Pregnancy and bad teeth. Is it possible to treat teeth during pregnancy? Interesting video: is it possible to treat teeth during pregnancy and what is important for every expectant mother to know?

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

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, your teeth need to be put in complete order even before pregnancy, at the planning stage, and you need to visit the dentist several times during the 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 a huge amount of 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
- Good nutrition and vitamin intake

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 a medium-hard toothbrush, 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 toothpastes, but these pastes have a high calcium content and are created specifically 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

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 of the 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 a carious cavity, cleaning of 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 of dental examination for preventive purposes:

Registration at the antenatal clinic
- 20-24 weeks
- 32-34 weeks

Teeth after pregnancy

Pregnancy is an important event and a wonderful period in the life of any woman. However, during this period the risk of developing various dental diseases increases significantly. This is due to a general restructuring of the body, including hormonal levels and metabolism, and a decrease in the body’s protective fluids. How to keep teeth healthy during pregnancy? And what to do if a pregnant woman develops dental diseases?

Why treat teeth during pregnancy?
Having learned about her pregnancy, the first doctor a woman should visit is a dentist, even if she has never had problems with her teeth. Pregnancy is accompanied by a restructuring of the hormonal background of a woman’s body, as a result of which the immune system is weakened, and as a result, favorable conditions are created for the development of many microorganisms, including the oral cavity. Therefore, even caries during pregnancy develops much faster than in the normal state. The process of forming and carrying a pregnancy takes a lot of energy from a woman. For the bone structure of a child, a woman’s body needs a significant amount of calcium, fluorine, phosphorus and other minerals, the deficiency of which is replenished from the mother’s bones and teeth. This kind of process negatively affects the bone tissue and teeth of the expectant young mother, as a result of which caries develops very quickly.

If caries is not treated, it can lead to the development of more complex dental diseases - pulpitis (inflammation of the nerve of the tooth) and periodontitis, which should also not be ignored during pregnancy, since in the future the young mother will acquire many problems not only with her health, but also with baby's health. For example, infections penetrate through the inflamed teeth and gums of the mother into the body of the unborn child, weakening his body, as a result of which he may develop a tendency to allergies, and most importantly, caries may appear on the first teeth that appear.

If previously it was contraindicated to treat teeth during pregnancy, since the technologies used were dangerous for the health of the unborn baby, today, according to most experts, it is simply necessary to treat bad teeth during pregnancy. In addition, modern dental clinics have in their arsenal special medications for pregnant women, safe digital X-ray equipment (minimal dose of radiation, the effect is local and highly targeted), highly qualified specialists competently select anesthesia for pregnant women, which would simultaneously effectively relieve pain and not cause harm to the future child. In addition, special dental clinics for pregnant women have already appeared in our country, which have been effectively operating in the West for a long time.

During pregnancy, you can remove teeth, treat caries, periodontal disease, gingivitis, bleeding gums, inflammatory processes in the teeth, and it is also possible to install braces. But you should wait with implantation and removal of tartar; these procedures are not recommended for use during pregnancy.

If you don’t have any dental problems during pregnancy, it is still recommended to visit the dentist’s office once every three months (three in total during pregnancy), where the doctor will tell you about all the nuances of oral care during pregnancy and recommend a brush and toothpaste .

Another reason for mandatory visit to the dentist during pregnancy and after it is periodontal disease and its initial stage - gingivitis (inflammation of the gums), the symptoms of which increase towards the end of pregnancy. Particularly careful adherence to hygienic rules in oral care can significantly alleviate the condition and prevent possible complications. However, it is impossible to completely get rid of this disease on your own. And untreated gingivitis leads to tooth loss even more often than untreated caries. If a woman develops gingivitis during pregnancy, the chance that the condition of the oral cavity will return to normal after the birth of the child is much higher than if the woman suffered from this disease before pregnancy. Therefore, it is recommended to visit the dentist at least once a year even before pregnancy. When treating gingivitis, as a rule, professional teeth cleaning and anti-inflammatory therapy are carried out.

