The Pregnant Woman and Dentistry  

The Pregnant Woman and Dentistry

Pregnancy is not only a wonderful time for a woman, but can also be a stressful and confusing time. There can be information overload, with everybody wanting to offer advice. The following is what to expect from a dental point of view and also a basic protocol to follow and why.

There is an old wives tale that says a mother will lose a tooth for every child born. This is no longer the case, largely due better diet, better oral hygiene, better information relating to issues which may arise and how to treat them, and also to the preventative nature of dentistry.

The most common dentally related issues that arise when you are pregnant are:

* Morning sickness, including feelings of nausea and vomiting episodes;

* Sore and swollen gums. If an underlying gum disease exists, an exacerbation of this condition can occur;

* Gum ulceration;

* Occasionally there is a gum growth that occurs called a pyrogenic granuloma;

* Mobile or "wobbly" teeth;

* Decreased salivary flow, that can lead to a dry mouth sensation;

* Cravings and snacking to reduce nausea; and / or

* The need to eat smaller meals more frequently.

All of the issues above are preventable and relate to two main areas, gum disease and the increased activity of bacteria that can cause dental decay.

Dental Protocol for the Pregnant Woman

Before Pregnancy or late in the first trimester

1. Full check up and examination;

2. Set of radiographs as necessary, usually bitewings only. Generally x-rays will be taken only if necessary. Although considered safe, it is always better during pregnancy to only carry out treatment that is essential;

3. Thorough Scale and Clean; and

4. Education as to what to expect with oral changes and preventative measures during pregnancy.

It is ideal to have a dental check up when planning the pregnancy. Of course, not all pregnancies are planned. Therefore late in the first trimester is the next most appropriate time to do this.

Having check-ups at these times enables the dentist to plan appropriately if further treatment is necessary and also educate the pregnant patient as to the most appropriate preventative measures for you.

Appropriate Treatment Times

1. If possible, any necessary treatment should be carried out in the second trimester. Always watch the supine (lying flat on the back) position, especially late in the second trimester and third trimester. Remaining stationary in this position for any length of time may cause feelings of nausea or light-headedness due to a reduction in blood flow. The right hip should be elevated 10-15cm to avoid this. Try and find an appropriate time that suits the patient, usually mornings are not appropriate but be guided by the patient.

2. Emergency treatment can be carried out whenever necessary. There is more risk to the baby from being stressed due to pain, anxiety, or having an ongoing infection, than from having dental treatment carried out, at any stage.

3. Elective procedures should be carried out at least 6 weeks post birth.

General Prevention

1. Full clean every three to four months during pregnancy, ideally just before the pregnancy, late in the first trimester, late in the second trimester and then again just before delivery. It may be necessary that more than one appointment is required to return the gum tissue to base line health or at least a stable condition.

2. Use a Fluoride mouthwash, containing no alcohol, every night before bed or after a vomiting event. The eating or drinking of basic pH foods e.g. yoghurt, milk and cheese will also help to rebalance the oral pH. Even chewing sugar free gum will help the salivary flow.

3. Clean teeth, during normal periods 2-3 times daily. We would encourage three times daily. DO NOT CLEAN STRIAGHT AFTER A VOMITING EVENT, WAIT AT LEAST 1 HR POST EVENT.

4. Watch for snacking. Having regular meals at least 1-2 hours apart is ideal. DO NOT CONSTANTLY SNACK.

5. If feeling nauseous avoid fatty foods, highly acidic or spicy foods.

6. Watch that indigestion and reflux formulations are sugar free.

7. In the case of gingival ulceration, warm salty water mouthwashes are appropriate. If necessary, a chlorhexidine or a low strength peroxide based mouthwash can be used. Only use this mouthwash while symptoms persist and do not swallow.

8. It is important that the mother-to-be is informed of any medical changes. For example, if they are on anti-coagulants, this information needs to be passed on to the dental practitioner.

Why is this Protocol Necessary?

By taking a preventative approach we can reduce the likelihood of issues developing down the track. It is necessary that while a mother-to-be is in a phase of her life where medical issues are of an upmost priority, that the dentist is also involved in the initial stages. This will enable conditions to be diagnosed early and treated at the most appropriate times.

