Pregnancy is a unique moment in a women’s life, it is associated with several physiologic changes that also impact oral health. Many oral diseases are frequently encountered in pregnant women, few of these are pre-existing, which tend to get exacerbated during this period.
Aim of this write up is to discuss the common oral challenges faced by pregnant women and to highlight options available which are deemed safe, which can go a long way in reducing pain and anxiety associated with dental treatment.
Dental care in pregnant women is challenging as it not only effects the mother but also has implications on the developing fetus. Pregnancy is associated with a plethora of physiologic changes, a hyper coagulable state, hypotensive syndrome, increased risk of gestational diabetes and higher levels of estrogen which impacts gum health.
Many a time patients have an opportunity to plan a pregnancy. In such cases, a visit to a dentist can be very useful to avert many dental complications that may otherwise occur. In this visit, the dentist can perform a clinical examination of teeth and gums along with routine intra oral radiographs to detect any existing decay and can examine the bone levels surrounding the dentition to examine the supporting apparatus of the dentition. Deep scaling can be done to restore good gingival health. Faulty restorations, caries superficial or deep can be treated and the tooth can be secured and inadvertent flare ups can be prevented. Oral hygiene instructions and measures can be taught to the patient to help in maintenance of good oral hygiene.
Dental Radiographs
Xray’s of teeth form an important assessment tool for diagnosis of carious teeth, extend of the caries, proximity of the decay to the nerve structure of teeth, assessment of lesions surrounding the tooth apparatus and also for diagnosing bone loss surrounding the periodontal structure of teeth. Digital dental radiography (RVG – Radiovisiography) is the norm in current scenario. This has greatly reduced the radiation exposure to pregnant women and the fetus. It has been stated the mean organ dose to the uterus is 0.4µSv per radiograph (Kelaranta etal 2016) and the use of a protective lead apron with a thyroid collar reduces the dose by a factor 2. European guidelines on radiation protection in dental radiology state that there is no contraindication in preventing females who are or may be pregnant from undergoing dental radiography when clinically justified. The exposure to radiation is done adhering to ALARA principle (As low as reasonably achievable) and also only when absolutely necessary to diagnose and treat a dental emergency during pregnancy. This is done only after prior consultation and discussion with the attending gynecologist and obstetrician.
The most common oral condition in pregnancy is gingivitis, and afflicts about 60-70 % of pregnant women. This is in part is related to estradiol levels, poor oral hygiene, and also increased response to inflammatory agents (Plaque bacteria) in these women. Several studies have explored correlation between preterm births and periodontal disease with varying outcomes. Research has shown non-surgical periodontal therapy that is oral prophylaxis and root planning during the second trimester is safe.
This is also known as pregnancy granuloma/ pregnancy tumor. This is a benign tumor which histopathologically shows hyperplastic gingival connective tissue. This is often seen in areas of the gum adjacent to poor oral hygiene. This is treated by conservative non-surgical subgingival scaling and root planning with reinforcement of oral hygiene maintenance instruction. It usually regresses spontaneously post-delivery in most cases; however occasional cases may require surgical excision.
Nausea and vomiting are common complaints in pregnant women. Many women find tooth brushing difficult, as it triggers a sensation of nausea. This can be addressed by moving the brushing time to later in the morning, changing the tooth paste to some other flavor which may be more aggregable to the patient. Repeated and intense vomiting can lead to dental erosions which is a chemical dissolution of tooth enamel leading to tooth sensitivity. Patients should avoid brushing immediately after being sick as the enamel is hypomineralised and is more vulnerable to loss.
Although there is no increased incidence of tooth decay in pregnant women, there is a greater risk of progression in pre-existing and untreated caries. Higher anxiety levels are common in pregnant women; this adds on to anxiety that frequently is associated with dental treatment. Deep caries is often accompanied by excruciating relentless pain. With limited oral pain killers that can be used in these women, and in many cases the pain is not alleviated by medications and dental intervention often becomes necessary. Several conservative treatment options exist like direct and indirect pulp capping, Root canal treatments (RCT) which are routine outpatient procedures and are a non- surgical form of caries management performed under local anesthesia. These can be done to relieve severe pain which is especially exacerbated in reclining position during night time, affecting sleep and adding to anxiety levels due to lack of rest. All treatments are done only after due clearance and consultation with the attending gynecologist and obstetrician.
Diet plays a very important role in general and oral health of the pregnant woman and fetus. The health of dental enamel is primarily affected by carbohydrates, which undergoes a continuous cycle of abrasion, demineralization, restoration, and remineralization. This can be greatly aided by reducing consumption of refined carbohydrates, reducing in between meal carbs, and most importantly maintaining good oral hygiene. Topical fluorides especially in the form of fluoride-based mouthwashes along with correct brushing technique greatly aids in rendering the tooth structure more resistant to tooth decay.
The Basic unit of life is a cell, and just as cells interplay with each other forming a tissue; multiple tissues form an organ; organs together function in harmony to create the organ system, and organ systems like an harmonious orchestra constitute the human body; inter disciplinary cooperation and referral can lead to an extended care and well being in a pregnant woman.
Dr. Preeti L. Anand Senior Dental Surgeon & Implantologist Kauvery Hospital Chennai
