Why go to the dentist during pregnancy? Dental hygiene during pregnancy

27.11.2019

Pregnancy is a special period in a woman’s life, during which it is necessary to be most responsible and careful when using any medications. Especially those that can have a significant impact on the body of the expectant mother. These drugs include any painkillers used during anesthesia and anesthesia.

It is not surprising that many women are afraid to use anesthesia even for severe toothache, as they are not sufficiently aware of the safety of this procedure.

Why should a pregnant woman go to the dentist?

After the gynecologist - to the dentist! If your suspicions about pregnancy are confirmed, the first, or one of the first, doctors you visit after leaving the antenatal clinic should be a dentist - even if you have never complained about your teeth before.

Features of dental treatment for pregnant women

Dental treatment is a mandatory medical procedure, regardless of whether a woman is preparing to conceive a child or is already pregnant. The dentist’s tactics depend on the trimester of pregnancy, its course, the general somatic health status of the pregnant woman and indications for treatment. Peculiarities of management of pregnant women are characterized by the following features:

Treatment planning

During pregnancy, emergency dental treatment is performed, the indications for which are:

Carious lesions of hard and soft tissues of teeth: pulpitis, periodontal inflammation (periodontitis).
Pathological processes of soft tissues of the oral cavity, gums: gingivitis, stomatitis, cheilitis, glossitis, inflammation of periodontal tissues.
Tooth injuries: fracture of the crown or root of the tooth, dislocation, cracks and chips of the crown part.
Abscesses.
Acute purulent inflammation of the jaw bone tissue.

Planned therapy (orthodontic, implantological and orthopedic treatment) is postponed to the postpartum period.

Pregnancy data

Before starting treatment, you should inform your doctor about the duration and course of pregnancy, taking medications prescribed before conception and during pregnancy, and bad habits. These data can significantly affect the treatment plan drawn up by the dentist.

X-ray diagnostics

X-ray examination is extremely undesirable in all trimesters of pregnancy: failures in the formation of fetal cells can lead to irreparable consequences and abnormalities. The 1st and 3rd trimesters are especially dangerous for radiation diagnostics, however, the 2nd trimester is no exception, although it includes lower risks of developing pathology.

Dental filling

When filling teeth, materials of both chemical and light curing are used. Curing lamps used for curing are also not safe for the developing fetus.

Anesthesia

At the present stage of development of dentistry, painkillers are produced that are absolutely harmless to the pregnant woman and the fetus. High-quality anesthesia is half the success of treatment.

We know that it is possible to treat in a certain trimester

Pain relief at the dentist during pregnancy

Local anesthesia (an injection into the gum) is quite possible, however, during pregnancy there are a number of restrictions and features, so you must inform your doctor that you are expecting a baby.
Even if you still suspect that you might be pregnant, it is better to play it safe and tell your dentist about your suspicions - he will certainly select an effective and safe anesthetic for you and the child (for example, ultracaine or ubistezin). There are people who are terrified of the dental office and dream of solving their “dental” problems “by magic” - with the help of general anesthesia. I would like you to know: dental treatment under general anesthesia is generally a double-edged sword (no one can predict in advance how your body will react to anesthesia), and during pregnancy it is completely contraindicated.

Anesthesia, painkillers and antibiotics

Anesthetics during pregnancy are dangerous because they can penetrate the placenta and also increase blood pressure due to the high content of adrenaline. However, its concentration in a ratio of 1:200,000 has been proven to be safe for both mother and child. It is recommended to use ultracaine and ubistezin as pain-relieving injections during pregnancy. And it is better not to use lidocaine, which is more popular in dentistry, as a “freeze”: it causes cramps and muscle weakness. Also, during pregnancy, anesthesia is strictly prohibited. If complex treatment or tooth extraction cannot be avoided, the doctor may prescribe painkillers to the patient. Ibuprofen and paracetamol are considered the safest during pregnancy, but you need to keep in mind that taking ibuprofen is not recommended in the 3rd trimester. Antibiotics should also be avoided by expectant mothers, but if there is a risk of complications and the development of bacterial infections, drugs from the group of penicillins and cephalosporins are acceptable.

