Teeth during pregnancy need special care; it is not without reason that people say that giving birth to a child means the loss of one tooth for its mother.
Pregnancy and teeth
Bad teeth and pregnancy are not compatible concepts, and there are a number of reasons for this.Caries actively progresses during pregnancy
- decreased maternal immunity leads to easy complications of deep caries
- a decaying tooth is a source of infection in the mother’s body, which can cause obstetric complications and infection of the child
Therefore, the teeth need to be brought into full order even before pregnancy, at the planning stage, and visit the dentist several times during pregnancy. If you have not prepared for pregnancy, a visit to the dentist will definitely be suggested to you by your supervising gynecologist at the time of your first visit to the antenatal clinic, along with all other tests and examinations.
But even if you did everything on time, you may have dental problems while you are carrying your baby. The teeth deteriorate and crumble in many pregnant women, regardless of whether they were preparing for conception or not, why does this happen? How does pregnancy affect teeth?
Starting from the second trimester, the need for calcium increases several times, because the child’s skeletal system begins to form. To build bone tissue he needs great amount calcium, but sometimes there is nowhere to get it, especially if the expectant mother does not really like dairy products, fish and refused to take prenatal vitamins. Calcium begins to be washed out of the mother's bones, and, of course, from her teeth too. Pain in the bones and back is often associated with this process, and teeth respond to the loss of calcium by demineralizing the enamel, a thin, very durable surface layer of dental tissue. This is why tooth sensitivity increases during pregnancy in almost all women.
But thin enamel becomes vulnerable to destruction. Old fillings wobble and fall out, because it is now easier for microbes to penetrate under them, teeth crumble, and fresh pockets of caries appear in the folds of crowns. Tooth pain during pregnancy can strike you unexpectedly and at any time, but more often it happens in the second half of pregnancy, when calcium deficiency is obvious, and the disease has had enough time to weaken even your strongest fillings. Based on this sad picture, the question arises: how to preserve teeth during pregnancy and is it even possible?
Yes, it's possible:
Preventive visits to the dentist
- Fully healed teeth before pregnancy
- Proper care
- Nutritious food and taking vitamins
Usually these simple measures are enough to protect a white-toothed smile.
Brushing your teeth during pregnancy is a special matter. The fact is that not only does your enamel become thin, your gums often become sensitive and even bleed.
Brushing teeth and pregnancy
Choose toothbrush medium hardness, change it at least once every 2 months for a new one
- you should not use pastes with a high fluoride content, its excess will harm the baby. It is better not to waste money and buy a specialized paste for pregnant women at the pharmacy. Yes, it will be a little more expensive than regular pastes, but these pastes have increased content calcium and are specially designed for the vulnerable teeth of pregnant women. We recommend pastes such as 9 months-Pregnadent, Splat-Biocalcium, Splat-Organic, Paradontax and many others. All these pastes are medicinal and before using it, you should consult a dentist; you will still go to him at a very early date.
- brush your teeth 2 times a day, after breakfast and after dinner, after each meal, rinse your mouth with water or at least tea.
If you notice that your teeth are deteriorating, remember that during pregnancy they decay much faster, which means you should contact your dentist as soon as you notice that something is wrong.
Dental treatment during pregnancy
Dental treatment during pregnancy is even associated with some myths that have become established among pregnant women. For example, many people think that they cannot take pictures, take pain relief, cannot pull out a tooth, etc., and are afraid to go to an appointment if a tooth hurts, in case the child is harmed?Believe me, if you have a toothache during pregnancy, delaying time will only harm yourself (it will collapse) and the baby (risk of infections). Or maybe you don’t have any problems at all, and it’s just increased sensitivity enamel or a wisdom tooth is growing (and this happens).
Today, dental treatment during pregnancy is carried out almost in full, as in non-pregnant women, only some things are not done, for example, teeth whitening and dentures, but everything else is possible, necessary and safe.
Yes, once upon a time they were afraid to take an extra photo, because the devices were antediluvian and created a huge radiation load. They could, like a child, be given arsenic and sent home for a week, to suffer from pain until the nerve dies. But not now.
Dental X-rays during pregnancy are performed using equipment that irradiates literally 3 cm of your body, specifically above the tooth, while your baby is completely safe. This means we can solve even the most complex dental problems.
A bad tooth during pregnancy is not a reason to remove it or treat it in wild ways. Anesthesia for dental treatment during pregnancy is carried out with minimal doses of potent modern non-toxic anesthetics that do not affect the fetus in any way. If necessary, safe anesthesia is possible at any time. They definitely won't hurt you.
Thanks to modern equipment, removal of dead tissue from carious cavity, cleaning the canals and their further filling are carried out as sparingly as possible; moreover, they even try to keep a pregnant woman’s tooth alive for as long as possible. So, dental treatment during pregnancy is not painful, scary or dangerous.
Regarding tooth extraction. There are situations when it is easier to remove a tooth than to treat it, for example, if it is a decayed wisdom tooth. There is no need to be afraid either, you can have teeth removed during pregnancy, and if necessary, then under anesthesia too. And the best thing, of course, is to simply try to prevent tooth decay.
Optimal timing dental examination With for preventive purposes:
Registration in antenatal clinic
- 20-24 weeks
- 32-34 weeks
Teeth after pregnancy
Your baby was born, you are happy and it seems that everything is over. No matter how it is. For six months after pregnancy, teeth may continue to be vulnerable and weak, especially if you are breastfeeding. This means that all preventive measures must continue to be observed. Take care of yourself.
Dental treatment for pregnant women is not only possible, but necessary. You cannot tolerate toothache; it is a huge stress for both the woman’s body and the baby. In addition, hidden foci of infection in the mouth can lead to infection of the fetus. Therefore, you should not put off visiting the dentist.
Features of dental treatment for pregnant women
Pregnancy is not an absolute contraindication to any dental procedures. However, the patient must warn the doctor about her situation, and also indicate the exact duration of pregnancy.
