Prenatal care is often ignored by the patient and dentists as well, as any elective or surgical procedures pose a risk at times. Let us take a look into the dental problems encountered during pregnancy and prenatal care that would require a visit to your dental doctor and precautions to be exercised by the patient in this phase.
Several transient physiologic changes are part and parcel of pregnancy. Around 40 to 45 % of pregnant patients report some sort of gum issues. The most common gum-related and dental conditions reportedly that may be encountered during pregnancy are as follows:
1) Pregnancy Gingivitis:
This affects women who have more plaque or tartar deposits (calculus), causing an increased inflammation of the gums. Apart from pain and bleeding, the color of the gums may be abnormal. It can turn from the usual pink to a dark reddish tinge. This is a spontaneous condition that heals post parturition (childbirth) but is most frequent from the second month of gestation to the eighth month.
2) Pregnancy Tumor or Pyogenic Granulomas:
Pyogenic granuloma is reported in 1 to 5 % of all pregnant women. Usually, when the gingiva or gum inflammation becomes too localized or limited to a specific area of the gums, the swelling is observed like a bulbous red overgrowth. This is seen more often on the interdental margins (gum margins in between the tooth contacts) rather like a swollen strawberry appearance. The cause of this is an underlying local irritant like plaque, food deposits, calculus deposits, or it would also be due to an increase in the circulating progesterone (female hormone) levels in the bloodstream. A visit to the dentist should be scheduled definitely on observation of bleeding gums, pregnancy tumors, or outgrowths, and changes in the gingival contour.
3) Tooth Decay and Erosion:
The phenomenon of multiple teeth decaying or the front enamel layer of the tooth thinning out in pregnant women is attributed by dental surgeons to two main reasons - vomiting and decreased calcium concentration in the body during pregnancy.
Vomiting increases the acidic environment of the oral cavity that can progress enamel erosiveness. During the first few months of pregnancy, some mothers also show an increased interest in consuming rich carbohydrates (high-energy carbohydrates) that accelerate tooth decay. A few pregnant patients also report a decrease in salivary flow (decrease in mouth saliva). The saliva is an important carrier of several antibodies deemed to be the first line of defense against various pathogenic bacteria and host secretions. (The antibodies are also termed immunoglobulins that are of mainly two - the secretory IgA and IgG synthesized in the salivary glands and gingival crevices in between teeth). A decreased salivary flow can again impair the defense mechanisms of the tooth to resist bacterial or carious invasions. Hence it is another major factor accelerating dental caries.
The baby’s tooth development starts at the fifth to sixth week of pregnancy. To ensure that there is more nutrient intake, fiber-rich foods and green leafy vegetables and dietary supplements like Folic acid and Calcium supplements with a rich diet comprising fruits, vegetables, dairy products, fish, and eggs are highly beneficial to the dental development of the fetus. Tooth brushing should also be done strictly and more efficiently than ever in this period by following proper brushing techniques to prevent dental caries and enamel erosion.
4) Periodontal Disease or Tooth Mobility:
Attachment loss and chronic gum recession, along with mobile teeth, are also not uncommon in this phase. In fact, researchers often link periodontal disease as a cause of low birth weight in infants. The dentist can address periodontal issues or other dental and elective issues of the patient in the second trimester of pregnancy as organogenesis (organ development) of the fetus is complete by this period. It is considered safe to get full dental prophylaxis done by your dentist in the second trimester. The first trimester of pregnancy is usually considered high risk for getting any dental treatments done.
5) Pregnancy Melasma or Mask of Pregnancy:
This is characterized by muddy brown pigmentation on the cheeks or elsewhere on the face like upper cheeks, lip, or the forehead that develops very commonly in pregnancy. This pigmentation is further worsened by exposure to heat and UV radiation or light. Light chemical peels for the facial skin or the use of topical ointments recommended by dermatologists will reduce the hyperpigmented areas on the skin surface.
6) Teratogenic Exposure to the Fetus:
Teratogens are harmful agents that can potentially disturb fetal growth, causing congenital abnormalities or even be a cause of abortion. The classes of teratogens include harmful chemicals, nicotine, alcohol excess or alcohol overconsumption, teratogenic medications or drugs, and maternal body infections. Excessive heat and ionizing radiations like x-rays are also unnecessary exposures that would be teratogenic. The dentist can avoid routine radiography in pregnancy unless it is essential.
7) Gestational Diabetes:
Gestational diabetes mellitus (GDM) is a condition associated with people having glucose intolerance that usually accompanies the onset of pregnancy. The glucose metabolism in the body is impaired by inflammatory mediators impacting the beta cells of the pancreas that release insulin, causing resistance in the body cells to this hormone (Insulin Resistance). The dental implication of GDM is periodontal disease, which again, as discussed earlier, may lead to low birth weight infants and preterm birth. This condition is believed to affect 15 % of women worldwide and a major risk factor for fetal complications as well as maternal complications like preeclampsia (high blood pressure, protein secretion in the urine, and weakened immune mechanism of the mother resulting in liver and kidney damage).
Recommended Procedures by the Dental Surgeon:
The current recommendation to undergo dental procedures is hence in the second trimester of pregnancy that includes:
- Scaling (teeth cleaning).
- Root planing.
- Gum curettage.
- Periodontal prophylaxis.
These are some of the treatments safe in this period and essential too when the above conditions remain a cause of concern to the mother.
Strict oral hygiene, follow instructions given by your dental surgeon for regular oral hygiene, proper brushing technique, nutrient-rich diet, and avoiding unnecessary exposure to harmful agents will definitely impact the positive and proper prenatal care that needs to be ensured by the mother for healthy childbirth.