Fluoridation of pregnant teeth

To preserve and strengthen tooth enamel, doctors often recommend so-called local fluoridation with fluoride-containing solutions and varnishes. The fact is that fluorides suppress the metabolism of bacteria, promote hardening of the surface of the teeth and increase the resistance of teeth to acidic environments. In domestic dentistry, two methods of fluoridation are practiced. With the application method, a so-called “individual tray” is made - a kind of individual wax impressions of the teeth. A fluoride-containing composition is poured into the recesses of such impressions, and then they are applied to the patient’s teeth. This procedure requires 10-15 visits to the dental office. The second method is to apply fluoride-containing varnish with a brush to the surface of the teeth (in 3-4 visits).

Bleeding Gums

If you suddenly notice that while brushing your teeth, traces of blood remain on the brush, and when you further rinse your mouth, the foam from the toothpaste turns pink, this means that you have increased bleeding gums. Increased bleeding is a warning sign that all is not well.

Healthy teeth do not necessarily mean healthy gums. Increased bleeding of gums during pregnancy is not uncommon. It may be due to hormonal changes in a woman’s body. To solve this problem, you need to consult a doctor. In this case, the diagnosis sounds like this: “gingivitis of pregnant women.”

To prevent the occurrence of this unpleasant disease, plaque should be removed and tartar in the subgingival area should be removed. In a dental office, these procedures are performed using different techniques. One of them, the so-called “air flow,” is carried out without the use of a bur and without a tip. A stream of air, water and powder flows under pressure. In this way, plaque and partially tartar are removed. This procedure is also called gentle whitening, since the teeth are restored to their natural shine and whiteness, and the enamel structure does not deteriorate.

Another method of preventing gingivitis allows you to completely remove massive deposits of tartar. It requires the use of ultrasound. The procedure is completed by polishing the teeth and coating them with a special fluoride varnish. Both “air flow” and other methods will require significant material costs. The cost is approximately the same - 80-90 rubles per tooth.

As a rule, gum inflammation is caused by “harmful” microflora of the oral cavity.

A number of toothpastes, including extracts of medicinal plants, have an antiseptic effect. Additions of chamomile, calendula, and sage relieve inflammation and strengthen the gums. To enhance the effect of the paste, it is supplied with a complex of vitamins.

If, however, gingivitis does develop, then after removing plaque and tartar, the dentist will most likely suggest using a special gel for the gums; you can read about it in more detail in the “review of oral hygiene products for pregnant women.”

The gel is used in addition to toothpaste, and not instead. If the manifestations of gingivitis are severe, then gingival anti-inflammatory dressings are used. The course is 3-10 sessions. They contribute to the rapid subsidence of the inflammatory process and reduce bleeding.

It is worth checking your toothbrush; sometimes the reasons for increased bleeding of the gums are quite commonplace - the bristles are too hard.

Increased bleeding may be a symptom of a more serious disease - periodontitis. Periodontium is the soft tissue surrounding the tooth. Their inflammation is periodontitis. It is quite severe and can result in the loss of healthy teeth.

Teeth whitening during pregnancy

The teeth whitening procedure consists of two stages. First, plaque and tartar are removed and removed, then the teeth are treated with special whitening pastes and elixirs. Plaque is removed either using ultrasound (it may make sense to refrain from this procedure in the first half of pregnancy), or using special pastes that are used to treat each tooth separately (which is absolutely safe at any stage of pregnancy). Whitening pastes and elixirs are completely harmless to the mother or fetus. The teeth whitening procedure usually lasts about an hour.

Tooth extraction during pregnancy

Tooth extraction is a good reason for stress. During pregnancy it is strictly contraindicated. Therefore, the decision to remove a tooth is made only in extreme cases:

The presence of a cyst more than 1 centimeter in diameter.
Fracture of the root or crown.
Acute pain that cannot be relieved in any other way.
A deep focus of caries, which is a source of suppuration.