Main nuances of therapy:
- during pregnancy, caries, pulpitis, periodontitis and inflammatory diseases gums (gingivitis, periodontitis, stomatitis);
- To fill a tooth, you can use both chemically curing materials and light-curing composites; photopolymer lamps are safe for the fetus;
- enamel bleaching is prohibited;
- dental treatment is carried out under local anesthesia(injection of Ultracaine, Articaine), the expectant mother must not be allowed to endure terrible pain in the dentist’s office;
- General anesthesia is strictly contraindicated.
Early and late dental treatment
The entire period of pregnancy is conventionally divided into 3 periods (trimesters).
First trimester (up to 12 weeks)
In the 1st trimester (the earliest period), all the vital organs of the child are formed. The placenta is just beginning to form; it cannot yet protect the fetus from negative influence. Therefore, it is undesirable to carry out any medical intervention during this period. However, the dentist may prescribe local drugs to relieve inflammation (Chlorhexidine, Miramistin, Cholisal).
Second trimester (from approximately 13 to 24 weeks)
In the second trimester, the risk of dangers decreases significantly. The placenta serves as a reliable protective barrier for the baby. This is the optimal period for dental treatment and other dental procedures.
Third trimester (from 25 weeks to delivery)
In the 3rd trimester, increased sensitivity of the uterus to drug effects occurs. In addition, during this period the woman’s body is quite weakened. Therefore, “extra” stress in the dentist’s office is extremely undesirable. If possible, it is better to postpone dental treatment during lactation. However, this does not apply to emergency cases, such as acute toothache.
Dental diagnostics during pregnancy
Treatment of pulpitis and tooth extraction during pregnancy cannot be done without diagnosis. Traditional radiography (sight X-ray) - not the best option for pregnant women. Fetal cells are in the process of dividing, so they are especially sensitive to radiation.
But if there is a need for such diagnostics, it is better to carry it out in the second trimester. Be sure to cover your stomach and pelvic area with a protective lead apron.
The safest option for women during pregnancy is digital radiovisiography. This method has minimal radiation exposure– 90% less compared to film X-ray.
Anesthetics are used local action that do not cross the placental barrier. Another requirement for painkillers is a low degree of impact on blood vessels.
Lidocaine is not suitable for expectant mothers, as this drug can cause muscle weakness, cramps and a sharp decrease in blood pressure.
The best option is anesthetics based on anticaine:
These drugs do not harm the baby because they act locally. They also have a reduced concentration of vasoconstrictor components (adrenaline, etc.), which is safe for the mother.
Tooth extraction during pregnancy
Tooth extraction is a surgical operation that is always accompanied by psycho-emotional stress. Of course, it is undesirable for women while carrying a child.
Therefore, tooth extraction is carried out only in extreme cases:
- crown or root fracture;
- deep carious lesion, which becomes the cause purulent inflammation;
- formation of a cyst whose diameter exceeds 1 cm;
- incessant sharp pain which cannot be eliminated with conservative therapy.
Wisdom teeth removal is generally not performed during pregnancy. This operation often ends with alveolitis (inflammation of the socket) and other complications requiring antibiotics.
Implantation and dental prosthetics during pregnancy
During pregnancy, you can have any type of prosthesis, including crowns and bridges. The exception is dental implants.
Implanting a dental implant often requires a lot of vital energy. But during pregnancy, all resources are aimed at development healthy baby.
In addition, after implantation, anti-inflammatory and painkillers are required, which are contraindicated for the expectant mother.
Dental treatment during pregnancy can be done absolutely free if you use the compulsory medical insurance policy. List of all government agencies, as well as private dentistry you will find on our website.
Caries during pregnancy generally occurs more often than in other periods of a woman’s life, and often occurs very actively at this time, sometimes even in an acute form. It is quite understandable for expectant mothers to be concerned about the possible impact of caries on the fetus, as well as fears about whether it is even possible to treat teeth during such a crucial period.
In some cases, during pregnancy, caries is just beginning its destructive work (and many try to wait out this time), and the most noticeable and sensitive consequences of dental damage await the woman after childbirth.
On a note
The statistics are eloquent:
- Caries is found in 91.4% of women with a normal pregnancy and in 94% of women with toxicosis.
- The average intensity of dental damage in pregnant women is from 5.4 to 6.5 (this is a high level);
- Enamel hyperesthesia (increased sensitivity) is observed in 79% of women during pregnancy.
It is believed that caries itself during pregnancy does not have such a negative effect on the fetus as its treatment can have. Taking advantage of this popular belief, many pregnant women are wary of visiting the dentist, and the reason for this is that expectant mothers do not understand the nature of caries and the very dangers it poses.
Let's figure out what is actually more dangerous and can have a stronger effect on the fetus - and also see how you can carry a healthy baby and at the same time keep your teeth in excellent condition.
Does tooth decay affect the fetus?
To begin with, it is useful to remember that caries is a disease caused by pathogenic bacteria in the oral cavity. It is believed that through microdamage to soft tissues, these bacteria can penetrate the bloodstream, enter the fetus’s body and cause various pathologies.
However, the likelihood of this is extremely low: bacteria manage to penetrate the placental barrier only in extremely rare cases, and the inhabitants of the oral cavity have practically no chance of surviving in the tissues of the embryo and having any effect on it. Viruses mostly have these abilities. But, as is the case with any infectious disease, the presence of caries in pregnant women requires a number of hygiene procedures and careful oral care.
Caries and pregnancy are more closely related precisely through the physical condition of the mother. For example, constant pain in a tooth affected by caries (which, by the way, is not uncommon during pregnancy) leads to the woman’s inability to eat normally, general deterioration emotional state. All this together can really have some negative impact on the development of the fetus.
In addition, complicated caries affects pregnancy due to the fact that with lesions, for example, periodontal disease, inflammatory process, which may affect the overall physical condition expectant mother: lead to an increase in body temperature and the need to take antipyretic drugs, exacerbation of toxicosis, disturbances in the functioning of the digestive system.
