THE DENTAL PREGNANT PATIENT

REBECCA B. SINGSON, M.D., FPOGS

Dental problems that may arise during pregnancy are given attention since it may also potentially affect the growing fetus. Here are some facts and problems for the dental pregnant patient to know

ARE DENTAL CARIES CONSIDERED AN INFECTIOUS DISEASE?

Dental caries is considered an infectious disease since it is caused by a bacteria called Streptococcus mutans which can be can potentially be transmitted to the fetus. If a pregnant mother has multiple caries in her mouth, it is not sufficient to do restorations or extractions since it won’t solve the problem. Unless she takes therapeutic measures during her pregnancy to diminish the bacterial load causing caries in her mouth, the baby is at risk of infection through the transplacental route. Vertical transmission of the mutans strep bacteria can occur from mother to child occurs after the eruption of the primary teeth.

WHAT ARE THE COMMON GUM DISEASES?

Normally, millions of microscopic monsters called bacteria make your mouth their home feeding on food particles left on our teeth. These bacteria produce acid as a result of their feasting and it is this acid which eats into tooth enamel creating cavities. If this wasn't bad enough, the bacteria also pour out volatile sulfur compounds creating embarrassing bad breath. Normally bacteria are found within a mesh of mucus and debris known as plaque. Without regular dental hygiene these bacteria will multiply and pour out toxins causing gum inflammation leading to the following conditions:

1. Pregnancy gingivitis can affect quite a number of pregnancies, some authorities saying at least half and other authorities saying even as much as a hundred percent of pregnant women. The changes in the gum are brought about by hormonal changes which alter the rate at which estrogen and progesterone are metabolized in the gums plus the change in prostaglandin synthesis. These affect the pregnant immune system altering the pattern and rate of collagen production in the gums which in turn, reduces the pregnant woman’s ability to repair and maintain gum tissue. Studies have shown that women with chronic gingivitis have an increased risk for preeclampsia, which is a pregnancy complication marked by swelling of the leg due to marked fluid retention, a rise in blood pressure and protein in the urine. The condition may lead to the more serious eclampsia where the pregnant woman goes in to convulsions compromising the fetus in the womb.

2. Periodontitis – a chronic gingivitis may progress to a more serious condition if uncared for, where the infection can go beyond the bone and the tissues supporting it, leading to periodontitis. This can have serious implications on the pregnancy because research has shown that women with periodontitis are seven times more likely to have a premature delivery. Treating the condition can significantly decrease the risk because another research showed that pregnant women with preiodontitis who were treated with plaque & tartar removal called “scaling & planning” had significantly less preterm babies than women who were not treated.

SHOULD I TAKE FLOURIDE SUPPLEMENTS DURING PREGNANCY?

Most clinicians are not prescribing supplemental fluorides to pregnant women due to lack of evidence of efficacy for the unborn child. Also, it is important to note that current scientific evidence has demonstrated that prenatal fluoride supplements are not beneficial in preventing caries in the child's primary dentition, and therefore are not prescribed to pregnant women. It was previously thought that fluoride could not pass through the placental barrier, but studies have shown that it does indeed cross the placental barrier. However, it is still not known how fast fluoride can transfer to the fetus by. Perhaps because fluoride gets diluted in the amniotic fluid, research shows that there is rapid maternal clearance with only a slight increase in fetal blood fluoride concentrations.

Since 1966, the Food and Drug Administration in the U.S.A. has banned the use of advertising and labeling of fluoride supplements for "prenatal use". It has also banned claims that these supplements will prevent or reduce decay in the offspring of women who use them. The ban, however, does not prevent the prescription of fluoride supplements for pregnant women; it just restricts advertising claims until more solid evidence is available.

HOW CAN I CARE FOR MY TEETH DURING PREGNANCY?

• Brush your teeth at least twice daily. If you can brush after every meal and especially after indulging in sweets. An electric toothbrush cleans better than a manual toothbrush. Research shows that more dental plaque is dislodged with an electric toothbrush in 2 mins. than a manual toothbrush removed in 6 mins.
• Floss at least once a day as recommended by the American Dental Association. Flossing removes the bacteria that escape brushing by hiding in the tiny spaces between the teeth. Brushing without flossing is like washing only 65% of your body. The other 35% remains dirty!!
• Rinse with mouthwash or warm salt water. Warm salt water can help to soothe inflamed tissues.
• It is certainly best to visit your dentist regularly for professional teeth cleaning especially if you are contemplating a pregnancy. If you are already pregnant and have not ever seen a dentist, it is never too late. Make sure you tell your dentist you are pregnant and how many weeks of gestation so she may tailor your treatment without jeopardizing the baby.

You may not realize how important dental hygiene is to insure a non-complicated pregnancy. Healthy gums and healthy teeth in a pregnant mom is a vital component in having a healthy baby.