Wisdom teeth should never be removed in pregnant women. After all, after such an operation the socket often becomes inflamed. Stopping this process requires taking antibiotics. This, in turn, is extremely undesirable for the mother and fetus.

What kind of water should a pregnant woman drink?

It has been proven that fluoridation of drinking water significantly reduces the likelihood of developing caries. In our country, fluoridation is carried out (the standard concentration of fluoride in drinking water is 1.5 mg/l), however, unfortunately, there are frequent cases of both a lack and an excess of fluoride in drinking water. Don't think that low fluoride levels are the only cause for concern. An excess of this element is fraught with fluorosis (a specific lesion of tooth enamel, manifested externally in the form of yellow spots), which threatens not only the mother, but also the unborn baby (after all, baby teeth are formed at 3-5 weeks of intrauterine development). You can find out what the concentration of fluoride is in your drinking water at your local SES (but do not expect that SES employees will, on their own initiative, inform you about the level of fluoridation in your drinking water!). To regulate the level of fluoride in water, you can use special filters that are now commercially available.

Rotten tooth! Delete or wait?

Elena K.: “Before pregnancy, I had very bad teeth, some required removal, and I didn’t have enough time and courage to go to the dentist. Now that I'm pregnant, I'm afraid of being completely without teeth. What is the best thing to do?

Due to the environment, not everyone can boast of healthy and white teeth, especially those with average and low incomes. So if pregnancy threatens to deprive you of your last teeth, you need to take immediate action. Remove all rotten, damaged teeth that cannot be restored. Firstly, this will eliminate the source of infection from the mouth, and secondly, diseased teeth tend to worsen during childbirth. And then you may have to give birth in the dentist’s office with an acute toothache.

Thanks to the development of new anesthetics that do not pass through the blood-placental barrier, removal will not be a particular problem. New drugs “Ubistezin” and “Ultracain DS” will provide fast and reliable anesthesia.

The safest time for tooth extraction is the 3-6th month of pregnancy.

Dental hygiene during pregnancy

And yet, the main way to fight bacteria is regular (at least 2 times a day!) brushing your teeth and sanitizing the oral cavity. When brushing your teeth, you must follow a number of simple but very important rules:

The toothbrush should have stiff bristles of different lengths, the head should be elastic and movable (different bristle lengths and the elasticity of the head will ensure better “passability” of the brush). The brush should be changed 2-3 times a month. Fluoridated paste is preferable (see above).
It is necessary to brush all surfaces of the teeth - the front, palatal ("backside") and chewing ("horizontal"), brush movements - vertical and following the contours of the gums. You need to brush your teeth in the morning and evening (at least) for 3-5 minutes.
The most vulnerable area to the harmful activity of bacteria is the border between the gums and teeth. These areas need to be cleaned especially carefully and at the same time with great care so as not to injure the gums.
It is useful to know that caries most often begins with the last - seventh or eighth - teeth. These teeth should be given special attention when brushing.
No matter how masterfully you use a toothbrush, at least a third of the surface of your teeth will still remain inaccessible to you. Therefore, it is recommended to use floss every day after meals - a special silk thread for cleaning interdental spaces (even fluoridated flosses have appeared recently). In the absence of floss, you can also use a toothpick, but with its help it is more difficult to “get” to hard-to-reach places, in addition, the toothpick should be used carefully so as not to injure the gums.
As an additional remedy, you can use dental elixirs that have both a cleansing and protective effect. There are special devices that supply dental elixir under pressure, which allows you to “get” to the most inaccessible places.

If you brush your teeth after every meal, it is easier to deal with harmful bacteria, but this, as you understand, is not always available to everyone. Try to at least rinse your mouth after eating, and if you enjoy something sweet, it is useful to eat a piece of cheese. The fact is that there is such a thing as the buffer capacity of saliva. Without going into details, let's say that this indicator characterizes the ability of saliva to neutralize acids and bases. It has been proven that when eating carbohydrate foods, the buffer capacity of saliva decreases, while protein foods (including cheese) increase it, and therefore resistance to caries.