But still, the main and most real danger of caries during pregnancy lies in the possibility of its transition to acute form, severe damage to many teeth at once and the woman’s loss of them in a fairly short time. In other words, tooth decay is usually more dangerous for the mother than for the fetus.
The same is true in the case of caries in a nursing mother. The only differences here are the reasons for refusing to visit the dentist: if a pregnant woman is often afraid that caries treatment will harm the unborn baby, then a nursing mother simply does not have 2-3 hours of time to go to the clinic.
Causes of caries development in pregnant women
Caries during pregnancy is largely due to the same reasons as in cases with other categories of patients: poor oral hygiene, an abundance of snacks during the day, a passion for sweets.
But for many women, additional reasons due to gestation come to the fore:
- A decrease in the concentration of calcium and fluorine compounds both in saliva and in the blood due to some consumption of them for the needs of the developing embryo. Calcium is not consumed from the teeth themselves, as many people incorrectly believe. But the remineralization of enamel and its strengthening, which always occurs in other periods due to the action of saliva, can slow down or even stop during pregnancy. As a result, the enamel becomes weakly mineralized and is more easily damaged by acidic waste products of bacteria.
- Hormonal changes in the body and, again, corresponding changes in the composition of saliva, which leads to a decrease in its bactericidal properties. Simply put, the saliva of pregnant women is in some cases less effective at destroying cariogenic bacteria.
- Changes in diet – pregnant women can go to different extremes; they often develop strong cravings for sweets and starchy foods.
- Improper dental care - due to fatigue, toxicosis, worries and fuss, some expectant mothers regularly forget to brush their teeth or do not do it thoroughly.
In addition, many pregnant women manage to hear a lot of statements from friends and relatives that it is impossible to treat teeth during pregnancy, and simply do not go for preventive examinations. And as a result, they miss the moment when the tooth could actually still be cured absolutely safely for the fetus.
Treatment of caries at different stages of pregnancy: is it dangerous and how is it carried out?
Caries during pregnancy is not only possible, but also absolutely necessary. Sometimes due to risk acute development For some pregnant women, timely treatment of the disease is the only way to prevent it. Of course, the management of the disease itself must take into account the patient’s situation.
The main danger that arises when treating caries during pregnancy is the risk of exposure of anesthesia drugs to the fetus. All anesthetics are absorbed into the blood and can pass through the placenta, and some of them are quite capable of having an adverse effect on the developing embryo.
This is why, by the way, it is so important to see a dentist throughout pregnancy - if caries is detected on the most early stages its development, treatment can be carried out using remineralization methods without anesthesia, without a drill and without discomfort. But already advanced caries without anesthesia will be really painful to treat.
Often it is impossible to do without anesthesia when treating complications of caries: with pulpitis or periodontitis, this approach is unacceptable, since a pregnant woman may experience painful shock.
As a rule, treatment of average caries during pregnancy, especially if the pathology occurs in chronic form, dentists prefer not to perform it until the beginning of the second trimester. It is in the first 12-13 weeks that the formation of all organ systems in the fetus occurs, and the risk of negative effects of medications on it during this period is maximum, although still small. Already starting from 14-15 weeks, the use of special anesthetic drugs allows for safe sanitation.
On a note
Dental X-rays are strictly not used during pregnancy. If the cavity is hidden from view, they try to resort to other methods. They even try not to study the quality of canal filling using x-rays.
Modern radiography using a visiograph has several times less radiation exposure. If there is an urgent need, it can only be done from the second trimester of pregnancy on this device.
Acute pulpitis is treated using local anesthesia, regardless of the stage of pregnancy, purulent periodontitis and periostitis. When treating caries, even deep ones, the doctor begins treatment without the use of anesthesia and gives an injection only if the patient begins to feel pain when excision of carious areas of dentin.
Specially adapted drugs are used as painkillers for the treatment of pregnant women in dentistry, for example, Septanest and Scandonest at a dilution of 1:200,000. Pregnancy is not a contraindication for their use, and already 3 hours after the injection they are not detected in the blood.
Dentist's opinion:
Pregnancy is not a contraindication for other medications, judging by the instructions. The fact is that reducing the concentration of adrenaline, and in Scandonest - also preservatives, minimizes risks, but does not eliminate them. In any case, I observed on popular portals the position that articaine-type drugs are positioned as relatively safe for local anesthesia with relative risks, therefore they are made in case emergency, one of which is pain!
Towards the end of pregnancy, therapy is further complicated by the fact that when sitting in a dental chair, due to the specific position of the fetus, the load on the inferior vena cava and aorta increases, which leads to a decrease in pressure and possible loss of consciousness in the patient. To avoid this, the pregnant woman lies down in the chair slightly on her side, which reduces the load on the fetus. At the same time, the risk of teratogenic effects of anesthetics on the fetus becomes minimal by the end of pregnancy.
You can take painkillers on your own at home only if the pain is completely unbearable and you are unable to this moment consult a doctor. If it comes to this, the doctor should see the tooth as early as possible. Good dentist will do everything possible to cure the mother’s tooth and not harm the unborn baby.
If you decide to take a painkiller yourself, then keep in mind that taking almost any drug in some cases may well have Negative consequences. You can choose this in individual case“self-medication”, that even a single dose of a strong painkiller will affect the health of the mother and fetus. Do not forget about individual intolerance and side effects for each drug, especially since painkillers have a whole range of them.
“At one time I went to a clinic where pregnant women did not have their teeth treated at all until the 20th week. Before pregnancy, I didn’t think about it, but when I came in the third month with initial caries, I was turned around. They said that I needed to walk around for another two months, and then they would treat me. This is a disgrace! At the spot stage, caries is treated without anesthesia and without any medications; nothing affects the fetus at all. And in two months they will open my tooth and put a filling, God forbid the nerves will be removed. I had to change the clinic, the tooth was cured, without a filling and without anesthesia. Now I’m already playing with my little one, but my tooth remains healthy.”