Having the ability to diagnose prior to pregnancy is the most important aspect of this protocol. If this time has passed, then late in the first trimester is the next most appropriate time for diagnosis. This enables treatment to be carried out in the second trimester if necessary.

The use of a fluoridated, alcohol free mouthwash every night is a good preventative approach. Fluoride has long been considered a preventative measure for reducing caries. Due to the reduced salivary flow, reduced pH, and increased proliferation and desquamation of the oral mucosa, the pregnant woman's oral environment is primed for an increase in the activity of the carious bacteria and periodontal bacteria (dental decay and gum disease).

Vomiting events also cause not only decreased oral pH, but also an increase in the direct acidic attack on the teeth. Luckily, the teeth are always in a state of breakdown and repair. Hence, extra fluoride across the teeth enables the repair mechanism to work more efficiently and also the repaired structure is stronger against further attacks. The mother-to-be often cleans her teeth after a vomiting event to freshen her breath. This is not appropriate. The pregnant woman needs to be informed that this is damaging and that the use of a fluoridated, alcohol free mouthwash or chewing sugar free gum is more appropriate. TEETH SHOULD NOT BE CLEANED FOR AT LEAST ONE HOUR AFTER A VOMITING EVENT. The erosive effect of the acid, combined with tooth brushing, increases abrasion of the tooth structure.

The feelings of nausea, cravings and the reduced stomach capacity often lead to constant snacking and frequent meals. The mother-to-be has to be informed that eating should be kept at least 1-2 hours apart, and to watch what foods are eaten with the cravings. Avoiding reduced carbohydrate foods and sugary foods would be appropriate.

To control the gum conditions during pregnancy, it is best to carry out a proper clean prior to pregnancy, returning the women to a base line good oral health. This base health can then be easily controlled by regular 3-4 monthly cleans. Pregnancy may exacerbate any existing conditions. Having the woman healthy prior to pregnancy could reduce gingival and periodontal issues (gum disease). It has been speculated in recent research that ongoing gum disease in the pregnant patient can lead to preterm delivery and low birth weight babies.

According to some of the articles reviewed, it is around the 15-20 week mark in pregnancy that it is important to have good base gum health. This is early to mid second trimester. So, even if the pregnant woman has a check up and proper clean very late in the first trimester or early in the second trimester, perhaps requiring extra appointments, then good base-line oral health is definitely achievable by the most critical period.

Conditions such as mobile teeth will return to normal post birth. Pyrogenic Granuloma's can be dealt with if necessary by removing them. However, removing the stimulator factors like plaque and calculus, caught under the swollen tissues, will help to control these issues. Otherwise, this condition is best left until after the birth, generally after 6 weeks.

By following a general preventative strategy you are not only improving you general dental health but also reducing the likelihood of having ongoing problems. The main issue with pregnancy is vomiting and having to eat smaller, more regular meals. Doing this improves the oral environment for the bacteria that cause dental decay and gum disease. Follow a preventative, well constructed and easy protocol like the one discussed here and you will be fine. In this day and age, there is definitely no need to lose a tooth for every child born!

Dr Adam Alford graduated form the University of Sydney, Australia, in 2000 with honors. Dr Alford has worked extensively in Cosmetic and Implant practices in Australia and the UK. He has a special interest in cosmetics and tooth whitening. Dr Alford is the author of the article and he maintains a General Dental, Cosmetic and Implant Dental Surgery in Sydney http://www.mlccentredental.com.au Webmasters are free to reprint this article provided that it is not edited, the authors information is included, and the links are included as live links. To find out more about pregnancy and dental issues please view http://www.mlccentredental.com.au/pregnancy.php.

About the Author

Dr Adam Alford graduated form the University of Sydney, Australia, in 2000 with honors. Dr Alford has worked extensively in Cosmetic and Implant practices in Australia and the UK. He has a special interest in cosmetics and tooth whitening. Dr Alford is the author of the article and he maintains a General Dental, Cosmetic and Implant Dental Surgery in Sydney http://www.mlccentredental.com.au