Pregnant patients at dental appointments represent a special risk group. This is due to certain physiological changes in the woman's body that occur during this period. On the one hand, the source of infection in the form of untreated caries or inflammation of the periodontium can provoke severe pregnancy complications, on the other hand – dental intervention may be harmless at certain times of gestation. The need to maintain dental health during pregnancy is due to the importance of maintaining the health of the mother and the normal development of the fetus. Many authors have previously noted that during pregnancy there is an active increase in dental diseases, as well as an exacerbation of previously existing chronic infections, both general somatic and in the oral cavity. Despite a lot of work dedicated to the provision of dental care to pregnant women and their education in the field of prevention, the prevalence of dental diseases among pregnant women remains high. In most cases, this is due to a low hygienic culture, poor oral hygiene and financial difficulties. So, in the physiological course of pregnancy, the prevalence of dental caries is 91.4%, and periodontal diseases occur in 90% of cases, while the predominantly acute course of the process with damage to previously intact teeth was noted in 38% of cases. Periodontal pathology occurs in cases where signs of inflammation were already noted before pregnancy or there was poor oral hygiene.
the prevalence of dental diseases among pregnant women remains high. In most cases, this is due to a low hygienic culture, poor oral hygiene and financial difficulties. So, in the physiological course of pregnancy, the prevalence of dental caries is 91.4%, and periodontal diseases occur in 90% of cases, while the predominantly acute course of the process with damage to previously intact teeth was noted in 38% of cases. Periodontal pathology occurs in cases where signs of inflammation were already noted before pregnancy or there was poor oral hygiene.the prevalence of dental diseases among pregnant women remains high. In most cases, this is due to a low hygienic culture, poor oral hygiene and financial difficulties. So, in the physiological course of pregnancy, the prevalence of dental caries is 91.4%, and periodontal diseases occur in 90% of cases, while the predominantly acute course of the process with damage to previously intact teeth was noted in 38% of cases. Periodontal pathology occurs in cases where signs of inflammation were already noted before pregnancy or there was poor oral hygiene.
poor oral hygiene and financial difficulties. So, in the physiological course of pregnancy, the prevalence of dental caries is 91.4%, and periodontal diseases occur in 90% of cases, while the predominantly acute course of the process with damage to previously intact teeth was noted in 38% of cases. Periodontal pathology occurs in cases where signs of inflammation were already noted before pregnancy or there was poor oral hygiene.poor oral hygiene and financial difficulties. So, in the physiological course of pregnancy, the prevalence of dental caries is 91.4%, and periodontal diseases occur in 90% of cases, while the predominantly acute course of the process with damage to previously intact teeth was noted in 38% of cases. Periodontal pathology occurs in cases where signs of inflammation were already noted before pregnancy or there was poor oral hygiene.
What are the dangers of dental problems for a pregnant woman
It has been proven that periodontal pathology is a risk factor for severe pregnancy complications. These include gestosis of the second half of pregnancy, preeclampsia, eclampsia. Extragenital and infectious diseases of the mother during the period of laying and formation of the dentoalveolar system of the fetus can cause deviations and the development of pathology of the maxillofacial region. A group of scientists from the United States conducted studies that found that low birth weight of a child is directly related to the presence of periodontal disease in the mother during pregnancy.
Today, in addition to dental diseases, there is an acute problem of the development of perinatal pathology due to the high frequency and significant increase in somatic morbidity among women of childbearing age.
70% of pregnant women have chronic somatic pathology, and 76% of them experience its exacerbations during pregnancy. In modern obstetrics and gynecology, the most urgent problem is preeclampsia, over the past 15 years that have not had a downward trend. According to various authors, the incidence of gestosis varies from 8 to 17%. A favorable background for the development of such obstetric pathology as preeclampsia, miscarriage, placental insufficiency, anemia, bleeding, are malnutrition, deficiencies of proteins, vitamins, minerals and the presence of chronic infection.
Thus, the importance of oral hygiene during pregnancy is undeniable and important, and the elimination of foci of chronic odontogenic infection not only improves the dental status of a pregnant woman, reduces the risk of infection of the fetus, the development of prenatal and postnatal complications, but also helps to alleviate or eliminate extragenital diseases, which ultimately has a positive effect on both the health of the mother and the development and health of the unborn child.
Rules for dental treatment in pregnant women
With regard to the prevention of dental diseases in pregnant women, the results of studies by both domestic and foreign authors have been published, in which various options and schemes for both individual and group work are proposed. To date, many of them have been implemented and are working. However, despite this, the prevalence of dental diseases among pregnant women remains high. There is a need for dental intervention with local anesthesia, and in some cases – and X-ray control.
- Scientists from different countries noted that the most favorable period for dental treatment remains the second trimester of pregnancy, namely from the 15th to the 22nd week of gestation, when the fetal organogenesis is already completed, the placenta is formed, the fetoplacental circulation is functioning, the indicators are improved maternal immunological status. In the first trimester, it is recommended to limit yourself to hygiene procedures due to the possible high risk of developing feto- and embryopathies, as well as placental insufficiency. In the course of the research conducted by a team of domestic authors, it was found that the incidence of miscarriages during dental interventions in the first trimester averaged 6–9%, while in the second – 2–6%.
- This is due not only to the severity of the dental intervention, but also to a number of predisposing factors, such as:
- I trimester of pregnancy;
- repeated pregnancies, especially in multiparous women;
- age over 25;
- complicated obstetric and gynecological history;
- burdened history of general somatic pathology (especially diseases of the liver, kidneys, intestines);
- pregnancy with toxicosis;
features of emotional status.
However, it should be noted that emergency dental care should be provided at any stage of pregnancy, taking into account the allergic status and comorbidities.
At any period of pregnancy, dental care should be painless, using modern local anesthetics, psychological methods for correcting the emotional state, and according to indications – and premedication. It has been established that when large doses of local anesthetics are used during pregnancy, respiratory depression in the newborn is possible. In the course of the research, a team of authors developed recommendations for the choice of rational anesthesia in pregnant women of various groups during dental intervention.
These recommendations include not only the choice of local anesthetic and method of pain relief, but also the use of sedative, analgesic and psychotherapeutic methods of distress correction for safe and comfortable dental treatment of pregnant women. For short-term interventions, it is recommended to use drugs based on 3% mepivacaine without a vasoconstrictor, but the optimal local anesthetic drug that provides effective and safe analgesia for dental interventions in pregnant women is 4% articaine with epinephrine 1:200000.
Are x-rays allowed?One of the most important issues in the daily practice of a dentist is the use of X-ray examination during pregnancy. We did not find a clear answer to this question in the domestic literature. However, according to the American College of Radiology (2013), none of the current X-ray machines is powerful enough to cause negative effects in a developing embryo. The correctness of the technique for performing an x-ray examination, the permissible doses of radiation exposure, methods and means of protection against radiation were not described.
According to L.M. Lukinykh (2003), all the efforts of dentists and patients are focused on the restoration of teeth, but excision of carious tissue and filling of a defect cannot be a full-fledged treatment in conditions of increased pathogenicity of the oral microflora, but is only symptomatic. Nevertheless, there is no clear algorithm for managing pregnant patients by a dentist, which is the subject of our further study.Share:
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