Anna, St. Petersburg
Prevention of caries and proper preparation for pregnancy
Prevention of caries in pregnant women should begin even before pregnancy. At the planning stage, the expectant mother should check with a dentist, heal all diseased teeth, and remove plaque and tartar. The doctor will draw up a schedule at this time. preventive visits which will need to be observed (it is not known what the cariogenic situation in the mouth will be with the onset of pregnancy and fetal development).
On a note
The question is often asked: “Can pregnant women undergo professional hygiene?” There is a list of diseases for which ultrasonic (US) teeth cleaning and apparatus are not recommended or prohibited. Air Flow: epilepsy, presence of a pacemaker, nasal breathing disorders, asthma, chronic diseases lungs in exacerbation, HIV and hepatitis, venereal diseases, high sugar in the blood or diabetes, ARVI, herpes and transmitted diseases by airborne droplets, malignant neoplasms.
Most often this is due to the aerosol that rises when brushing teeth from plaque and tartar. A cloud of wet dust and infection can cause respiratory failure in a pregnant woman, and high blood sugar can lead to the risk of prolonged bleeding from the gums during traumatic manipulation. In some cases, the possibility of carrying out manipulations in a pregnant woman can be determined with a related specialist (gynecologist, endocrinologist, therapist, ENT doctor, oncologist).
Directly during pregnancy, caries prevention requires:
- Compliance with the rules of oral hygiene: teeth are brushed after each meal, preferably with pastes selected by the dentist; after random acts of vomiting due to toxicosis, the mouth is rinsed with a soda solution to neutralize acids from the vomit.
- Compliance with the diet, restriction in the diet of sweet flour and chocolate products.
- Compliance with all the dentist’s instructions - the use of systemic preventive measures, professional cleaning teeth, visiting the dentist for routine checkups, etc.
Practice shows that the correct one during pregnancy, although it should be systematic and regular, it usually does not present any difficulties. At the same time, it is the main guarantee that a woman will keep all her teeth in good condition during pregnancy and breastfeeding.
Interesting video: is it possible to treat teeth during pregnancy and what is important for every expectant mother to know?
Some more important nuances of caries treatment during pregnancy
Update: October 2018
During pregnancy, almost every woman faces the problem of “bad” teeth. The condition of teeth worsens even in those women who did not have dental problems before pregnancy. What is the reason for this? Is it possible to have dental treatment during pregnancy? How to protect your teeth when carrying a child and does dental health affect the course and development of pregnancy?
How does pregnancy affect the condition of teeth?
It is during gestation that the condition of teeth deteriorates sharply. And this is not at all connected with the well-known postulate: “the child takes calcium from the teeth to build his skeleton,” which is fundamentally wrong, but with powerful hormonal changes that begin from the moment of conception.
Increased blood supply leads to increased blood supply not only to the uterus, but also to other organs, as well as the gums. As a result, the gum tissue softens and becomes loose, which facilitates the penetration of microbes into the gums and teeth and contributes to the development of gingivitis, stomatitis and exacerbation of caries.
Gingivitis without timely treatment easily progresses to periodontitis, which is dangerous not only with the loss of a tooth or teeth, but also with the loss of pregnancy. In addition, hormonal changes affect the amount of saliva and its acidity. During pregnancy, there is increased salivation and a shift in the pH of saliva towards acidity, which contributes to the thinning of tooth enamel and the proliferation of microbes. As a result, caries develops and progresses rapidly.
Toxicosis also affects the condition of the oral cavity and teeth in particular. Nausea and vomiting also play a role in shifting the pH of saliva, leading to the loss of minerals (fluoride, calcium, phosphorus, magnesium), which causes demineralization of teeth (thinning of enamel) and the progression of caries.
Changes in taste during pregnancy and consumption in large quantities also play an important role. simple carbohydrates, which quickly break down in the oral cavity, serves as a catalyst for the proliferation of bacteria and the spread of caries (both deep into the tooth and onto neighboring teeth).
Changes in the composition and pH of saliva, as well as weakening of the immune system during gestation, also affect the formation of dental plaque. If you do not prevent oral diseases during pregnancy and ignore dental plaque, it will quickly transform into tartar, which can also lead to tooth loss. In addition, dental plaque is one of the predisposing factors in the development of gingivitis.
What affects dental health?
However, not all pregnant women's dental health deteriorates dramatically. Some people lose several teeth in 9 months, while others maintain a healthy and snow-white smile before and after childbirth. What is this connected with? Dentists, in addition to the mandatory hormonal changes that occur during gestation, also identify a number of predisposing factors that provoke diseases of the oral cavity and teeth:
Genetic predisposition
Heredity plays an important role in the condition of teeth. If the parents of the expectant mother started having problems with teeth when they were still at a young age, most likely she cannot be avoided dental pathology during pregnancy.
Failure to comply with oral hygiene rules
During pregnancy, a woman should especially carefully monitor and care for her oral cavity. This is not only brushing your teeth twice, but also regular (at least 3 times during pregnancy) visits to the dentist, identifying the first signs of caries and its active treatment, taking vitamins and mineral complexes indicated for pregnant women and adherence to healthy eating rules.
Presence of chronic somatic pathology
Existing chronic diseases digestive tract(enteritis, gastritis, colitis), endocrine pathology(diabetes mellitus, thyroid diseases), bone and joint pathology (arthritis and arthrosis, osteoporosis) lead to it not being absorbed by the body in the required dosage, which aggravates the condition of the teeth, promotes their demineralization and the development of dental diseases.
Bad habits
As sad as it is to say this, not all pregnant women are able to refuse bad habits for the sake of the future baby. Smoking affects the acidity and composition of saliva, which has not undergone any changes during pregnancy. better side, and drinking alcohol interferes with the absorption of minerals necessary for dental health. Also, do not forget about the habit of chewing nuts or hard candies, which is traumatic not only for the fragile teeth of a pregnant woman, but also for ordinary person.
