Dentists often hear their pregnant patients saying, “For every child she bears, a woman loses a tooth.” This indeed is a myth, this old saying might have borne some truth someYears ago, but today women are better educated about their teeth and dentists understand more about her altered physiological and psychological state, neglect in oral hygiene or postural position during treatment. Teeth related problems could result in compromised nutritional status to the fetus and therefore needs immediate attention.

PHYSIOLOGICAL CHANGES DURING PREGNANCY:

Pregnancy results in several physiological changes. Changes occur in the endocrine, cardiovascular, respiratory, urinary and the gastrointestinal systems.

First trimester is very critical. During this period serious complications and abortion can occur.

ENDOCRINAL CHANGES – During pregnancy placenta secretes three major hormones; namely estrogen, progesterone and chronic gonadotrophin. These hormones ensure viability of placenta and the fetus.

CARDIOVASCULAR CHANGES – In pregnancy there is increase in cardiac output and gradual increase in mean blood pressure which reaches its peak by early part of second trimester and returns to normal level on completion of the term.

RESPIRATORY CHANGES – Include increased metabolic rate with an increase in maternal oxygen uptake by 20 percent.

HEMATOLOGICALY – There is an increase in blood volume up to 40 percent by the end of pregnancy. Iron deficiency anaemia is also a common feature in pregnancy.

Increase in Glomerular filtration rate is common in pregnancy.

Decreased gastric motility is a common feature during pregnancy.

These physiological changes result in alteration in drug absorption, metabolism and excretion.

* Decrease in plasma proteins results in modification in drug binding which alters activity of given drug.
* Increased renal filtration rate increases excretion of drugs.
* Increased biotransformation of drugs in the liver result in decreased availability of drug.
* Decreased gastric motility enhances absorption of hydrophilic drugs which are poorly absorbed normally.

Healthy mother and good foetal care make less complication during pregnancy.

FOETAL CONCERNS:

Foetus is susceptible to malformations during the first and second half trimester as it plays important role in the formation of organ system while the remainder of pregnancy is devoted to growth and maturation with diminished changes of malformation. A notable exception to this is the foetal dentition ,which is susceptible to staining and enamel hypoplasia due to tetracycline and nutritional deficiencies .

ORAL FINDINGS IN PREGNANCY:

It’s very important for you to take good care of your dental health while you are pregnant. This is because hormonal changes a woman undergoes during pregnancy may have an effect on her teeth, increases her risk of developing gum disease and her bad oral health can affect the health of her developing baby.

PREGNANCY GINGIVITIS –

* Plaque related mild gingivitis to extensive periodontitis is common in pregnancy. This is largely due to exaggerated inflammatory response to local irritants mediated by elevated levels of estrogen and progesterone.
* Gingivitis in pregnancy begins in marginal and inter-dental papillae in the first trimester.
* Pyogenic granuloma / pregnancy tumor – is seen in 1 percent of expectant mothers. It is seen as a sessile or pedunculated asymptomatic soft tissue mass in maxillary anterior region. The gingival mass usually doesn’t need any much treatment – it resolves after child birth and removal of local irritants.
* Professional dental scaling twice or thrice during pregnancy, as well as frequent daily brushing and flossing will greatly reduce gums swelling and risk of developing pregnancy tumor.

DENTAL CARIES – An increase in sugar intake increase the incidence of caries, caries can also be attributed to poor diet and lack of oral hygiene. Regurgitation of acidic stomach content can result in erosion of the lingual surfaces of maxillary anterior teeth, a fluoride mouth wash to neutralize the acidity in mouth is recommended.  

Dental Care During Pregnancy:

Here are a few suggestions for maintaining good oral hygiene .

Before Getting Pregnant:

Get a dental check up appointment at a dental clinic as you are planning for pregnancy. In this way the dentist will clean your teeth, examine your gums and teeth, if any problem is identified that can be treated well in advance. It’s always best to complete any major dental treatment prior to pregnancy.

During Pregnancy:

- Tell your dentist which trimester you are in as he can plan for the treatment accordingly, dental treatments in first and second half of third trimester should be avoided.

- Morning appointments should be avoided in first trimester due to vomiting.

- Tell your dentist about the medications you are taking. Antibiotics such as penicillin, cephalosporins, erythromycin and clindamycin are used with no apparent toxic manifestations while streptomycin, chloramphenicol and metronidazole are associated with foetal defects when used during pregnancy. Yellow or brown discoloration of teeth can be caused by tetracycline during the formative phases of tooth development.   

· 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 dentistry have made X-rays much safer today than in past decades.

- Due to hormonal changes in pregnancy there is increased risk of gum diseases. Get your teeth professionally cleaned during your second and early third trimester.

- keep good oral hygiene practice by doing regular twice a day brushing and flossing of your teeth. Use a regular mouth wash too.

-  If morning sickness is keeping you away from brushing your teeth, change to a bland-tasting toothpaste during your pregnancy. Ask your dentist or hygienist to recommend brands.

- Eat a healthy and well balanced diet. Your baby’s first teeth begin to develop about three months into your pregnancy. Healthy diets containing dairy products, cheese, and yogurt are good sources of these essential minerals and are good for your baby’s developing teeth, gums, and bones.

- Avoid sugary and sticky foods and remember — the more frequently you snack, the greater the chance of developing tooth decay.

- AMALGAM FILLINGS – there is a controversy on the use of amalgam restorations in pregnant persons. It is a good practice to minimize exposure of pregnant patients to mercury. Amalgam fillings should not be removed or placed in pregnant persons, if unavoidable, a rubber dam should be used while placing amalgam filling.

Post-Partum Blues:

It is estimated that over 50 percent of women experience some degree of depression after a pregnancy. Studies demonstrate that estrogen and progesterone levels change, similar to the hormonal variances that many women experience during their menstrual cycle. Sheer exhaustion, apprehension about new responsibilities and anti-climactic shock may contribute to a sense of an overwhelming burden.

It is natural and quite common for many women to take time to refocus attention on themselves after having a child. Don’t despair! Resuming your normal lifestyle, including a visit to the dentist, is crucial to the recovery process. A woman cannot be the best mother if she fails to maintain her own mental and physical well being.

Here are some helpful hints:

- Do not be afraid to seek help taking care of the baby.

- Rest and regain your strength.

- Eat right and try to get some exercise. The better you feel about yourself, the better you will feel about everything else.

- Talk to other people who understand what you are going through.

- Your family and friends need to know that you need their support.

Be sure to visit your dentist regularly during and immediately after your pregnancy.

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