardest. 5
• Ketonuria and a loss of at least 5 percent of pre-pregnancy weight, together with dehydration and electrolyte disturbances, generally mark hyperemesis gravidarum, the more severe form of pregnancy nausea. 6

When should I call my provider about nausea and gagging when brushing your teeth?

Gagging on a toothbrush is ordinary early-pregnancy nausea, not a warning sign on its own, but frequent vomiting that goes beyond typical morning sickness deserves attention. Hyperemesis gravidarum, the more severe form of pregnancy nausea, affects roughly 3 in 100 pregnancies and is generally marked by ketones in the urine and a loss of 5 percent or more of pre-pregnancy weight. Call your provider the same day if you cannot keep fluids down, feel faint or unusually weak, or notice weight loss, since nausea and vomiting at this level can call for hospitalization for IV fluids and nutrients. When in doubt, call your obstetric team the same day. Early input almost always beats waiting, and the on-call line exists exactly for this.