Constant stress
During times of stress, the hormone cortisol is released into the blood in large quantities, which reduces the already weakened immune system in people. expectant mother. Reduced immunity“plays into the hands” of pathogenic bacteria, including those living in the oral cavity, which contributes to the flourishing of dental diseases. And pregnant women, as you know, are emotionally labile; for them, any seemingly trivial matter turns into a serious one. stressful situation, as a result of which both the state of health in general and the condition of the teeth in particular deteriorate.
Are pregnancy and dental treatment compatible?
Many women still do not know whether teeth are treated during pregnancy or not. Yes, teeth during gestation are not only possible, but also necessary to be treated, especially if the woman has not taken care of their health in advance. Carious teeth, gum and oral cavity diseases are sources chronic infection, in particular staphylococcus, which is very dangerous for the unborn child.
In almost every third woman who has a chronic source of infection in the body during pregnancy, the fetus becomes infected, and diseased teeth play an important role in this situation. Pathological bacteria from carious or decayed teeth, along with food, enter the gastrointestinal tract, from where they enter the bloodstream and spread throughout the body.
Not only can pathology of the oral cavity lead to the development of sepsis, but it will certainly affect the course of pregnancy, the growth and development of the fetus. Caries and other dental diseases predispose to the occurrence of gestosis, cause infection of the membranes, waters and fetus, which is especially dangerous in the first trimester, when the placenta is not yet formed and pathogenic microorganisms easily penetrate to the fetus. This can provoke a threat of interruption, and even spontaneous abortion.
IN late dates diseased teeth can cause premature birth, the birth of a weakened, low-birth-weight baby with digestive and respiratory systems, skin and reduced immunity.
In addition, a woman’s carious teeth pose a danger to the baby even after pregnancy (childbirth), since close contact between mother and child cannot be avoided (breastfeeding, kissing, etc.).
Optimal timing for dental treatment
Ideally, sanitation of teeth, as well as chronic gynecological and somatic diseases, should still be done at the pregnancy planning stage. A woman should take her upcoming pregnancy seriously, because any source of chronic infection in the body poses a potential threat to the fetus. But, as a rule, either pregnancy happens unexpectedly, or the expectant mother neglects the examination during the planning period.
It doesn’t matter what condition a woman’s teeth are in, she mandatory in addition to delivery various analyzes They will schedule a consultation with a dentist when registering for pregnancy. A repeat preventative dental examination is scheduled before leaving for maternity leave, that is, at 30 weeks, and the last time you should see a doctor is at 36 weeks. But if a woman has problems with her teeth and oral cavity, then more frequent visits to the dentist cannot be avoided.
Dental treatment during pregnancy
First trimester
The first trimester lasts from the moment of fertilization and implantation of the egg until 14 weeks. This is the most crucial stage of pregnancy, because it is at this time that all the organs and systems of the baby are formed. The placenta, as is known, completes its formation at 16 weeks, so dental treatment within this period is not advisable, since protective function the placenta is not yet fully expressed and the embryo is vulnerable to medicines.
In addition, the first trimester is maximum amount critical deadlines for the threat of miscarriage (visiting the dentist is always stressful not only for a pregnant woman, but also for an ordinary person). But the exception is the situation when teeth hurt in the early stages. In this case, emergency procedures are carried out (removal of the “nerve” or the tooth itself) after consultation with the attending obstetrician and taking into account the risk of exposure of the embryo to drugs.
Second trimester
The second trimester (14 – 26 weeks) is considered the most favorable period for dental therapy. The laying of organs has already occurred, the placenta has formed and is actively functioning, the psycho-emotional state of the pregnant woman is quite stable. At this time, it is recommended to carry out all the necessary preventive procedures and, if necessary, therapeutic ones (tooth extraction, filling).
Third trimester
Dentists do not recommend undergoing dental treatment in the third trimester. Firstly, the uterus is already so enlarged in size that in a horizontal position on the dental chair it compresses the inferior vena cava and aorta, which impairs uteroplacental blood flow, and, in addition, sharply reduces blood pressure and provokes the development of acute vascular insufficiency (fainting) . In addition, the uterus in the last stages of gestation reacts very sensitively to external stimuli, which can result in premature birth, A physical strength and the psycho-emotional state of the pregnant woman is significantly depleted.
Acute toothache
It is difficult to find a person who has not experienced acute toothache at least once in his life. It is especially possible that a tooth hurts during pregnancy - what to do in this case? First of all, you need to contact your dentist (appear for an appointment or extreme case call). To soothe a toothache, if it is not possible to immediately visit a doctor, some folk remedies, having previously eliminated irritating factors (stop eating, carefully brush your teeth):
Rinsing
Rinse your mouth with warm (not hot) water with the addition of soda or sea salt, or a decoction of medicinal plants (mint, chamomile, oak bark, St. John's wort flowers - whatever is on hand). Rinsing is more effective the more often and longer it is carried out (every 30 – 60 minutes).
Applying tampons
Apply a cotton swab soaked in fir, cloves to the gum or “put a mask” of propolis on painful area gums.
Applications with onions and garlic, with lard
Apply a paste of finely chopped onion and garlic (antiseptic effect), mixed with salt, to the sore tooth and gum. Lard applications - apply a small piece of unsalted lard to the gum on the side of the cheek.
If traditional methods did not bring relief, you can use (preferably after consulting a doctor) some medications:
- paracetamol (safe during pregnancy) - take no more than 4 tablets per day;
- – antispasmodic, effectively relieves toothache, 2 tablets no more than 3 times a day;
- spasmalgon - eliminates only mild pain, take 1 tablet no more than 3 times a day;
- Nurofen (active substance) - has an anti-inflammatory and analgesic effect, take 0.2 - 0.6 g. three times a day.
Expectant mothers must remember that no matter how strong toothache, warming up the painful area (fraught with periostitis - flux), drinking alcohol and aspirin, and, especially, applying a pill is not allowed acetylsalicylic acid to the gum (an “aspirin” burn will occur).
