Managing pregnant dental patients – Dr Nik Sisodia, implantologist at Ten Dental

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  Posted by: The Probe      4th February 2019

Pregnancy is often an exciting time in a woman’s life, but it can also be a period filled with uncertainty and anxiety. If a patient is expecting, then there is likely to be some big physical changes in store for their body within the next nine months. Pregnant women not only have to worry about increased weight gain, fatigue, and morning sickness, but there’s also a whole host of aches and pains to contend with in preparation for giving birth. The fact is pregnancy affects nearly every aspect of a woman’s life, including their oral health. This is a factor of pregnancy that should not be overlooked, particularly as the consequences of doing so can be devastating and far-reaching for both mother and baby.

With so much for pregnant women to reflect on, it can be easy to disregard dental care as non-essential, which is perhaps the reason why some women choose to skip regular visits to the practice during pregnancy. Contrary to what some might believe, however, timely dental care is crucial to prenatal treatment, especially as pregnancy triggers elevations of hormones such as oestrogen and progesterone, causing a heightened inflammatory response to the build up of plaque in the oral cavity.[i]This results in sore and bleeding gums, which is a condition commonly referred to as ‘pregnancy gingivitis’. Affecting approximately 70% of pregnant women, the severity of this inflammatory disease gradually increases until the 36thweek of gestation.[ii]

Naturally, it is crucial for practitioners to monitor pregnant patients to prevent gingivitis from developing into a more serious issue. If left untreated, gingivitis can quickly progress into periodontitis and loss of alveolar bone around the teeth, thus leading to the loosening and subsequent loss of teeth.[iii]Extra care should be taken due to increased susceptibility to these complications, particularly as several studies have shown an association between periodontal diseases and adverse pregnancy outcomes. These include preterm birth or low birth weight, pre-eclampsia, and even stillbirth.[iv]

Although additional research is still required to confirm the cause of these adverse reactions, it is thought that some of the bacteria responsible for destroying the periodontium can invade cells and tissues. Subsequently, the body’s exposure to these microorganisms generates an inflammatory response at a systemic level, causing potential damage to specific organs such as the placenta, which is fundamental to successful gestation.[v]This is a very worrying problem considering there is currently no evidence to suggest that prenatal oral healthcare can actually improve pregnancy outcomes if a woman is suffering from periodontal complications.

As such, the importance of taking preventive steps cannot be underestimated, particularly as pregnant women are also at an increased risk of developing dental caries.[vi]Again, this stems from the influence of hormones leading to a lack of saliva, which is key to washing away food particles and controlling oral bacteria.[vii]With many women experiencing food cravings during this time of drastic physiological change, their consumption of sugary treats and savoury snacks can also increase. These factors combined with poor or neglected oral hygiene – often as a result of feeling tired or unwell – can result in a greater risk of caries in pregnant patients.

Frequent vomiting is another common dental problem encountered in the early stages of pregnancy, and one that can have negative effects on a woman’s oral health. This is because stomach acid is strong enough to erode dental enamel and increase demineralisation, making teeth more prone to caries. Tooth erosion can be effectively controlled with the use of solutions containing sodium bicarbonate, which neutralises acids and prevents damage caused by residue left on the teeth due to vomiting.iThis should be considered as part of a good oral hygiene routine, which includes limiting the consumption of sugary foods, and brushing regularly with fluoridated toothpaste and mouthwashes in order to counteract the effects of demineralisation.

While many dentists stress that it is important for pregnant women to attend the practice for routine examinations and professional cleanings, some mothers-to-be may lack the inclination to do so. It’s hard to blame them when they may be more anxious about other aspects of pregnancy. This ultimately presents a problem for practitioners, as pregnant women may be difficult to treat in the event of more serious oral health complications. For instance, treatment of acute dental pain in emergency situations during pregnancy is often a delicate procedure fraught with contraindications and the necessity for multiple precautionary measures. In fact, some medications cannot be administered because they may affect the development of the foetus.

Therefore, a carefully considered approach will have to be taken, possibly involving multidisciplinary treatment that might be beyond your professional remit. In this case, it is worth referring to a trusted clinic like Ten Dental Facial. Its award-winning team of specialist practitioners are highly experienced in treating complex cases and are well equipped with the essential skills needed to deliver the highest quality care to patients with additional needs, including expectant mothers. Comprehensive dental treatment combined with good oral hygiene is as vital during pregnancy as it is once the baby is born. Reminding patients of this fact is essential to ensuring both mothers and their babies can benefit from long, healthy lives free from dental problems.

 

For more information, visit www.tendental.comor call on 020 33932623

 

REFERENCES 

[i]Naseem, M., Khurshid, Z., Khan, H. A., Niazi, F., Zohaib, S. and Zafar, M. S. (2016) Oral health challenges in pregnant women: Recommendations for dental care professionals. The Saudi Journal for Dental Research. 7(2): 138-146. Link:https://www.sciencedirect.com/science/article/pii/S2352003515000404/. [Last accessed: 02.10.18].

[ii]De Vasconcellos Piscoya, M. D. B., de Alencar Ximenes, R. A., da Silva, G. M., Jamelli, S. R. and Coutinho, S. B. (2012) Periodontitis-associated risk factors in pregnant women. Clinics. 67(1): 27-33. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248597/. [Last accessed: 02.10.18].

[iii]Khan, S. A., Kong, E. F., Meiller, T. F. and Jabra-Rizk, M. A. (2015) Periodontal Diseases: Bug Induced, Host Promote. PLoS Patheogens. 11(7): e1004952. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520614/. [Last accessed: 02.10.18].

[iv]Kloetzel, M. K., Huebner, C. E. and Milgrom, P. (2011) Referrals for Dental Care During Pregnancy. Journal of Midwifery & Women’s Health. 56(2): 110-117. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074205/. [Last accessed: 02.10.18].

[v]Varadan, M. and Ramamurthy, J. (2015) Association of Periodontal Disease and Pre-term Low Birth Weight Infants. Journal of Obstetrics and Gynaecology of India. 65(3): 167-171. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464563/. [Last accessed: 02.10.18].

[vi]Wagle, M., D’Antonio, F., Reierth, E., Basnet, P., Trovik, T. A., Orsini, G., Manzoli, L. and Acharya, G. (2018) Dental caries and preterm birth: a systematic review and meta-analysis. BMJ Open. 8(3): e018556. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855295/. [Last accessed: 02.10.18].

[vii]VT, H., T, M., T, S., Nisha, V. A. and A, A. (2013) Dental Considerations in Pregnancy-A Critical Review on the Oral Care. Journal of Clinical and Diagnostic Research. JCDR. 7(5): 948-953. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681080/. [Last accessed: 02.10.18].


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