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Periodontal Disease and Pregnancy

Pregnany mother sitting at the table with a healthy diet
Pregnant Mums need special care.  They sometimes feel queasy and tired, they may not be eating correctly because certain foods just do not appeal, and they may be letting their oral hygiene slip as is often the case.  There is an old saying that mother’s loose one tooth per child, but all that is preventable.

We must all take care of our teeth, but it is critical you take extra special care to brush and floss and rinse well when you are expecting. There are hormonal changes during pregnancy that greatly increase the risk if developing gum disease, and this in turn can effect your health and the health of your developing baby and even cause pre-term birth, which is a potentially serious complication to pregnancy and may result in other health concerns which are usually related to low birth weight.

So here are some tips to help you maintain a healthy mouth during pregnancy:

1.     If possible make a dental appointment before getting pregnant. Your teeth can be professionally cleaned, your gum tissue can be carefully examined, and any oral health problems can be treated in advance of your pregnancy.

2.      Visit your dentist and have your teeth and gums checked immediately and plan to have a second visit during your pregnancy.  It is important to have any problems treated immediately and completely, because you will not easily find time for many months after your baby is born.

3.     Tell your dentist (and doctor) if you are pregnant. As a precautionary measure, dental treatments during the first trimester and second half of the third trimester should be avoided as much as possible. These are critical times in the baby's growth and development and it's simply wise to avoid exposing the mother to procedures that could in any way influence the baby's growth and development. However, routine dental care can be received during the second trimester. All elective dental procedures should be postponed until after the delivery.

4.    Avoid dental X-rays during pregnancy. If X-rays are essential (such as in a dental emergency), your dentist will use extreme caution to safeguard you and your baby. Advances in technology have made X-rays much safer today than in past decades.  We use digital X-rays that reduce the usual dosage by up to 90%.

5.    If major dental work becomes necessary during pregnancy a local anesthetic will usually suffice, and that’s safe.

6.     It is possible that calculus or tartar below the gumline may be present, which will constantly irritate the gums, creating more inflammation. Some scaling and root planing may be necessary, although it is advisable stick with routine teeth cleaning during the first trimester. If any scaling and root planing is needed, it should wait until the second trimester.   

7.    Care should be taken to limit or avoid nitrous oxide, some prescribed antibiotics and some pain medications. Your dentist can contact your obstetrician with any questions.

What dental problems to watch our for

Consider possible dental health problems during pregnancy:

    Tooth decay. During pregnancy, increased acidity in the mouth increases the risk of tooth decay. Vomiting during pregnancy can aggravate the problem by exposing the teeth to more gastric acid.
    Loose teeth. Increased levels of progesterone and estrogen can affect the ligaments and bones that support the teeth, causing teeth to loosen during pregnancy — even in the absence of gum disease.
    Gum disease. The hormonal changes of pregnancy can lead to gingivitis, an inflammation of the superficial gum tissue. Left untreated, severe gum disease may be associated with preterm birth and low birth weight.

So what can you do to keep your teeth and gums healthy during pregnancy? Stick to the basics. Use a soft bristled toothbrush. Floss regularly. Rinse with a fluoride mouthwash. If you have morning sickness, rinse your mouth with a solution of baking soda and water after vomiting. Mix one teaspoon baking soda in one cup water and rinse, this will neutralize the stomach acid which dissolves the teeth.

Researchers have shown that periodontal disease in expectant mothers actually exposes their unborn child to many different risks; particularly if they also happen to be diabetes sufferers.

Periodontal disease generally begins with a bacterial infection in the gum (gingival) tissue, which progressively destroys the tissue and the underlying bone.  If left untreated, the bacterial infection causes an inflammatory reaction in the body, which can significantly deepen the gum pockets (space between the teeth and gums) and forces the gum and jawbone to recede.  Eventually, the progressive nature of periodontal disease causes the teeth to become loose and unstable, and eventually fall out.

Pregnancy causes many hormonal changes which increase the risk of the expectant mother to develop gingivitis (inflammation of the gum tissue) and periodontal disease.  These oral problems have been linked in many research studies to preeclampsia, low birth weight of the baby and premature birth.  Expectant women should seek immediate treatment for periodontal disease in order to reduce the risk of pre-natal and post-natal complications.

Reasons for the Connection

There are many different reasons why periodontal disease may affect the health of the mother and her unborn child:

  • Prostaglandin – Periodontal disease appears to elevate levels of prostaglandin in mothers who are suffering from the more advanced forms of the condition.  Prostaglandin is a labor-inducing compound found in one of the oral bacteria strains associated with periodontitis.  Elevated levels of prostaglandin can cause the mother to give birth prematurely and deliver a baby with a low birth weight.
  • C - reactive protein (CRP) – This protein, which has been previously linked to heart disease, has now been associated with adverse pregnancy outcomes including preeclampsia and premature birth.  Periodontal infections elevate C-reactive protein levels and amplify the body’s natural inflammatory response.  Periodontal bacteria may enter the bloodstream causing the liver to produce CRP which leads to inflamed arteries as well as possible blood clots.  These inflammatory effects can then lead to blocked arteries causing strokes or heart attacks.
  • Bacteria spread – The bacteria which colonize in the gum pockets can readily travel through the bloodstream and affect other parts of the body.  In pregnant women, research has found that oral bacteria and associated pathogens have colonized in the internal mammary glands and coronary arteries.

Diagnosis and Treatment

There are many safe, non surgical treatment options available for pregnant women.  It is of paramount importance to halt the progress of periodontal disease in order to increase the chances of a safe and healthy delivery.

Initially, the dentist will assess the exact condition of the gums and jawbone in order to make a precise diagnosis.  Scaling and root planing are two common non-surgical procedures used to rid the tooth-root surfaces of calculus (tartar) and remove the bacterial toxins from the gum pockets.

The advantages to the pregnant woman are plentiful.  The risks of pregnancy complications caused by periodontal disease are reduced by as much as 50%, and these treatments will alleviate many unpleasant and harmful effects associated with gingivitis and periodontal infection.

Dentists can provide dental education and recommendations to the pregnant women on effective home care which can reduce risks that may affect her and/or her child’s health.  Risks of periodontal disease can be vastly reduced by proper home care, smoking cessation, dietary changes and the ingestion of supplementary vitamins.

If you have any questions or concerns about periodontal disease and its affect on pregnancy, please ask your dentist.

More Information is available here
Web MD
http://www.webmd.com/oral-health/dental-care-pregnancy
Mayo Clinic
http://www.mayoclinic.com/health/dental-health-during-pregnancy/MY00719 
iVillage
http://www.ivillage.com/are-dental-problems-normal-during-pregnancy/6-n-138372#ixzz1Usbc3z6Y
The American Academy of Pediatric Dentistry
http://dentistry.about.com/od/basicdentalcare/qt/perinatalguidelines.htm
 

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