In addition to dental treatment, it is also necessary to remove plaque and tartar.

During what period of pregnancy is it best to treat teeth?
In the first trimester of pregnancy, the formation of all organs and systems of the unborn child occurs, in the second trimester - the development of these organs and systems, in the third trimester - the preparation or independent functioning of these systems and organs. Each trimester has its own characteristics: the first and third trimesters account for the largest number of “critical” periods, so any medical interventions are not advisable during these months. The exception in this case is those medical procedures and manipulations that are necessary to preserve the life and health of the unborn child and his mother. That leaves the second trimester, which is considered relatively safe. Therefore, the period from the fourth to the sixth month of pregnancy (this is 14-20 weeks) is recommended to be used for dental procedures. When visiting a dentist, it is imperative to notify the doctor about your situation, stage of pregnancy, and indicate the medications you are taking. Depending on these factors, treatment tactics will be developed.

Treatment of caries during pregnancy.
Since anesthesia during dental treatment in pregnant women is strictly contraindicated, as a rule, treatment of caries in a pregnant woman is carried out without anesthesia. Using a drill, the dentist removes damaged tooth tissue and places a filling, which can be chosen according to your taste (chemical or light-curing). Neither one nor the other filling poses any danger, either for the mother or for the child. If anesthesia is still needed, do not worry about this, since today there are special anesthetics (Ubistezin, Ultracain) that have only a local effect and do not penetrate the placental barrier. This means that they are absolutely safe for the unborn child. In addition, these drugs contain a rather low concentration of vasoconstrictors, and some do not contain them at all (preparations based on mepivacaine).

Inflammation of the nerve or pulpitis is treated with anesthesia, which was mentioned earlier. Treatment of periodontitis (inflammation of the peri-root tissues of the tooth), most often, is carried out without the use of anesthetics. However, in both cases, X-rays are necessary, which allow high-quality filling of the root canals. In general, x-rays are contraindicated before the 20th week of pregnancy. After this period, x-rays are allowed, only the doctor must know about your situation. If the office is not equipped with a special X-ray unit (the radiation dose is reduced tens of times), which protects the doctor and patient from radiation, the doctor will provide you with a so-called lead apron to protect your stomach.

Tooth extraction during pregnancy.
If it is not possible to save the tooth, it is removed under local anesthesia. To avoid any complications, you must strictly follow all medical recommendations (do not rinse, do not heat the surgical area, etc.). If it is necessary to remove a wisdom tooth, then it is better to postpone such removal until later, since such removal is usually accompanied by the prescription of antibiotics.

Prosthetics, fluoridation and teeth whitening during pregnancy.
There are no contraindications to prosthetics. The procedures performed by an orthopedic dentist are usually painless and safe. But dental implantation is not recommended, since the process of engrafting implants is accompanied by large costs for the body. A young mother should direct all her strength and energy to the development of a healthy child. In addition, implants are most often implanted under the influence of medications, the action of which reduces the body’s reactivity, which is an absolute contraindication during pregnancy.

To preserve and strengthen tooth enamel during pregnancy, local fluoridation with fluoride-containing solutions and varnishes is recommended. In domestic practice, the application method of fluoridation is used, in which a so-called “individual tray” (wax casts of teeth) is made, into the recesses of which a fluoride-containing composition is poured, after which the casts are applied to the patient’s teeth (10-15 procedures), and the second method is carrying fluoride varnish with a brush on the surface of the teeth (3-4 visits).

The teeth whitening procedure during pregnancy is absolutely safe and harmless to the expectant mother and fetus. It is carried out in two stages: removing and removing plaque and tartar using ultrasound and treating teeth with special whitening pastes. Teeth whitening is carried out within an hour.

How to preserve teeth during pregnancy?
The birth of a child must be taken very seriously, therefore, long before pregnancy itself, both parents should cure all damaged teeth, since affected teeth are a source of infection, which negatively affects the health of mother and baby.

