Treatment of pregnant women
Contrary to popular belief, it is possible and even necessary to treat teeth during pregnancy! Inflammation that develops and is accompanied by pain can put the baby at risk. Young mothers-to-be very often (unfortunately) turn to the painkillers and decide not to visit the dentist - such behaviour is reckless, as the inflammation will not go away on its own and the piercing pain will increase with every passing hour. Inflammation is dangerous for the baby, as any bacterial toxins come into direct contact with the foetus.
Dental care for pregnant women is particularly important as a woman's oral health has a significant impact on the course and timing of pregnancy termination. It is estimated that approximately 18% of preterm births and low birth weight births are associated with periodontal disease and oral inflammation. Particular importance is therefore attached to the correct prevention and treatment of periodontal disease, which can lead to a significant reduction in the incidence of preterm births.
In order to protect the unborn child from any defects, it is essential to prevent and treat any cavities before pregnancy (if possible). It is also important to know that during the first trimester of pregnancy most women suffer from recurrent nausea (vomiting), which leads to damage to the enamel and exacerbates the growth of existing carious lesions. It is the increasing carious lesions, periodontal disease, increased tooth mobility, sensitivity of the gums to pain and bleeding, as well as unpleasant odour from the mouth, that are the most important problems prompting a pregnant woman to visit the dentist.
During the nine months of pregnancy and during breastfeeding, teeth are more than usually exposed to decay. The baby extracts vitamins and calcium from the woman, which contributes to the destruction of teeth. The increase in carious lesions during pregnancy is mainly due to neglect of oral hygiene, increased cravings and frequent snacking on high-carbohydrate foods. It is also related to the acidic reaction of saliva during pregnancy and damage to the enamel as a result of pregnant vomiting. Under the influence of oestrogens, the gums becomeThey hypertrophy and congestion, which promotes their swelling and bleeding. Pregnant women are advised to rinse their mouth with diluted fluoride-containing liquid. It is not advisable to brush the teeth with a toothbrush immediately after vomiting, as this intensifies damage to the enamel. In these women, it is also advisable to rinse the mouth with 0.12% chlorhexidine solution, e.g. Eludril.
Pregnancy gingivitis and periodontal infections
Pregnancy gingivitis is a transient phenomenon. It can be generalised or localised. It most often appears at the beginning of the second trimester. Gradually, the symptoms worsen, peaking at ca. 8 months of pregnancy and then decrease as the due date approaches.
UNTREATED PERIODONTAL INFECTIONS HAVE BEEN FOUND TO CAUSE PREMATURE TERMINATION OF PREGNANCY AND LOW BIRTH WEIGHT BABIES
This is the result of a number of mediators whose secretion is stimulated by exo- and bacterial endotoxins. This increases the production of hormones that stimulate the contractile function of the uterus. The risk of preterm birth (before 37 weeks of pregnancy), according to various data, increases 3.9-7.9-fold in women with periodontitis, compared to women without inflammatory changes. It has also been shown that women in whom serum antibodies to the most common pathogen causing periodontitis (P. gingivialis) were detected in the third trimester were more likely to give birth to babies with a low birth weight of less than 2,500g (10-11% versus 1,84% ).
The most common symptoms of pregnancy gingivitis are distension, hypertrophy, soreness and bleeding of the gums. These are signals with which you should immediately visit your dentist.
Scope of dental treatment during pregnancy
Pregnant women, like at no other time in their lives, need planned and attentive dental care. Contrary to popular belief,
THERE ARE NO CONTRAINDICATIONS TO PREVENTIVE AND CURATIVE DENTAL TREATMENTS DURING PREGNANCY
However, the safest period is the second trimester. This is because the first three months are a special period - a time when the foetus is forming and the most important organs are developing, and in the third trimester, due to the inconvenience of the size of the abdomen, treatment can be more difficult. Although it requires a little more effort than usual, all dental problems during pregnancy can be prevented with prevention, regular check-ups and appropriate treatment.
X-ray during pregnancy
The effect of X-rays on the foetus has been the subject of much research work for many years. Recent studies have shown that there is a link between the use of dental radiography and low birth weight, through the effect of radiation on the hypothalamic-pituitary-thyroid system.