I feel what I feel in my teeth

During pregnancy, it is especially important to eat right.

However, if hot and cold dishes cause severe aching pain, appetite disappears, in this case at least two suffer (mother and fetus).

The problem of increased tooth sensitivity is associated with the thinning of the enamel, which, like a shell, covers the underlying dentin, enveloping the vessels and the actual sources of pain - the nerves. The appearance of pain is an impetus that forces you to go to the dentist. There may be several reasons for thinning enamel. One of them, the most common, is the loss of calcium by the enamel, as a result of insufficient intake from food and increased consumption by the body. Another reason is early toxicosis, which was already mentioned above. Another reason that is not related to pregnancy, but does occur, is the wrong choice of toothpaste.

Toothpastes of the “Sensitive” type have been developed especially for those with teeth with increased sensitivity.

According to dentists, the most common cause of tooth sensitivity is improper brushing.

To learn how to properly brush your teeth, you must contact a dental center. Training is carried out individually in one session. The cost of this procedure is about 300 rubles. As a rule, the dentist invites the pregnant woman for a follow-up cleaning. To assess whether the patient is coping with the task correctly or not.

Tooth sensitivity can be caused by cervical caries, when a hole in the tooth is located at its base, next to the gum. Then the solution to the problem is only a filling in the problem area. If tooth sensitivity does not decrease, despite all efforts, then “Sensigel” will help, it contains special substances that reduce tooth sensitivity. The cost of the drug is 180-190 rubles. The dental office has pharmacological agents to reduce tooth sensitivity that have a prolonged effect (up to 6 months), but the cost of the procedure is much more expensive.

Diet

First, as already mentioned, you should limit your intake of foods rich in carbohydrates, and first of all, your intake of sugar. It is necessary that food contains in sufficient quantities all the macro- and microelements and vitamins necessary for the human body. Calcium, phosphorus and fluorine1, as well as vitamin D are especially important (cod liver oil, cod liver and Atlantic herring, chicken eggs and some other foods are rich in vitamin D).

Dear expectant mothers, this may sound like a pun, but remember: your teeth are in your hands!

1 About the role of calcium in the body, food and other sources of calcium, see this issue of the journal: L. Belinskaya “Macroelements”. A continuation of this article will be published in the next issue, where you will find information about microelements, incl. phosphorus and fluorine.

Healthy teeth for the father and mother are the key to healthy teeth for the child

Already in the fifth or sixth week of pregnancy, the rudiments of the baby’s teeth are formed. If the mother has a “bad” mouth by this period of pregnancy, then the process of mineralization of the fetal tooth buds is disrupted, which over time will lead to problems for the child, both with milk and permanent teeth.

For normal growth of bones and tissues of the unborn child, in addition to other minerals, sufficient amounts of calcium and fluoride are necessary. A well-balanced diet rich in vitamins A, C, D, minerals, plus nutritional supplements or prenatal vitamins will fully compensate the body and promote good overall health and normal dental development for the baby. Nutritional supplements and vitamin-calcium complexes are individually selected by a gynecologist.

Foods richest in calcium: milk and dairy products, kale, broccoli, spinach, baby turnips. Calcium is best absorbed from fish products.

A lack of calcium may be indicated by seizures and tooth decay in the mother. If symptoms appear, you should consult a doctor. You should not take calcium supplements on your own, as an excess of it will lead to skeletal disorders in the fetus.

However, the quality of the baby’s teeth depends not only on the condition of the mother’s teeth. Half of all dental problems in babies are caused by their father. No matter how much a pregnant woman takes care of her mouth, when communicating with her husband, kissing him, she transfers “harmful” microflora into her oral cavity. The husband should have all his teeth treated after, or better yet before, he finds out about his wife’s pregnancy.

