Pregnancy and the oral cavity
I – Introduction:
Pregnancy is the set of events that take place between fertilization and childbirth during which the embryo, then the fetus, develops in the maternal uterus.
This period of development lasts 9 months, grouped into 3 trimesters, or 273 days from the date of fertilization.
The development of the egg occurs continuously, from fertilization to birth. However, two periods must be distinguished:
The embryonic period: covers the first sixty days of intrauterine life.
During the first four weeks 🡪 the embryo individualizes within the egg.
During the 2nd month, the main organs are established and the external modeling takes place.
An attack on the egg during this period can lead to embryonic death, or a congenital malformation, which will depend on the nature and date of the attack.
The fetal period: at the beginning of the 3rd month, the embryo becomes a fetus. Until birth, only growth and maturation phenomena will take place.
Some organs are at rest, such as the lungs, or semi-rest, such as the digestive system and the kidneys. The cardiovascular system functions in a particular way. Temperature is maintained by the amniotic fluid. It is the placenta that allows metabolic exchanges.
II – Main physiological changes observed during pregnancy:
Pregnancy is accompanied by hormonal, neurological, cardiovascular, hematological and respiratory changes. These changes must be given special attention.
This state of affairs can lead to the appearance and development of numerous mucosal, dental and salivary manifestations
. Endocrine changes: estrogens and progesterone.
Neurological changes: fatigue, depression.
Cardiovascular changes: blood V³ and heart rate (tachycardia), hypotension.
Hematological changes: Increased plasma volume, accelerated ESR, hemoglobin, neutrophilia, decreased blood count and decreased hematocrit. Increase in certain coagulation factors: fibrinogen, factor VII and VIII 🡨🡪 frequent thromboses.
Respiratory changes: increased oxygen consumption.
Gastrointestinal changes: esophageal reflux, decreased intestinal motility.
Kidney changes:
- Increased renal output by 25 to 30% as well as glomerular filtration.
-increased tubular reabsorption of water and electrolytes but unchanged urine output. - decreased creatinine + uricemia.
III – Stomatological pathologies linked to pregnancy:
periodontal pathologies:
Pregnancy gingivitis:
Different factors contribute:
- Significant increase in hormone levels
- Gingival microvascularization.
Gingival changes are apparent from the 2nd month, reaching a maximum at the 8th month. The gum is bright red in color. With hypertrophy with a tendency to hemorrhage associated with tooth mobility, all aggravated by poor hygiene.
Periodontal disease:
Periodontal disease occurring before pregnancy is exacerbated.
Childbirth spontaneously improves periodontal conditions, but definitive healing will only occur after eliminating the local etiology.
2 – Pseudotumors:
Pregnancy epulis
Pseudotumoral hyperplasia that responds to mild but permanent local irritation.
Single or multi-lobed mass located at the anteroposterior, vestibular or lingual level.
Appears during the last 2 trimesters.
Botryomycoma:
Soft, raised, pedunculated and purplish-red in consistency.
Recurrent, particularly hemorrhagic, secondary to trauma.
3 – Caries:
Calcium mobilization from mother to fetus and acid gastric regurgitation seem to promote caries in pregnant women.
🡨🡪Regular checkups, brushing teeth 3 times a day using fluoride toothpaste.
Pregnancy-related dental pathologies
Complications of caries:
Abscesses and cellulitis require tooth extraction in pregnant women.
This therapeutic aspect is currently well codified and requires special precautions.
4 – Abrasions: caused by vomiting and GERD, particularly affect the palatal and lingual surfaces of the incisors.
5 – Other manifestations:
Dentin hyperesthesia:
Occurring as a result of sudden temperature changes and contact with acidic substances, it contributes to poor brushing and maintains inflammation.
Stomatological pathologies linked to pregnancy
Saliva:
During pregnancy, it can undergo changes in volume and composition 🡪
Hyper salivation and sensation of dry mouth
Increase in salivary pH
Hyposial
Pemphigoid gravidarum:
Itchy dermatosis of pregnancy and postpartum.
Recurrent oral aphthosis:
A common disease that is more or less disabling, depending on the frequency of outbreaks and the number of common and/or giant aphthous ulcers.
Herpes:
Rare, may be responsible for abortion, local malformations, generalized herpes of the newborn by total transplacental contamination.
Most often located on the labial level.
Papillomavirus infections:
Favored by pregnancy and manifested by damage to the labial mucous membranes which must be known to the odontostomatologist.
IV – Management of pregnant women in odontostomatology:
Contact the attending obstetrician.
Only undertake treatment if the patient’s physical condition and the age of the pregnancy allow it.
Request a blood test: Blood count formula + hemostasis (TP + TCK).
Carry out short sessions.
Place the patient in left lateral decubitus
Management of pregnant women in odontostomatology
Depending on the stage of pregnancy:
Fertilization 🡪 3rd week (all or nothing)
A medication either causes an abortion or does not cause any action.
During the 1st trimester:
- period of organogenesis
- risk of malformation + abortion
During the 2nd trimester: - most stable period
- routine actions that can be performed
during the 3rd trimester: - risk of premature delivery
- fear, stress, anxiety, traumatic act, progesterone medication…
Aspiration before injection, not adrenaline-infused
Avoid prolonged decubitus position
“Utero cava” syndrome due to compression of the abdominal vascular system by the fetus is also to be feared
Avoid any anxiety which can cause shock harmful to fetal oxygenation.
Management of pregnant women in odontostomatology
Any irradiation during pregnancy is dangerous for the fetus, particularly during the first trimester.
The use of a lead apron, fast-printing films, and a long cone reduces the risks of irradiation.
Pregnancy and the oral cavity
Restorative dental care:
There are no contraindications to performing them.
It is important to be aware of the possibility of passive diffusion of mercury molecules through the placental barrier during amalgam restorations in pregnant women.
Management of pregnant women in odontostomatology
Surgical procedures:
The risk of bleeding in pregnant women should be taken into account due to an increase in bleeding and clotting time.
Management of pregnant women in odontostomatology
Surgical procedures:
Will preferably be carried out during the 2nd quarter.
In case of emergency, intervention can be performed at any stage of pregnancy, respecting the precautions mentioned above.
For antibiotics:
The location of the infection, the nature of the germ and also the pharmacokinetics of the products to be used must be taken into account.
For pain relievers:
Paracetamol is practically the only one that can be prescribed without risk (without overuse).
For anxiolytics:
Due to the increased emotionality and nervous tension in pregnant women, the dental surgeon may prescribe anxiolytics that have no depressant effect on the respiratory system.
Management of pregnant women in odontostomatology
For fluoride:
It will be prescribed from the 5th/6th month of pregnancy due to its beneficial effects on dental mineralization (building) of the fetus.
It is also recommended for children from birth to 12 years.
Prescription: administered in the form of sodium fluoride (Zymafluor ®) per os dose: 0.25mg – 0.50 -0.75mg – 01 mg per day.
strict monitoring of fluoride intake by:
- drinking water
- food (banana, apple, tea, etc.)
The therapeutic dose is very close to that of fluorosis, hence the importance of proper use.
Pregnancy and the oral cavity
V – CONCLUSION:
Pregnancy is a particular physiological state characterized by the risk of fetal-maternal life.
The dentist must be aware of the various changes that occur in pregnant women as well as the risks incurred by both the mother and her fetus in order to provide appropriate therapeutic care.
Pregnancy and the oral cavity
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.