Dental filling in pregnant women
Expectant mothers are very concerned about the question: “Is it possible to fill teeth while expecting a child?” The answer is clear - if there is such a need, then it is necessary to put a filling, since a tooth “with a hollow” can completely collapse during pregnancy and after childbirth it will turn out that there is nothing to fill. If dental caries is superficial or moderate, then its treatment will be completed in one visit to the dentist, which will not even require pain relief.
In the presence of deep caries, the doctor, using a drill, will mechanically eliminate (drill out) the dead and destroyed areas and first install an arsenic-free paste, which will “kill the nerve,” that is, cause necrosis and dissolution of the pulp, then put a temporary filling.
After a few days, the temporary filling is opened and depulpation is performed, followed by the installation of a permanent filling. During pregnancy, it is allowed to use all types of fillings, including light-curing ones. Treatment of deep caries is very painful and is carried out under anesthesia.
Dental anesthesia in pregnant women
The fear of visiting the dentist for many is associated with the fear of pain during the procedure. medical procedures. Dental anesthesia during pregnancy is completely acceptable and even recommended. Fear and pain not only cause a lot of unpleasant moments, but can also cause uterine hypertonicity. Anesthesia is carried out before drilling the tooth, removing the pulp or other manipulations of the pulp and before extracting the tooth.
When treating pregnant women, only local anesthesia is used (even ordinary patients undergo general anesthesia not advisable due to the high risk of complications). Currently, dentists use local anesthetics that do not penetrate the placental barrier and have a reduced concentration of vasoconstrictor substances (and some do not have them at all). Ultracain and Ubistezin are used for anesthesia in pregnant women. Before the anesthetic injection, the gums are treated with novocaine spray (saliva should be spat out).
It is important to remember that women preparing to become mothers should notify the dentist about their pregnancy and due date.
Tooth extraction in pregnant women
If the tooth cannot be saved, then the question arises of its removal. Tooth extraction during pregnancy is postponed until the 2nd trimester, but if an emergency arises, tooth extraction is carried out at any time. Removal is carried out under local anesthesia and after X-rays. To avoid possible complications, it is important to follow the doctor’s recommendations after tooth extraction and under no circumstances apply heat to the wound surface.
Wisdom tooth removal deserves special attention. In pregnant women, this operation is undesirable, since it is technically more complex and is often accompanied by complications (fever, inflammation, which requires the prescription of antibiotics). Therefore, if possible, the removal of wisdom teeth is postponed until the postpartum period.
X-ray of teeth
Probably, not only future and real mothers know about the dangers of X-ray radiation for the fetus, therefore, if possible, they try to exclude X-rays during pregnancy (except emergency situations). But when undergoing treatment at the dentist, it may be necessary to take an X-ray of the tooth, including during pregnancy (before tooth extraction or dental canal filling). If it is possible to postpone dental treatment until the second trimester, it is advisable not to perform x-rays in the early stages of pregnancy.
But, in fact, dental x-rays are not as dangerous as possible consequences an untreated tooth for the future baby. Moreover, the irradiation is targeted only to the maxillofacial surface, and the neck, rib cage and the woman's stomach are reliably protected from irradiation by a lead apron. Today, many dental clinics are equipped with special devices - radiovisiographs, with the help of which the exposure time, and, accordingly, the radiation dose is reduced tens of times (radiovisiography is optimal for examining pregnant women and children).
Dental prosthetics
While waiting for the birth of a baby, many women experience free time, and, accordingly, the question arises: “Is it possible to “do” teeth during pregnancy?”
Dental prosthetics at this stage of life has no contraindications; the procedures performed by an orthopedic dentist do not cause concern and are absolutely safe for the fetus. The only thing you should refrain from during gestation is dental implantation. Engraftment of a tooth requires expenses from the body large quantity energy that is necessary for the growth and development of the child. In addition, for better implantation, medications that suppress the immune system are often prescribed, which is absolutely contraindicated for pregnant women.
Oral care
It is important to implement proper care for the oral cavity during pregnancy:
- It is necessary to brush your teeth at least 2 times a day, and preferably after each meal.
- To remove plaque and food particles from hard to reach places You should use dental floss.
- Choose a toothbrush with soft or medium-hard bristles of different lengths.
- Brushing your teeth should last at least 3-5 minutes, covering all surfaces (front and palatal, chewing), and moving the brush in horizontal and vertical directions.
- Don't forget about the surface of your tongue.
- It is better to choose a toothbrush with an elastically movable head, and change it every 2, maximum, 3 months.
Special toothpastes are also produced for pregnant women, which are sold in pharmacies. Suitable pastes for expectant mothers: 
- Pregnant 9 months;
- Bionics green;
- Splat organic;
- Splat biocalcium.
When purchasing another toothpaste, you should carefully study its composition. Toothpaste for expectant mothers should not contain:
- sodium lauryl sulfate and sodium loreth sulfate (causes irritation of the mucous membranes and accumulates in the body)
- triclosan ( antibacterial effect, is detrimental not only to dangerous, but also beneficial bacteria)
- fluorine and fluoride are generally useful, but in high concentrations they are toxic, so their content should be no more than 0.1 - 0.6% of other substances
- abrasives such as silica and calcium carbonate in high concentration In addition to plaque, enamel is also scraped off, so the degree of abrasiveness should not exceed 25 units.
- You should not use whitening toothpaste (for smokers), and you should also give preference to toothpastes marked “hypoallergenic.”
Rinses - as an addition to brushing your teeth, rinsing with dental elixirs or home remedies (infusion of oregano, St. John's wort and mint) is used.
Chewing gum- if nausea and vomiting bother you at the beginning of pregnancy, it is recommended to use it to neutralize the acidity of saliva chewing gum with xylitol or without sugar. After each attack of vomiting, rinse your mouth with warm soda solution and brush your teeth if possible.
