Oral Health of the Pregnant Patient

Oral health care during pregnancy is often avoided and misunderstood by patients and clinicians. It is very important to the mom to be to get regular checkups throughout the pregnancy. Many oral manifestations can occur at anytime, such as gingivitis, pregnancy tumors and Periodontitis. Periodontitis is associated with preterm birth and low birth weight, cariogenic bacteria in mothers can also lead to increased caries in the infant. Every pregnant should be examined for possible oral health risks, educated on proper oral hygiene and take any necessary action on any problems that have occurred.During the second trimester it is safe to provide restorative treatment, take xrays, and provide periodontal treatment. As clinicians, it is our responsibly to effective identify and diagnose problems before they become serious and hazardous to the patients health. Introduction Only 22 to 34 percent of women in the United States see a dentist during pregnancy. When an oral health problem does occur, only one half of pregnant women attend to it. Women may be more motivated to make healthy changes to their life style during pregnancy.This is the perfect time for clinicians to encourage healthy dental care. In order to start with those healthy changes, Clinicians must understand oral manifestations that can occur throughout pregnancy so we can well address the issue and educate our patients. Common Oral Problems The most common oral disease in pregnancy is gingivitis. About “one half of women with preexisting gingivitis have significant exacerbation during pregnancy”(Silk et al. , 2008). Gingivitis in pregnancy is caused by fluctuations of estrogen, progesterone levels, oral flora and a decreased immune response.To manage gingivitis, thorough oral hygiene measures are taken including tooth brushing and flossing. Patients with severe gingivitis may need professional cleaning and a prescription mouth rinses such as chlorhexidine may be prescribed. Periodontal disease can occur if gingivitis is not managed. The second most common problem associated with pregnancy is morning sickness. The oral cavity is exposed to gastric acid that can erode the enamel. Later on during pregnancy upward pressure from the gravid uterus can cause or exacerbate acid reflux.To reduce erosion of teeth, have patients with a teaspoon of baking soda in a cup of water after vomiting can neutralize acid. After vomiting, patients should be advised not to brush their teeth immediately after. Dental caries is another concern among pregnant women. These women are at a high risk because of carvings that are sugary and are frequently consumed throughout the day. Increased acidity and limited attention to their oral health is a contributing factor. Pregnant patients can decrease their risk of caries by brushing twice daily with fluoride toothpaste and limiting sugary foods intake.Pregnancy tumor is another less common problem that can occur during pregnancy. This occurs in about 5% of pregnancies. It is a benign tumor caused by increased progesterone, local irritants and bacteria. Pregnancy tumors are most common after the first trimester. They grow rapidly and typically stay throughout whole pregnancy. They will recede after delivery, but sometimes they do need to be removed. Teeth can become loose during pregnancy, even when gum disease isn’t present. This happens because of increased levels of progesterone and estrogen affecting the periodontium.Clinicians should reassure patients that the condition is temporary, and will not cause tooth loss. Dental Treatment Dental procedures should be scheduled during the second trimester of pregnancy, ideally. At this time organogenesis is complete. Urgent dental care can be performed at any gestational age. During the third trimester additional problems may occur. A pregnant patient may feel discomfort lying back because the weight of the uterus pressing on the major vessels. To relieve this discomfort have patient lay on left side and place towel under right hip.If dental care is postponed until after delivery it can be problematic because the new mom may be to busy with their newborn. Dental xrays may be taken in pregnancy for acute diagnostic purposes. If possible xrays should be delayed until after first trimester. To limit radiation exposure to mom to be and fetus avoid retakes, use fast film and lead aprons with a thyroid collar. Conclusion Every pregnant woman should be seen by a dentist during their pregnancy to prevent or treat any oral conditions that can arise.Catching problems early will benefit the mom to be and the unborn fetus. Many women neglect the dentist because they don’t know how important it is. By spreading the word and educating patients who are planning to become pregnant clinicians can prevent or manage these conditions. . References Silk, H. , Douglass, A. , Douglass, J. , & Silk, L. (2008). Oral Health During Pregnancy. American Family Physician, 77(8), 7. Retrieved March 19, 2013, from the EBSCO Host database.


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