Pregnancy and Dental Health

Pregnancy is a dynamic, physiological state accompanied by several changes. A pregnant woman may not always understand the relevance of these changes, or how they impact her or her foetus’s health.

Pregnancy alters the immune response of the body. This  can make a pregnant woman more vulnerable to infection than others.

Dental Considerations during Pregnancy

A high incidence (from 30%-100%) of gingivitis or gum inflammation has been reported in pregnant patients. Gums may become noticeably reddish, swollen and have a tendency to bleed easily .These changes may be noticed in the second or third month of pregnancy and increase in severity by the eighth month. This change occurs because increased hormonal levels during pregnancy provide a favourable environment for certain oral bacteria which increase gingival inflammation. Multiple studies have reported that these bacteria are known to release some enzymes in circulation, which may stimulate cervical dilation and labour leading to premature births and low birth weight infants.

As gestational women need to increase their caloric intake in the form of multiple, small meals or carbohydrate based food; their teeth are exposed to higher levels of bacterial acid and dental decay. Dental caries also presents an added bacterial load on the patient. Left untreated, it may progress to development of dental or maxillofacial abscesses and systemic spread of infection. It is important that these infections are immediately addressed at source.

Role of Medications in Pregnancy

Some patients may have an irrational belief that all medications are harmful to the unborn child and should be avoided. The truth is that certain medical conditions, if left untreated, may pose a greater risk to the foetus.While some medicines are definitely contraindicated, safer alternatives are also available. Both the patient and the medical professional need to make an informed choice.

Herbal medications have been used throughout human history. Because herbs are considered as natural products, patients may not perceive them as harmful.Yet, these natural substances may carry their own risks. For example, ginger and garlic have been used  as spices for generations, yet high doses of the latter may increase the risk of heavy bleeding by its anti-platelet aggregation properties. Patients should discuss herbal and supplement usage with their physicians before incorporating them in their diet.

Dental Procedures in Pregnancy

Many pregnant patients and their families may be apprehensive about dental treatment due to fears of inadvertently harming the foetus.As a matter of fact, few dental procedures are contraindicated during non- complicated pregnancies, and those procedures that minimize bacterial load in the mouth are actually beneficial to both mother and foetus.

Dental hygiene procedures such as oral prophylaxis, deep scaling and root planing are effective in controlling inflammation of the gums, and are allowed in any trimester of pregnancy.

• If dental caries is a source of pain, the patient should immediately seek restorative dental therapy.

• In cases of acute infection, medication is of utmost importance to control the spread of infection and minimize complications, regardless of the phase of pregnancy.

• Frequent recall visits are advised to maintain oral health and reinforce good oral hygiene habits.

In summary, pregnancy is  a unique period of various physiologic changes that support the formation and maturation of new life. Every  pregnant woman should be encouraged to seek medical and dental care during her pregnancy, as failure to treat developing problems affects the health of both, the mother and her unborn child.

References:

1) Barak S,Oettinger-Barak O,Oettinger M, et. al.Common oral manifestations during  pregnancy: a review.Obstet Gynecol Surv 2003;58(9):624-8.

2) Dellinger TM, Livingston HM.Pregnancy:Physiologic changes and considerations for dental patients. Dent Clin North Am 2006;50(4):677-697.

3) Lopez NJ,Smith PC,Gutierrez J.Periodontal therapy may reduce the risk of preterm low birth weight infants in women with periodontal disease: a randomized controlled trial.J Periodontol 2002;73:911-24.