DURING PREGNANCY, X-RAY DIAGNOSIS SHOULD BE KEPT TO A MINIMUM AND ONLY PERFORMED WHEN NECESSARY
Local anaesthesia in pregnancy
There are no contraindications to the use of local anaesthetics in an expectant mother. However, the woman should inform the doctor in advance that she is pregnant, as this affects the choice of anaesthetic. It is often the case that the fear of dental treatment without anaesthesia causes the secretion of more stress hormone (adrenaline) than its content in the anaesthetic, which can have a much worse effect on the foetus.
FOR PREGNANT WOMEN IN THE UUDS CLINIC WE USE ANAESTHESIA WITHOUT VASOCONSTRICTORS
Painkillers during pregnancy
IN THE FIRST TRIMESTER IT IS ADVISABLE TO LIMIT THE USE OF ANALGESICS
Paracetamol is one of the few permitted agents used in therapeutic doses (daily dose max. 4g). However, its short-term use is recommended, as it crosses the placental barrier and passes into breast milk.
There is no clear position on the use of acetylsalicylic acid (aspirin) in pregnant women, especially in the first trimester of pregnancy. This is related to the conflicting results of studies on the effect of this drug on the occurrence of birth defects. However, the results of studies indicate an increase in stillbirth rates in mothers taking aspirin, which caused premature closure of the arterial duct, and an anti-aggregative effect of aspirin on platelets, causing bleeding in the foetus (including intracranial bleeding). Also in the mother, acetylsalicylic acid can cause increased perinatal blood loss and cause prolonged labour.
NSAIDs (non-steroidal anti-inflammatory drugs) have a similar effect to aspirin, causing inhibition of prostacyclin and prostaglandin E2 production. They affect premature contraction and closure of the arterial duct. It has been theorised that NSAIDs may inhibit labour function and prolong the duration of labour.
Antibiotics during pregnancy
For acute oral inflammation, the doctor may use antibiotics. Antibiotics are some of the most extensively studied drugs in pregnant women. The safe and widely used group are penicillins and cephalosporins. Penicillins can be used safely even in the first trimester of pregnancy, as no teratogenic effects of this group of drugs on the foetus have been demonstrated. They are recommended as drugs of choice for oral infections, including periodontal infections. It has also been established that cephalosporins can also be used safely during breastfeeding.
In patients allergic to penicillins or cephalosporins, macrolides, especially erythromycin, are recommended for the treatment of oral infections. It passes slightly through the placenta and can even be used in the first trimester of pregnancy. However, it is not recommended during breastfeeding due to its high accumulation in milk.
Tetracyclines, aminoglycoside antibiotics, chloramphenicol and polypeptide antibiotics should not be used in pregnant or breastfeeding women. Sulphonamides, trimethoprim and quinologues should also not be used during pregnancy. Metronidazole, due to its mutagenic effects found in rat studies, is avoided by most dentists.
Proper nutrition for mothers-to-be
A pregnant woman should not "eat for two" - experts estimate that she should consume just 500 kcal more than usual. It is also important to maintain an appropriate protein-carbohydrate-fat balance (with restriction of simple carbohydrates: sugar and white bread), the observance of which prevents excessive caries in the mother and creates optimal conditions for the development of the foetus's dental buds.
Pregnant women should pay attention to the fact that in the eighth week the taste receptors of the foetus are developing. The mother's predilection for sweets, occurring at this time, can increase the child's propensity for sweet foods in the future and thus increase the risk of caries.
Hygiene measures beneficial during pregnancy
During pregnancy, special attention should be paid to hygiene procedures, both at home and in the dental surgery. In home prophylaxis, tooth brushing with fluoride toothpaste is very important - preferably after every meal or at least twice a day. Pregnancy is the time when the patient should (if she has not already done so) start using additional utensils and hygienic preparations in the form of dental floss, toothpicks or rinses.
In the prevention of dental caries in the dental surgery, it is important to carry out systematic hygienization and contact fluoridation as well as tooth varnishing.
