Dental treatment during pregnancy in the early and late stages, is it possible to treat, what anesthesia to use

Nuances of dental treatment for pregnant women

The period of gestation in itself is not a contraindication to dental treatment. But when visiting a doctor, he must be warned about pregnancy, and also tell the due date. In this case, the following features arise during dental treatment:

Bleaching is not allowed.
Local anesthesia is required.
It is possible to treat caries, pulpitis, periodontitis and gum inflammation.
Under no circumstances should general anesthesia be used.
Chemical and photo-curing materials can be used for filling. Polymer lamps do not harm the child.

Advice to expectant mothers - try to treat your teeth and gums before pregnancy or between the 3rd and 6th months of pregnancy, and also review your diet. If you have carious cavities, you will pass on a bouquet of microbes to your unborn child, and the destruction of your own teeth will accelerate several times.

Medvedeva Tatyana Dmitrievna, Pediatric dentist, dental therapist, work experience 19 years

Dental treatment and lactation

Breastfeeding mothers often experience calcium deficiency, which affects dental health. Is it possible to treat teeth while breastfeeding? Will this affect the baby's health?

Dental treatment during lactation is mandatory. Moreover, modern dentistry offers gentle anesthesia methods that do not affect the child’s body. Since some medications are contraindicated for nursing mothers, please inform your doctor about your situation before treatment.

And remember that prevention is the key to the health of your teeth, so do not forget to visit the dentist every six months to check your oral cavity and, if necessary, carry out treatment at an early stage. This will save you time and money.

Features of dental treatment at different stages

0-12 weeks. The 1st trimester of pregnancy is very important for the fetus. It is during this period that the baby’s vital organs and placenta are formed. Therefore, the fetus is essentially not protected yet. Serious treatment cannot be carried out at this stage. But the doctor may prescribe topical medications to relieve the inflammatory process. These may be Cholisal, Chlorhexidine, Miramistin.

13-24 weeks. At this time, the placenta has already formed and protects the baby. Therefore, dental treatment and other procedures can be performed.

From the 25th week until birth. At this time, the female body is weakened, and the uterus is very sensitive to the effects of drugs. In addition, a visit to the dentist is often stressful for an expectant mother. Therefore, it is better to wait for treatment procedures until the feeding period. However, this does not apply to cases of acute toothache.

When can pregnant women have their teeth treated?

Pregnancy can be roughly divided into three periods (trimesters). Dental treatment can be carried out in the second trimester - it is considered the safest for procedures.

During the first and third trimester, it is better to conduct preventive examinations and treatment planning. It is better to postpone basic dental treatment during pregnancy and a complex of professional hygiene until the second trimester, and if possible, wait until childbirth.

Unfortunately, it is not always possible to follow these recommendations. There are times when emergency intervention is necessary, for example, in the treatment of acute diseases that are accompanied by acute pain and discharge of pus.

Dental diagnostics during pregnancy

If there is a need to remove a tooth or the patient has been diagnosed with pulpitis, an image cannot be avoided. However, traditional X-rays are contraindicated for pregnant women. After all, the fetus is sensitive to radiation. If an x-ray is necessary, it is best to postpone such a diagnosis to the 2nd trimester. In this case, it is necessary to cover the patient’s abdomen and pelvic area with a lead belt. It minimizes exposure to radiation.

The safest method of dental diagnosis for pregnant women is digital radiovisiography. This technique allows you to reduce the radiation load by 90% compared to conventional x-rays.

How does pregnancy affect teeth?

Ideally, the expectant mother should plan her conception and at this time eliminate all dental pathologies. But even in this case, problems can arise at any time.

This is due to powerful changes in the body:

immunity decreases, which suppresses the activity of pathogenic bacteria;
the composition of saliva changes - due to increased viscosity, it protects less well from pathogenic microorganisms and poorly enriches the enamel with minerals;
the body lacks calcium and magnesium, so bone tissue becomes more fragile;
soft gum tissues become loose and prone to infections.

For these reasons, patients develop caries, gingivitis, periodontitis, periodontal disease, and epulis. It is impossible to spread infectious diseases, because pathogenic microflora easily penetrates the blood, which means it can infect the fetus and lead to developmental abnormalities. At the first signs of disturbances, you should immediately contact a dentist, who will decide how best to cope with this or that disease.

