By Jennifer Lacey
You’ve heard that pregnancy is a total body experience – and it’s true. Even your mouth doesn’t escape the changes of pregnancy.
In fact, increased levels of estrogen often make your teeth and gums very vulnerable and susceptible to certain conditions, which is why taking care of your teeth is a must while you’re expecting.
Common dental concerns during pregnancy
Pre-Pregnancy Dental Precautions
Good dental care prior to and during your pregnancy is vital for your continued good health and the health of your baby. If a woman is planning on becoming pregnant, dental professionals agree it is a good idea to make an appointment to see the dentist, especially if it has been more than six months since your last visit.
The dentist will be able to let you know not only how healthy your gums and teeth are, but if there are any potential problems that need to be taken care of before you become pregnant.
Dan E. Peterson, D.D.S., of Family Gentle Dental Care, in Gering, Neb., advises his patients who are planning a pregnancy to take a good look at the care that they give to their teeth. “I tell them that if they do not have good dental health, they can transmit cavity-causing organisms known as streptococci to their baby,” he says. “These organisms are responsible for causing tooth decay. Research has shown that through brushing your teeth at least twice a day, flossing at least once a day to disrupt bacteria growth between your teeth and using a alcohol/sugar free mouth rinse with an antibacterial agent, you can suppress or reduce the bacteria which cause tooth decay.”
Oral Health While Pregnant – Dental Treatments while You Are Pregnant
dental visits during pregnancy are not taboo. Oral infections should be treated immediately because they can rapidly spread throughout the body. Systemic infections can adversely affect the fetus. If you are experiencing pain, emergency treatment and minimal emergency radiographs should be completed immediately. Toothaches usually do not subside without professional intervention! Annual dental exams and routine teeth cleanings are encouraged. However, elective treatment should be postponed until after you give birth. Elective treatment includes most cosmetic dental procedures. Routine radiographs should also be postponed.
Most obstetricians and dentists prefer that dental treatment take place during the second trimester, if possible. Many physicians and dentists agree that dental care during the first trimester should be kept to a minimum. The first trimester is the time when most of the fetal organs are developing. While dental treatment may not necessarily harm these organs, it is best to minimize any potential risk. During the second half of the third trimester, dental care should also be minimized. This is mostly due to the comfort of the expectant mother. When laying back in the dental chair during the late stages of pregnancy, the uterus can place pressure on the inferior vena cava (the main vein which returns blood to heart from the lower extremities). Not only is this uncomfortable, but it can also create a loss of consciousness. If treatment is to be rendered at this time, a shifting in the mother’s position must be allowed every 3-7 minutes. In addition, if the situation is stressful (as visiting the dentist can be for some people), premature labor can be induced.
When to consults your Obstetrician?
An article that appeared in the May, 1992 issue of the Journal of the American Dental Association (JADA) entitled “Treating the Pregnant Patient: Four Basic Rules Addressed” reviewed a survey of obstetricians. These obstetricians answered questions regarding consultations prior to dental treatment, use of radiographs during treatment, and stress during care. Ninety-one percent of the obstetricians stated that they did not want to be consulted prior to routine dental care, and 56% stated they did not require consultation prior to emergency care. Ninety-seven percent stated that emergency radiographs were acceptable. Only 27 percent asked for consultation prior to use of local anesthetic as it is a commonly used agent and has no documented ill-effects. Obstretricians were most concerned about the use of prescription drugs such as antibiotics and analgesics. A very low percentage of surveyed obstetricians wanted to be consulted prior to administration of local anesthetic. The main concerns are radiographs and certain types of medications which might be prescribed during the course of dental treatment. The antibiotics dentists prescribe, incluing penicillin and its derivatives, are usually fine for the developing fetus.
Dental Treatments During Pregnancy
Dental Anesthetics in Pregnancy
Novocaine used to be a common local anesthetic used in dentistry. Today, lidocaine (also called Xylocaine) is used because some patients had allergic reactions to novocaine. Lidocaine, which is also a local anesthetic, works in essentially the same way as novocaine without causing allergic reactions and other side effects. The chemical structure of lidocaine is different from novocaine, however.
On page 2231 of the American Hospital Formulary Service (AHFS) Drug Information reference, 1995 edition, it states: “Safe use of local anesthetics during pregnancy prior to labor has not been established with respect to adverse effects on fetal development. Careful consideration should be given to this fact before administering these drugs in pregnant women.” Injected local anesthetics can cross the placenta. However, the small amounts of lidocaine used in dentistry probably will not adversely affect a developing fetus. The following commentary addresses local anesthetics, in general, unless specifically stated otherwise:
Lidocaine works by preventing the initiation and transmission of nerve impulses to the brain. Without this anesthetic, these impulses would reach the brain and may be interpreted as pain. Generally, novocaine or lidocaine takes effect in about 2-5 minutes and is effective for 1-2 hours depending on the dosage, method of administration, individual patient and other variables. Novocaine and lidocaine are readily absorbed into the body after administration.
Most studies on the effects of novocaine on fetal development that I was able to locate, including one titled “Effect of infusions of glusose-novocaine mixture on the functional state of delayed-development fetuses” (translated), are published in Russian. These articles were published several decades ago. Their relevance to modern dental practice is questionable.
The filling material, amalgam, should not present any harm, if proper technique is observed by the dentist and his or her assistant. This should occur whether the patient is pregnant or not! If you have a cavity and your dentist thinks it should be a fairly simple, short procedure, it should be fine to complete the procedure. Postponing dental work due to pregnancy can sometimes cause worse problems than having the work completed. If you do decide to postpone work until after the birth of your baby, have it done soon afterwards so the cavity does not become larger and deeper.
Dental Radiographs (X-Rays) during pregnancy
A full mouth series of dental radiographs (X-rays) is generally taken about every 5-7 years. A full mouth series involves taking between 18-21 films. Dentists need to have the information this full mouth series offers to determine if any conditions, such as cysts, tumors, or abscesses, exist in the bone surrounding the teeth. Full mouth radiographs also help determine the health of the teeth and the nerve tissue within the teeth. If nothing else, the complete set of radiographs will serve as comparison for the future if any problems should arise.
The amount of radiation received from a set of 21 dental radiographs is approximately 3 millirems. What the heck is a millirem? Three millirems are equivalent to about 4 days of exposure to radiation received naturally from the environment (i.e. sun). A study done in 1983 from the Nationwide Evaluation of X-ray Trends Tabulations states that the probability of congenital anomalies and childhood malignancies from this amount of radiation is practically nonexistent. The double lead shield with a thyroid protector will reduce exposure even more.
Again, most dentists do not recommend routine radiographs during pregnancy. Of course, minimal radiographs may need to be taken during pregnancy to treat dental emergencies. By having your dental exam completed before you become pregnant, you will reduce your risk that a dental emergency will occur during pregnancy.
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