The best and most effective way to fight bacteria is to thoroughly brush your teeth in the morning and evening. During pregnancy, it is best to use a medium-hard toothbrush. The brush must be changed three times during the entire period of pregnancy. If your gums are bleeding heavily, use a soft-bristled brush. But it is not recommended to use an electric brush during pregnancy and breastfeeding.

To care for the oral cavity, you should additionally use dental floss or floss, which allows you to clean the interdental spaces; you can use dental elixirs, which have a cleansing and protective effect. Also, after every meal during pregnancy (and not only) you should rinse your mouth with boiled water.

Toothpaste used during pregnancy should also be of high quality: it should prevent the development of caries and gum disease and strengthen tooth enamel. Your dentist can recommend a suitable toothpaste during your consultation.

In addition, in order to preserve your teeth during pregnancy, you should limit yourself from consuming carbohydrate foods, especially sweets and starchy foods. A pregnant woman's diet should be balanced and include the necessary macro- and microelements and vitamins (calcium, phosphorus and fluorine, as well as vitamin D). Your daily diet should include fish oil, chicken eggs, cod liver, vegetables and fruits, cottage cheese, cheese, nuts and other products. During pregnancy, a woman should take vitamin and mineral complexes for pregnant women daily.

Pregnancy is a very trembling and exciting state in a woman’s life, but it is associated with an increased risk of 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.

Starting from the early stages of 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. In addition to the 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 the musculoskeletal system, the 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 skeletal system, including from the 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 in pregnant women provokes dental deterioration due to two mechanisms: damage to tooth enamel by the acidic contents of the stomach with frequent vomiting and heartburn, and a violation of general metabolism, 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 of the body, and also interferes with a balanced diet (dairy products, as a rule, cause attacks of nausea).

Anemia of pregnant women. The more pronounced the anemia of a pregnant woman, the worse the supply of minerals to tissues and organs.

History of chronic diseases of the digestive tract. If before pregnancy a woman suffered from chronic gastritis, peptic ulcer, gallbladder dyskinesia, cholecystitis, 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 the 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 provide 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 the dentist for a 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 for emergency indications (active caries, acute toothache), this is due to the undesirability of using anesthesia.

The second trimester is the ideal time for therapeutic measures. The period from 14 to 26 weeks is considered the safest for treatment. Almost all types of dental care can be provided. 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, this is also dangerous due to a possible increase in the tone of the uterus, and in the third trimester, spasm of all blood vessels can lead to a jump in 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 go to a dental clinic in early pregnancy other than through the antenatal clinic, 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 to lean meats, 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 their high content of 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 the inside of your cheeks and the surface of your tongue. 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 with 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, 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, a weak solution of soda (1/2 - 1 teaspoon per glass of warm water, if this does not provoke 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.

Dental problems in pregnant women

A baby growing inside a pregnant woman requires more nutrients to fully develop. And if he does not receive nutrients from his mother, he begins to take them himself. First of all, this concerns calcium for bone formation.

Smile of a pregnant woman

The condition of teeth worsens due to a slight disturbance in calcium metabolism in the pregnant woman’s body. A small hole becomes a deep cavity, or you can lose a tooth. A lack of calcium occurs due to an unbalanced diet or as a result of some pathologies.

An equally serious problem is gingivitis, which is inflammation of the gums caused by hormonal changes during pregnancy. If left untreated, periodontal disease causes gums to bleed when brushing your teeth and eating. But it doesn't end with just one toothache. Space appears between the gums and teeth, and the teeth begin to loosen. Pieces of food become clogged into the resulting cavities, which, when decomposed, contribute to the occurrence of caries.

You can reduce bleeding gums by changing your toothbrush to a softer one, doing finger massage of your gums, and rinsing your mouth with calendula, sage or chamomile. Women living in large cities are better off not using fluoride-containing toothpastes. By itself, this paste does not pose a threat and is beneficial for teeth, but together with fluoridated water it can cause enamel destruction during pregnancy. But enamel is not only destroyed due to an increase in fluoride, but can also be caused by a love of cold or hot food. For example, when hot coffee is washed down with cold mineral water or cold ice cream is washed down with hot coffee. Enamel does not like to be exposed to hard objects; you should not pick your teeth with sharp objects or chew nuts.