Features of anesthesia for pregnant women

During pregnancy, drugs that have minimal effects on blood vessels are used for pain relief. They also cannot cross the placenta and affect the baby.

Lidocaine is contraindicated during pregnancy. It can cause a sharp decrease in blood pressure, cramps and weakness.

Today, the best anesthesia option for pregnant women remains drugs based on anticain:

Ultracaine.
Altrifryn.
Ubistezin.
Alfacaine.

The listed drugs do not constrict blood vessels, which would be harmful for the expectant mother. They also have a local effect, so they do not affect the baby.

Pregnancy management program in the 1st trimester

The examination plan during the 1st trimester of pregnancy was developed strictly in accordance with the regulatory documents of the Ministry of Health of the Russian Federation and does not contain “unnecessary” examinations.

The pregnancy management program includes:

An initial consultation with an obstetrician-gynecologist, as well as a repeat consultation based on the results of the examinations completed,
is your chief physician and mentor. At the first consultation, the doctor examines the expectant mother’s medical history, gives a referral for examination, and helps in resolving the most significant issues based on the data obtained about the woman’s health condition. A repeat appointment is scheduled after a prenatal ultrasound and biochemical screening. The obstetrician-gynecologist registers the patient for pregnancy, fills out all the documentation, and gives recommendations.
Appointment with a general practitioner
- this doctor will help assess your general health, predict the risks of developing the most likely diseases during pregnancy and take timely measures. This is very important because during pregnancy a woman is strictly limited in taking medications and drugs.
ECG (electrocardiogram)
- allows you to assess the condition of the heart and identify pathologies: rhythm disturbances, blood circulation.
Appointment with an ENT doctor
- no woman is insured against diseases of the ear, nose and throat (colds, acute respiratory viral infections, sore throats), so it is important to carry out sanitation in a timely manner to avoid drug treatment during pregnancy.
Consultation with an ophthalmologist
- the doctor checks vision and evaluates the condition of the retina, and also determines whether the woman can give birth on her own or by cesarean section. Not only childbirth can affect vision, but toxicosis and other complications of pregnancy.
Ultrasound of the kidneys and bladder
- allows you to assess the condition of internal organs, identify hidden diseases (inflammatory, urolithiasis) and neoplasms.
Pelvic ultrasound
helps to study the anatomy of the pelvic organs, identify gynecological diseases and possible risks of complications.
Fetal ultrasound (performed by a perinatologist at 11-14 weeks of pregnancy)
allows you to see for the first time during pregnancy how the baby is growing and whether everything is fine.
Biochemical blood test
- study of more than 15 important indicators (sugar, protein, iron, etc.).
A general blood test
is the most important test, as a result of which the doctor obtains indicators of platelets, hemoglobin, red blood cells, etc., and then can accurately assess the general condition of the expectant mother’s body.
A general urine test
allows you to evaluate how the kidneys and urinary system work, as well as identify pathologies such as gestosis and eclampsia.
Blood group
- the analysis allows you to answer the question of whether there is a Rh conflict in the blood type of mother and baby.
A blood test for hormones
is a very important test that provides an understanding of the specifics of metabolism and allows one to predict how the fetus will develop.
Testing for HIV, syphilis, hepatitis B, C
is mandatory for the expectant mother.
PRC diagnostics
is a laboratory analysis aimed at identifying many hidden infectious pathogens (from pneumonia to herpes).
Laboratory examination of a gynecological smear
- analysis of the microflora of the vagina, cervical canal, urethra allows us to identify hidden inflammatory processes and their causative agents (gonococcus, trichomonas)
Biochemical screening (PAPP-A, hCG, risk calculation)
is a very important examination that allows you to assess the risk of chromosomal pathology, obtain the most important indicators of fetal development, and also answer the question of whether it is advisable to prescribe invasive diagnostic methods.
Extended coagulogram with determination of lupus type At+
- allows you to assess the risk of thrombosis and bleeding, which can lead to miscarriage.

Find out more about pregnancy management at the Pirogov Clinic (St. Petersburg)

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.

Is it possible to have teeth removed during pregnancy?