There probably won’t be a parent who hasn’t hugged and kissed their barely born child. Every kiss is a swarm of microorganisms, and not always harmless ones.

Be it a father, grandfather or grandmother, everyone considers it their duty to cuddle and breathe on the baby. Before allowing all relatives near the baby, a prudent mother should first send her household members to the dentist's line.

The effect of caries on pregnancy -

Why is caries dangerous during pregnancy? Is it even worth having dental treatment during pregnancy or is it better not to risk it? The answers to these questions are quite simple. For example, with ordinary average caries, the carious cavities contain a large amount of infection, which, against the background of hormonal changes in a woman (excess progesterone and estrogens), creates an increased risk of developing gum inflammation. The second thing to consider is that toothache leads to the release of a number of hormones and changes in hormonal status, which will certainly affect the fetus.

The influence of dental and gum diseases on the fetus -

Untreated caries in a timely manner leads to the development of a complication such as pulpitis (inflammation of the nerve in the tooth). The fact is that when a carious cavity in a tooth becomes too deep, pathogenic bacteria penetrate into the tooth cavity, where the neurovascular bundle (pulp) is located. However, if pulpitis is not treated in a timely manner, the inflamed pulp dies, i.e. necrosis occurs. As a result, pathogenic bacteria penetrate beyond the teeth through root canals and holes at the tops of the roots of the teeth, causing inflammation there. This inflammation is called periodontitis.

In the presence of an acute or chronic source of inflammation at the apex of the tooth root (i.e., periodontitis), bacteria in the site of inflammation produce toxins that are absorbed into the blood. The same thing happens when a pregnant woman has gum inflammation, i.e. for gingivitis and periodontitis. The presence of any of the above inflammatory diseases triggers the production of inflammatory cytokines, prostaglandins (PGE-2) and interleukins (IL-6, IL-8), each of which can negatively affect pregnancy.

For example, in periodontitis, elevated levels of these inflammatory markers and small amounts of bacteria are even found in the amniotic fluid that contains the fetus. In addition, studies have revealed a clear correlation between the presence of dental inflammatory diseases and premature birth (compared to healthy controls). Premature birth, according to researchers, is associated with two factors.

Firstly, it is the release of PGE-2, which limits placental blood flow, causes necrosis of the placenta and, as a result, restricts intrauterine growth. Secondly, with cytokines that promote contraction of the uterus and dilation of the cervical canal. All this data is taken from clinical studies - 1) Dyortbudak O., Eberhardt R. et al. “Periodontitis - a marker of the risk of premature birth during pregnancy”, 2) Goepfert A.R., Jeffko M.K. et al. “The relationship of periodontal diseases with inflammation of the upper genital tract and early premature birth.”

Dental treatment during menstruation –

There are no special contraindications for dental treatment on such days. However, if your periods are accompanied by increased nervousness, severe weakness, as well as a severe psycho-emotional state, then it is better to postpone dental treatment to more favorable days. Surgical interventions should also be avoided during this period, because starting 2-3 days before the start of menstruation in women, blood clotting decreases, which can lead to bleeding (for example, after tooth extraction).

Blood clotting indicators are fully restored approximately 2 days after the end of menstruation.

Safe anesthesia for pregnant women

To treat deep caries, pulpitis, and periodontitis, pain relief is necessary. More recently, anesthesia was not possible, and expectant mothers endured severe pain during immediate treatment. However, the strong emotional state of women at this moment led to a malfunction of the central nervous system, metabolism, and other disorders.

Lidocaine and other adrenaline-based drugs are toxic, cause muscle weakness, cramps, lower blood pressure, and provoke the development of allergies. If the concentration of adrenaline is insignificant, then the product can be used.

While carrying a child, pain relief is carried out:

alfacaine, ubistezin, artifrin based on anticaine;
ultracaine - safe and non-toxic;
primacaine with a short half-life.

All medications are used at the local level, that is, to anesthetize the tissues around the tooth and pulp.