Pregnant women would do well to brush their teeth after eating with a toothbrush or chew gum for 10 minutes or eat an apple after eating. This should be done to cleanse plaque and to additionally release saliva reserves. Then the self-cleaning mechanism is triggered when saliva neutralizes the acids that have settled on the teeth after eating.

Our teeth are protected by saliva; it contains substances that create a barrier to unfavorable processes. During pregnancy, the composition of saliva changes, the protection weakens and the number of useful substances decreases. All this affects dental health. Having a carious tooth is dangerous in itself. Even if there is a small hole in the tooth, it will be the source of a dangerous infection that can spread to other areas. Any infection in a pregnant woman will be a risk to the health of her unborn child.

When you go to the dentist, you need to say that you are expecting a child. There are few restrictions in the treatment of a pregnant woman, this concerns the type of x-ray, type of anesthesia and whitening procedure. Prosthetics, fillings, surgical and orthodontic interventions have no contraindications. In any case, before serious manipulations in the oral cavity, an experienced specialist will consult with your attending physician with whom you are registered. You need to be treated by a dentist from whom you regularly receive treatment and whose qualifications you are confident in. It is advisable that the dentist has experience working with pregnant women.

Pregnancy is a physiological condition characterized, among other things, by hormonal changes in a woman’s body, which can lead to problems with teeth and gums. Each of the three trimesters of pregnancy has its own characteristics, but the capabilities of modern therapeutic dentistry can eliminate any of these problems in each period.

Pregnancy is characterized by a strong hormonal shock, which involves a rather complex set of hormones. In addition, during pregnancy, strong vascular changes occur, in particular in the mucous membranes of the oral cavity, dentoalveolar ligaments (periodontal).

Hormonal and immunological changes

Physiological changes that appear in a pregnant woman occur as a result of the endocrine activity of the placenta, the release of estrogen and progesterone.

The secretion of these hormones increases during pregnancy up to 10 times for progesterone and up to 30 times for estrogens.

Some hormones associated with pregnancy, such as progesterone, have immunosuppressive properties (immune suppression). Also, when levels of sex hormones are high, polymorphonuclear chemotactism, phagocytosis, and antibody response are affected. Therefore, the risk of any infection during pregnancy increases significantly.

Changes in the oral environment

During pregnancy, quantitative and qualitative changes occur in a woman's saliva. During the first three months of pregnancy, salivation increases (until now this phenomenon has not been explained). In subsequent months, this phenomenon of hypersalivation disappears.

The pH value of saliva changes towards increasing acidity (from 6.7 to 6.2) and this decrease in pH reduces the protective function of saliva. In addition, the presence of hormones is observed in saliva, which contribute to the growth of the number of microorganisms in saliva, increased bacterial contamination, and the formation of dental plaque and dental plaques.

Pathologies of the oral cavity during pregnancy

The effect of pregnancy hormones on the oral mucosa has been proven experimentally and clinically.

• Inflammation of the gums (gingivitis) is an inflammatory process often observed during pregnancy, aggravated by the formation of dental plaque and plaque caused by an increase in the content of estrogen and progesterone in saliva.
• Tumor of the gums (supragingival) pregnant women is a benign tumor. The etiology of its occurrence is still unclear, although trauma, poor oral hygiene and hormonal changes certainly play a role. The tumor disappears spontaneously after childbirth.
• Caries. During pregnancy, the development of carious cavities is often observed. It has been established that caries during pregnancy is provoked not only by deterioration of oral hygiene, but also by changes in hormonal levels, changes in the pH of saliva (the acidity of which increases during pregnancy). Increased carbohydrate intake may also influence the incidence of dental caries in pregnant women.
• Diffuse toothache. Often pregnant women complain of non-localized, diffuse pain in the teeth. This is probably due to changes in blood circulation inside the dental pulp, which causes contractions of nerve fibers when the walls of the pulp chamber are motionless. This pain is not associated with dental caries. If pain suddenly appears on healthy teeth, it usually disappears after 1-2 weeks (while caries does not disappear spontaneously).
• Tooth hypersensitivity. It has been established that pregnancy contributes to changes in tooth sensitivity, reaching the degree of hypersensitivity.
• Tooth erosion - demineralization, loss of substance from hard dental tissues under the influence of chemicals. During pregnancy, erosion is observed mainly at the level of the necks of the anterior teeth of the upper jaw. Tooth erosion is caused by increased acidity or gastric juice, especially when vomiting during pregnancy toxicosis. When erosions occur, short-term pain sensations appear, usually after eating, which spontaneously disappear after childbirth.