This question is asked by almost every pregnant woman.
Unfortunately, not everyone likes to visit the dentist regularly, so a small carious cavity can very quickly develop into an inflammatory-purulent process that requires tooth extraction. This operation itself is already a complex manipulation. What may seem easy on the surface may lead to unforeseen complications. And during pregnancy this should be taken even more carefully.

It all depends on the administration of anesthesia. After all, previously the choice of local anesthetics was small. They could cross the placenta and affect the fetus. You cannot do without anesthesia, especially for pregnant women. In their position, women are even more sensitive and emotional.

Today there are various drugs for local anesthesia:

ultracaine;
mepivacaine;
ulfacaine;
scandonest;
articaine.

They can be said to be derivatives of lidocaine, which can also be used as an anesthetic. The above drugs either do not contain adrenaline, or contain a very tiny percentage, which is unable to harm the woman or fetus. The main thing is that there is no allergic reaction to one of the components.

Of course, if possible, it is better to remove a tooth after childbirth, especially the eighth or so-called wisdom teeth. The latter can cause severe discomfort even to a healthy person, both during and after removal. Pregnant women may have a higher temperature or lower blood pressure.

But there are times when it is necessary to undergo surgery to remove teeth, even during pregnancy.

Indications for removal:

Exacerbation of chronic periodontitis, in which conservative treatment is impossible or inappropriate;
Longitudinal fracture of a tooth;
If the tooth is the cause of the development of purulent processes such as periostitis and osteomyelitis.

These processes also belong to eights. If it is possible to somehow relieve the symptoms, then removal is postponed until the postpartum period. An experienced dentist weighs everything and decides whether there is a need to carry out the manipulation or whether it can be waited.

Removal or even just therapeutic treatment should be carried out in the second trimester of pregnancy. In the first three months it is strictly forbidden. In the latter, it all depends on the indications and general condition of the patient. In the second trimester there is no threat of miscarriage or premature birth.

Much also depends on the psycho-emotional state of the expectant mother. The more afraid she is, the worse it gets. For such patients, it is strictly forbidden to use an anesthetic with adrenaline or norepinephrine, even in small doses. This can speed up your heart rate and increase your blood pressure. Therefore, under no circumstances should you take risks.

In such cases, you should first talk to the patient and reassure her morally. It’s better to start talking about pregnancy - how long it is, how it’s progressing, how it feels, etc. Then gradually move on to explaining the procedure that the doctor will carry out. Warn about each manipulation.

To further reassure the patient, you can also first numb the site of the future injection for anesthesia. This is done using an anesthetic spray or applications with a cotton swab soaked in an anesthetic. Then calmly give the necessary injection into the gum.

Abortion in 2 weeks

Early medical abortion can be done even on an outpatient basis, but always under the supervision of a doctor. Its advantage is the absence of any medical manipulations. Certain medications cause miscarriage. These drugs are not sold in pharmacies, even with a doctor’s prescription, but are dispensed only by the attending physician. The indication for premature termination of pregnancy, which is carried out for medical reasons, is the period of pregnancy. It can be carried out after 2 weeks, and the maximum period of pregnancy should not exceed 6 weeks. In this case, the size of the fertilized egg should not exceed 20 mm. In some cases, an early abortion done with medication may not be effective enough to completely remove the egg. In such situations, a full surgical abortion is additionally performed. Even a successful medical abortion significantly affects the woman’s hormonal state and requires the subsequent prescription of hormonal contraceptives.

Early abortion: how to prevent

To avoid a situation where artificial termination of pregnancy is necessary, it is advisable to control the menstrual cycle, especially if pregnancy is undesirable at this stage. It is also important to use a reliable method of contraception. Your doctor will help you choose the most appropriate and effective method. If an unwanted pregnancy continues, you should consult a doctor as soon as possible to terminate it. The day after an early abortion, as with any other artificial termination of pregnancy, is the day of a new cycle, when the next pregnancy can already occur, so you should immediately choose the optimal method of contraception.

Some women mistakenly believe that it is not difficult to perform a premature abortion at home on their own. Such an event could cost the life of an unlucky mother or seriously harm her health. Under no circumstances should you try to induce a miscarriage, but you should always seek medical help.