Proper nutrition— it is advisable to exclude sweets and confectionery products, sweet carbonated drinks and store-bought fruit juices from the diet, replacing them with fresh fruits and mineral water. The diet should be dominated by foods high in calcium (milk, cottage cheese, kefir, eggs, cheese, nuts), vitamin D and phosphorus (cod liver, sea fish, seafood).
Do not neglect taking vitamin-mineral complexes that contain calcium (Pregnavit, Elevit). But from additional intake Calcium supplements should be avoided (excess causes premature aging placenta and early ossification of the sutures of the fetal head).
To prevent the development of gum diseases, massage should be performed (the gums are massaged with a finger with a small amount of toothpaste, every day for 5 - 7 minutes).
The expectant father should also have all his teeth treated before the baby is born, since then there will be close contact with the newborn (hug, kiss, swaddle, play).
Pregnancy is a very exciting and exciting state in a woman’s life, but it is associated with increased risk many diseases. Among others, teeth suffer; sometimes teeth are even considered a marker (indicator) of the health of a pregnant woman. So, we will tell you how pregnancy affects teeth, whether it is necessary to treat teeth during pregnancy and whether it is safe for a pregnant woman to do this, and you will also receive recommendations for prevention and self-help measures.
How does pregnancy affect teeth?
During pregnancy, the condition of teeth definitely worsens and this is due to the influence of two factors at once:
1. Hormonal changes.
Beginning with early dates pregnancy, the body gradually switches to a different hormonal background. To maintain pregnancy, natural immunosuppression (suppression of immunity) is necessary; this mechanism allows the mother’s body to “come to terms” with the presence of the fetus (the fetus is a foreign independent organism, because half of its chromosomes were inherited from the father). Natural immunosuppression during pregnancy is provided by progesterone, a hormone whose content increases significantly with the onset of pregnancy. Besides positive effect, decreased immunity contributes to a much faster progression of caries and gum disease. This applies to both diseases of the teeth and gums that existed before pregnancy and did not manifest themselves, as well as newly acquired ones.
2. Increased consumption of minerals.
The increased consumption of minerals, primarily calcium and phosphorus, is due to the needs of the growing fetus. Calcium is necessary for the baby to build bones. muscular system, formation of the organs of vision and hearing. If there is insufficient supply of calcium from the outside, the concentration of ionized calcium in the mother’s blood decreases and it begins to be washed out of the mother’s blood. skeletal system, including from teeth (to a lesser extent). However, teeth are a very sensitive object and the loss of even a small amount of calcium salts weakens and thins the enamel. if calcium replenishment does not occur, then the teeth become extremely vulnerable to infection (remember immunosuppression).
There are factors predisposing to dental disease during pregnancy:
Severe toxicosis in the first half of pregnancy. Vomiting of pregnant women provokes dental deterioration due to two mechanisms: damage to tooth enamel by acidic stomach contents during frequent vomiting and heartburn, and disturbance general exchange, which occurs when food is indigestible and lack of appetite due to nausea.
Late vomiting of pregnancy. Late (after 22 full weeks) vomiting of pregnant women itself indicates a metabolic disorder and possible intoxication body, and also prevents rational nutrition(dairy products tend to cause nausea).
Anemia of pregnant women. The more pronounced the anemia of a pregnant woman, the worse the supply minerals tissues and organs.
History of chronic diseases of the digestive tract. If before pregnancy a woman suffered chronic gastritis, peptic ulcer, dyskinesia of the gallbladder, cholecyst, pancreatitis, then during pregnancy the course of these conditions may worsen. The reason for the deterioration is the high content of progesterone, which reduces the tone of ALL smooth muscle organs, but if this is good for the uterus, then a decrease in the tone of the esophagus, stomach, and gall bladder leads to disruption of their work, heartburn, nausea, and belching. Periodic reflux of acidic stomach contents into oral cavity leads to damage to tooth enamel and opens the door to infection.
Adherence to irrational diets before and during pregnancy. This includes veganism (refusal of all products of animal origin, including indirect ones, such as honey and other bee products), a strict raw food diet (this way of eating often leads to hyperacid conditions and also damages the gums), and a diet with severe restriction of calories and protein.
Poor nutrition (excess flour, abuse of fast food, consumption of carbonated drinks, etc.) also does not contribute to both health in general and dental health in particular. This diet is low in fiber, but rich in simple sugars, which serve as abundant food for oral bacteria.
Is it necessary to treat teeth during pregnancy?
The answer here is clear - YOU NEED IT!
During pregnancy, pre-existing problems may become worse and appear, and the risk of new caries is high. Ideally, a woman approaches pregnancy as planned and undergoes sanitation of all foci of infection before conception (oral cavity, throat and tonsils, sinuses, gastrointestinal tract, urinary system, reproductive system and bronchopulmonary apparatus). But this is not always the case.
Therefore, when you register with the antenatal clinic, one of the first referrals you will receive is to see a dentist for preventive examination and, if necessary, treatment.
Optimal timing of dental examination for preventive purposes:
Registration at the antenatal clinic (up to 12 weeks)
- 20-24 weeks
- 32-34 weeks.
The minimum scope of examination is twice during pregnancy: at registration and in the third trimester.
In the first trimester, dental treatment is indicated only according to emergency indications(active caries, acute toothache), this is due to the undesirability of using anesthesia.
The second trimester is the ideal time to therapeutic measures. The period from 14 to 26 weeks is considered the safest for treatment. It is possible to provide almost all types of dental care. It is not recommended to just start dentures, since dental tissues are quite fragile, and the gums are loose, there is a possibility of implant failure and an increased risk of infection.
It will also not hurt to carry out hygienic teeth cleaning, fluoridation and other types of enamel protection. But it is better to refrain from removing tartar; this procedure has a strong effect on the enamel, and its restoration during gestation will be slow, increasing the risk of cervical caries.
If there are indications, it is possible to perform tooth filling, depulpation and canal filling.
Tooth extraction is performed according to extreme indications, but is not contraindicated. Limitations may arise due to the choice of anesthesia, which takes into account the balance of benefit to the mother and risk to the fetus.