Treatment of dental and oral diseases in pregnant women

There are no contraindications for dental treatment for pregnant women. On the contrary, if treatment is not carried out, this can further have a detrimental effect on the health of both mother and baby.

However, when treating pregnant women at the dentist, it is necessary to observe some precautions, namely, pay attention to the following factors:

• stressful situations during treatment;
• use of ionizing (X-ray) radiation;
• anesthesia;
• filling materials;
• medications used;
• the presence of other pathologies in the body;
• choosing the moment to start treatment.

Stress

Anxiety and stress during dental surgery in a pregnant woman can be reduced by the attentive attitude and patience of the doctor. It is important that the dentist explains in detail to the expectant mother what manipulations he will perform, and that it is absolutely harmless for her unborn child.

Ionizing radiation (X-ray)

Dental x-rays are considered virtually harmless to pregnant women. However, it is recommended to observe the following rules:

• short irradiation time;
• protection of the pregnant woman’s abdomen and chest with a special apron (personal protective equipment);
• the number of x-rays should be kept to a minimum.

All of these precautions reduce the child's risk of exposure to radiation. However, it is still best to avoid X-ray examinations in the first trimester of pregnancy, unless absolutely necessary.

Anesthesia

Local anesthesia used in dentistry is not contraindicated for a pregnant woman. Regarding the drugs used, it is necessary to take into account that:

• the toxicity of painkillers increases due to a decrease in proteinemia (the presence of proteins in the blood plasma) of the pregnant woman;
• local hyperemia (overflow of blood in the vessels of the circulatory system above normal) when an anesthetic is injected causes acidification of the environment, which favors the cationic form of the anesthetic molecule to the detriment of the main form (namely, the main form acts on the nerve of the tooth, so the degree of pain relief in pregnant women may be reduced);
• all drugs have molecular weights of about 250-330, and any molecules with a molecular weight below 600 are retained by the placenta;
• the toxic dose of the anesthetic is 400 mg, which is significantly higher than the therapeutic doses used; however, it is desirable to use drugs that are least toxic, least lipid soluble, and most protein bound. The lipid solubility of the drug used determines its effect on the development of the embryo. Bonding with proteins increases the molecular weight and makes it impossible for the drug to cross the placenta.

Therefore, it is better to avoid the use of anesthesia drugs such as Prilocaine, Lidocaine and Mepivacaine. It is preferable to use Articaine (Alfacaine, Ultracaine, Primacaine, Septanest, Bucanest, Deltazin, Ubistezin).

Filling materials

No studies have shown that materials used for conservative dental treatment (composites, glass ionomer cements, etc.) or their components can penetrate the placenta or act as cellular poisons. But you should avoid using any materials containing mercury.

Medicines

If the dentist determines the presence of an infection in the oral cavity (teeth, gums), it will likely be necessary to resort to additional drug therapy. During pregnancy, you should avoid some antibiotics, some anti-inflammatory drugs, and some pain relievers.

Antibiotics

It is best to use penicillin antibiotics. First generation cephalosporins and erythromycin may sometimes be used as they have been shown to be safe. Tetracyclines should not be used because, in addition to causing dyschromia (staining) of the newborn's teeth, they are also responsible for clouding of the lens (cataracts) and congenital abnormalities of the limbs of newborns. Tetracycline can also cause fatty degeneration of liver cells and pancreatic necrosis in a pregnant woman.

