Dental Care: Maternal Oral Healthcare
“Oral healthcare in pregnant women is often neglected and sometimes avoided even after there is a known problem in the oral cavity,” and this can lead to the poor oral health of the mother and the newborn baby post-pregnancy.
This was said by Dr. BibhakarRanjan, who explains that this is a worldwide problem for which there are many reasons, including myths, a lack of awareness, and a lack of proper clinical guidelines among dentists and physicians, for the management of the oral conditions of pregnant women.
Dr. Ranjan has been working as the principal dentist at ‘Dr. Murthy’s Family Medical & Dental Klink’ at Anse Aux Pins for more than two years. He has diverse experience in general dentistry for more than eight years.
In the following interview, he talks to us about some of the myths related to pregnancy and oral health, as well as the oral conditions that are commonly seen in pregnant women and preventative measures which can be taken to avoid these.
Seychelles NATION: What are some oral conditions commonly seen in pregnant women?
Dr. Ranjan:Periodontitis: this is a serious inflammatory condition of the gingiva and the other surrounding tissue and ligaments which support the teeth. It often begins with swollen, reddish gingiva and hardened yellow plaque around the teeth which bleeds while brushing. If it remains untreated, the bacteria infiltrate the periodontium and even causes bone loss around the teeth; at the end, the patient often complains of a loosened tooth.
Aggressive Periodontitis
Many researchers in different studies have found pre-term birth and low birth weight associated with periodontitis in pregnant women.
If a woman has any pre-existing periodontal conditions, deep scaling and root planning should be done before planning a pregnancy. Also, if the dentist finds a periodontal condition during pregnancy, there should be regular cleaning procedures in place, and the patient should be educated about oral hygiene measures and food habits.
Tooth Mobility: during pregnancy, women have hormonal changes in the body, they have increased levels of progesterone and estrogen which often affect the periodontal ligaments which hold the teeth, and in turn, this results in tooth mobility. Through proper oral hygiene measures, this can be treated and reversed to its normal condition and the patient shouldn’t panic about it.
Morning Sickness & Enamel Erosion: During pregnancy, most women go through morning sickness, they often vomit and the gastric acid which comes along with the vomit can erode the enamel of the tooth, and subsequently it develops into a cavity, with extreme sensitivity to cold water.
Most pregnant women are advised to make some dietary changes, including consumption of milk, yogurt, and green vegetables, and to also use antacids to minimize oral acid exposures.
Pregnant women should also avoid using a hard bristle toothbrush and brushing just after vomiting to avoid any enamel erosion.
Pregnancy Tumor / Pyogenic Granuloma: the patient often presents with a swollen reddish mass on their gingiva which sometimes bleeds while brushing. This is a benign tumor and the patient shouldn’t worry about it. It is usually seen in the 2nd and 3rd trimesters and often regresses on its own post-pregnancy. If it doesn’t regress on its own and it affects the patient in brushing or eating food, it can be removed by a dentist.
Pregnancy oral tumor is caused by increased progesterone level associated with a pre-existing oral plaque or periodontal condition, so to avoid this, pregnant women should have good oral hygiene.
Gingivitis: it is one of the most common oral diseases in pregnant women. Gingivitis is nothing but an inflammation of the gum tissues which often results in bleeding and painful gums.
Gingivitis
Bleeding gums
During pregnancy, most women go through hormonal imbalances, with progesterone and estrogen levels going up and down, and this has adverse effects on the gums. It is often reversed with good oral hygiene measures at home like brushing twice a day, flossing, and using lukewarm salt water or mouth wash to reduce inflammation of the gums.
Halitosis: Around 60-70% of pregnant women often complain of bad breath or changes tothe appearance of their tongue; this is due to poor oral hygiene and also due to changes in dietary habits during pregnancy. Proper brushing and tongue cleaning is advised, along with the use of Chlorhexidine mouthwash to avoid bad breath.
Seychelles NATION: What is your advice for the prevention of these oral conditions during pregnancy?
Dr. Ranjan: To avoid any complications, every pregnant woman should be examined, consulted by their dentist during their pregnancy and also before family planning, just like any other disease.
Every healthcare agency in any country should adopt clinical guidelines to educate women to go for early oral examination and consultation (Pre-Pregnancy Consultation) with their dentist to check if they have any pre-existing dental diseases and to have them treated before they even plan to conceive.
Early screening has an important role to play if we want to avoid any pain related to teeth or gingiva during pregnancy. It has been well documented in the past that women who have an existing bad oral hygiene or multiple cavities before they conceive have more chances to develop mild to moderate periodontal conditions or to even have generalized dental cavities.
If the patient has any dental issues, it should be examined, radiographed, documented, and treated as much by a dentist to avoid any dental complications during the pregnancy.
Seychelles NATION: You mentioned that there are some myths related to oral health and pregnancy that you would like to clarify. Tell us about these.
Dr. Ranjan: Myth No1: The patient often says they have lost calcium from their teeth during their pregnancy.
Fact: The fact is most women develop cavities during their pregnancy due to poor oral hygiene and lack of dental care, and in many cultures, people believe that the growing child is taking away calcium from the mother’s teeth – this is not true.
Myth No2: In many countries, people believe that a pregnant woman loses a tooth depending on the number of the child she gives birth to.
Fact: Hormonal changes and lack of knowledge regarding oral hygiene often leads to a mobile tooth or grossly decayed tooth, and many times women avoid going to the dentist during pregnancy and even after delivery, which often leaves their dentist with no other choice than to extract the tooth.
Myth No3: It’s not safe to go to a dentist during pregnancy.
Fact: This is one of the most popular myths among developed and underdeveloped countries. It’s always advisable to visit your dentist for a routine check-up. To avoid any elective treatment, if there are any cavities, gingival conditions which are affecting the pregnant woman’s wellbeing, then these should be treated during the 2nd trimester before they become extremely painful.
Myth No 4: Never take a tooth x-ray upon your dental visit.
Fact: Fetal exposure to more than 10 rads has been associated with morphological abnormalities upon birth, with the latest advancement of dental imaging a single tooth x-ray exposure is less than 0.01 rads, which are very insignificant and won’t affect the mother or the growing baby.
If the x-ray needs to be taken for diagnosis and any emergency treatment procedure, a pregnant woman should be well protected with a lead apron and thyroid collar, and this should be done in the 2nd trimester.