If necessary, it is possible to install braces, but only after consulting an orthopedic dentist.
In the third trimester, all of the listed types of dental care are also allowed.
Anesthesia for dental treatment. Is it possible or not?
Difficulties in providing dental care arise in the first and third trimester, this is due to restrictions in the use of local anesthetics. Most drugs contain adrenaline, which reduces the toxicity of the anesthetic, but creates a sharp, albeit short-term, vasospasm. In the first trimester it is also dangerous because possible increase tone of the uterus, and in the third trimester, spasm of all blood vessels can lead to a jump blood pressure in the mother, which indirectly affects the condition of the fetus.
Providing local anesthesia in the second trimester is considered the safest and most recommended.
Currently, drugs based on articaine hydrochloride (ultracaine, ubistezin, alfacaine, brilocaine) without adrenaline are most often used in pregnant women. The use of these anesthetics is safe; they do not penetrate the hematoplacental barrier to the baby and do not cause vasospasm.
Is it possible to take dental x-rays during pregnancy?
If possible, any radiation exposure should be avoided during pregnancy. But sometimes without this examination it is impossible to determine the extent of the damage, and therefore the amount of assistance provided. Now there are X-ray machines with minimal radiation exposure, as well as special dental tomographs. The study is performed according to indications, starting from the second trimester.
If you contact dental clinic in the early stages of pregnancy not in the direction of the antenatal clinic, then always inform the dentist about your situation.
What are the dangers of untreated teeth during pregnancy?
1. An untreated tooth will continue to decay, and if you delay treatment until after childbirth, it is possible that treatment will be much more difficult or tooth extraction will be indicated.
2. An untreated tooth is a source of infection. As you know, the most evil and active bacterial flora is found in the oral cavity. The oral cavity comes into contact with many external pollutants (contaminated food, inhalation of suspended matter and dust, household infectious agents, such as the habit of biting nails or the tip of a pen, wetting a finger with saliva when turning pages, and so on).
The mouth has an ideal temperature and humidity environment for bacteria, as well as an abundant blood supply. Infectious agents can penetrate the bloodstream, and therefore to the child, through the mother-placenta-fetus system. Chronic circulation of bacteria threatens many adverse consequences: intrauterine infection of the fetus, chronic fetal hypoxia, increased risk of preeclampsia in the mother.
Prevention of tooth decay during pregnancy:
1) Balanced diet.
Rational nutrition implies nutritious food in sufficient quantities, which brings maximum benefit to the mother and child. Preference is given low-fat varieties meat, any fish, dairy products, cereals, vegetables, fruits and herbs.
If we are talking about a diet that prevents tooth decay, then first of all we are interested in foods rich in calcium. Contrary to popular belief, cottage cheese is not a calcium-rich product; the content of this mineral in cottage cheese is the same as in kefir or broccoli.
Calcium rich foods:
cheeses (Parmesan cheese comes first), sesame seeds, canned sardines, almonds, herbs (parsley, lettuce and basil), cabbage, beans and chocolate. Dairy products contain calcium in small quantities (the most calcium-rich product is skim milk), but in an easily digestible form, so they should not be neglected.
Red and black currants, sorrel, spinach and gooseberries make it difficult to absorb calcium due to high content fruit acids. In combination with these acids, calcium forms insoluble compounds that will not bring benefits, but will simply be excreted from the body. Coffee, tea and cola also make it difficult to absorb calcium due to the presence of caffeine and tannin.
2) Hygiene.
Oral hygiene is the basis of dental health. Currently, various methods of care are available, you just need to not be lazy regularly (use them 2 times a day).
The toothbrush should be soft or medium hard and should be changed at least once every 3 months.
Teeth cleaning is carried out according to a simple algorithm.
Before cleaning, you need to rinse your mouth to remove the bacterial mass that has accumulated overnight. Before use, the brush should be washed with soap or scalded with hot water. This rule is rarely observed by anyone, but think about how many bacteria have settled and multiplied on the brush overnight, especially since the humid and warm atmosphere of the bathroom is very conducive to this.
You need to brush your teeth for three or more minutes. Why exactly three minutes? The fact is that you should do about 300-400 brushing movements, and this takes just about 3 minutes. Direct brushing is performed in three techniques: “sweeping” and “sweeping” movements from top to bottom to clean the front and back surfaces of the teeth, back and forth movements to clean the chewing surface and circular polishing movements in conclusion.
After this you need to clean inner side cheeks and tongue surface. Use the back of a toothbrush with a ribbed surface to do this. If you have toxicosis, do not press too hard on your tongue, especially in the root area, as this will provoke vomiting.
After brushing, rinse your mouth again warm water and wash the brush. The brush should stand in the cup with its head up to dry.
For intermediate hygiene use dental floss(floss), irrigator and mouth rinses.
Dental floss
Floss must be used very carefully if there is a problem with bleeding gums. Floss is used to clean spaces between teeth that are difficult to reach with a brush.
An irrigator is a device that gently washes away dirt from the spaces between teeth using a stream of water under low pressure.
Irrigator
During toxicosis, when vomiting periodically bothers you, you need to take special care of your dental health. After each vomiting, rinse your mouth with warm water. weak solution soda (1/2 - 1 teaspoon per glass warm water, if it does not cause vomiting), and then use mouth rinses.
3) Taking vitamins and mineral complexes.
Taking into account the vitamin and mineral poverty of our modern diet, all pregnant women are advised to take special complexes, starting from the early stages (Femibion Natalcare I, Elevit Pronatal). In combination with a fortified diet, this is usually sufficient.
But if necessary, the prescription of additional calcium supplements (calcium D3-Nycomed, Calcemin Advance) is indicated. The medications are taken under the supervision of a doctor, the duration is determined individually.
Timely care and contact with a dentist will save you from many problems and preserve the beauty of your smile. Take care of yourself and be healthy!
Obstetrician-gynecologist Petrova A.V.
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