Which is normal, but you should pay attention

Nausea and vomiting

Occurs in every 3rd pregnancy.
In 90% of cases, nausea and vomiting in pregnant women are a physiological sign of pregnancy, in 10% - a complication of pregnancy. During normal pregnancy, vomiting occurs no more than 2-3 times a day, more often on an empty stomach, and does not disturb the general condition of the patient.

In most cases, nausea and vomiting resolve on their own by 16-20 weeks of pregnancy and do not worsen its outcome.

Recommendations:

Fractional meals, small portions, exclusion from the diet of fatty, fried foods, chocolate, spicy foods, carbonated drinks, coffee, strong tea.

To reduce nausea in early pregnancy, ginger, chamomile, and vitamin B6 preparations are recommended.

Soreness and engorgement of the mammary glands

It is a normal symptom during pregnancy, observed in most women in the 1st trimester of pregnancy and is associated with swelling and engorgement of the mammary glands due to hormonal changes.

Pain in the lower abdomen can be normal during pregnancy, such as when the ligamentous apparatus of the uterus is stretched during its growth (aching pain or sudden stabbing pain in the lower abdomen) or during Braxton-Higgs training contractions after the 20th week of pregnancy (pulling pain in the lower abdomen abdomen, accompanied by uterine tone, lasting up to a minute, not having a regular character).

Heartburn

Heartburn (gastroesophageal reflux disease during pregnancy is observed in 20-80% of cases.

More often it develops in the 3rd trimester of pregnancy.

Heartburn occurs due to relaxation of the lower esophageal sphincter, a decrease in intraesophageal pressure, and a simultaneous increase in intra-abdominal and intragastric pressure, which leads to repeated reflux of gastric and/or duodenal contents into the esophagus.

Recommendations:

Avoid body positions that contribute to heartburn; diet; wearing loose clothing that does not put pressure on the stomach area.

If there is no effect from diet and lifestyle, enveloping and astringent drugs may also be prescribed.

Constipation

The most common intestinal pathology during pregnancy occurs in 30-40% of cases.

Constipation is associated with impaired passage through the colon and is characterized by a stool frequency of less than 3 times a week.

They are accompanied by at least one of the following signs: a feeling of incomplete bowel movement, a small amount and dense consistency of stool, straining for at least a quarter of the time of defecation.

The reasons for the development of constipation during pregnancy are an increase in the concentration of progesterone, a decrease in the concentration of motilin and changes in blood supply and neurohumoral regulation of the intestines.

Recommendations:

Correction of nutrition, to eliminate constipation, wheat bran or other sources of dietary fiber may be prescribed.

Haemorrhoids

Approximately 8-10% of women develop hemorrhoids during each pregnancy.

The reasons for the development of hemorrhoids during pregnancy may be: pressure on the intestinal walls from the uterus, congestion in the portal vein system, increased intra-abdominal pressure, congenital or acquired weakness of connective tissue, changes in the innervation of the rectum.

Recommendations:

If there is no effect from following the constipation prevention regimen, it is recommended to prescribe antihemorrhoidal drugs in the form of rectal suppositories or creams.

Varicose veins

Develops in 20-40% of pregnant women.

The reason for the development of varicose veins during pregnancy is an increase in venous pressure in the lower extremities and the relaxing effect of progesterone, relaxin and other biologically active substances on the vascular wall of the veins.

Recommendations:

Wearing compression hosiery, physical therapy sessions and a contrast shower, elevated position of the legs, with pronounced dilation of the veins of the lower extremities, consultation with a vascular surgeon.

Discharge

Vaginal discharge without itching, pain, unpleasant odor or dysuria is a normal symptom during pregnancy and is observed in most women.

Pregnancy management after IVF in the 1st trimester

The pregnancy management program after IVF in the 1st trimester may differ slightly from the usual one. Firstly, the woman continues to be observed at the IVF center by a fertility specialist until 6-7 weeks, when the doctor can record the heartbeat of the embryo. Only after this can the expectant mother contact an obstetrician-gynecologist. At the first stage, the doctor decides on the advisability of maintenance hormonal therapy

, prescribed earlier at the IVF center. Whenever possible, we try to either reduce or eliminate additional hormonal therapy.

Thus, monitoring of pregnancy after IVF begins at an earlier stage, and the program can be adjusted depending on the characteristics of the individual case: is it a singleton or multiple pregnancy, what problems should be taken into account, etc.