Anti-inflammatory drugs

The dentist can prescribe anti-inflammatory therapy, however, the use of these drugs in pregnant women should still be avoided, both steroidal and non-steroidal. Steroid drugs can cause embryonic growth retardation, as well as affect the formation of lung tissue and tissue of some parts of the brain. Such drugs can only be used in case of a life threat, for example, in case of anaphylactic shock.

Non-steroidal anti-inflammatory drugs may be responsible for premature closure of the arterial canal, which can lead to heart problems in the newborn. Such drugs are prohibited for use in the 2nd and 3rd trimesters of pregnancy.

Painkillers

The most recommended painkiller is paracetamol. It is not toxic and teratogenic (contributing to the appearance of deformities in the unborn child). The use of acetylsalicylic acid (aspirin) should be prohibited. Aspirin has been shown to contribute to the formation of palatal clefts, intrauterine death of the child and growth retardation. Dextropropoxyphene is contraindicated in the first trimester due to the potential for respiratory depression in the infant. Codeine-containing drugs should not be used as they can cause congenital deformities and cardiac abnormalities.

When should a pregnant woman be examined by a dentist?

A woman must, first of all, register with a gynecologist in order to know exactly the duration of her pregnancy and the general condition of her body. Pregnancy is divided into three main periods (trimesters), during which the risks vary.

1-3 month

During the first trimester, the risk of deformities in the development of the fetus is greatest, and the likelihood of spontaneous miscarriage is high (up to 75% of miscarriages occur in the 1st trimester). During this time, dental intervention (endodontics and tooth extraction) is only necessary in urgent cases to avoid stress, pain and the risk of infection. In addition, during this period, women often experience toxicosis, irritability, and increased salivation, which interferes with normal dental treatment.

4-7 month

This is the best time for treatment at the dentist, because... The period of organogenesis (development of the child’s organs) has ended. During this period, it is desirable to eliminate all pathologies associated with the teeth and oral cavity, accompanied by pain or inflammation.

8-9 month

In the last months of pregnancy, a woman is already constrained by her weight, her movements are limited, and her due date is close. During this period, the dentist should be contacted only in emergency cases, and visits to the doctor should not be long and should take place in a semi-sitting position.

Treatment of oral pathologies associated with pregnancy

Tumor of the gums (supragingival)

The tumor disappears immediately after birth. Surgery is only necessary if the tumor interferes with the process of chewing food. In this case, the dentist can only give recommendations on oral hygiene.

Primary periodontal lesions

In case of gum disease associated with pregnancy, the first step is to remove plaque, plaque and tartar. After removing plaque, rinse your mouth with a 0.12% chlorhexidine solution. In cases of periodontal damage, only minimal treatment of the affected areas is carried out. The main therapy is postponed until after childbirth.

Caries and damage to dental tissues

To prevent caries, it is necessary to remove dental plaque and seal defects using glass ionomer cements or liquid composites. To consolidate the effect, the teeth are coated with chlorhexidine varnish. You can coat your teeth with fluoride varnish, which will help avoid the appearance of new foci of caries and prevent the occurrence of dental hypersensitivity. It is better to postpone full treatment of carious cavities with permanent filling materials until after childbirth.

In the case of pulpitis, placing calcium hydroxide into the canal will temporarily soothe the pain and have an antibacterial effect. Complete canal treatment is performed only in the second trimester or after childbirth.

Erosion of teeth

In case of erosion of dental tissues, it is recommended to rinse with a solution of baking soda (especially after vomiting); brushing your teeth with a hard brush is not recommended. It is necessary to follow a diet and exclude acidic foods from the diet (lemons, oranges, sauces made from vinegar, oil and salt).

Observation and treatment of pregnant women at the dentist is not much different from that for ordinary patients. Only a few precautions are necessary. You need to be especially careful in the first trimester of pregnancy, when dental intervention is allowed only in critical cases. All other treatment should be postponed to the second trimester. In the third trimester, treatment is indicated only if there is particular urgency.