Dental Health during Pregnancy and Avoid Common Dental Problems in Pregnancy

1. Dental HEALTH AND PREGNANCY By Dr. Rajat Sachdeva No one is you and that is your Power

2. Why Complete Oral Health Is Important During Pregnancy? Increased Hormonal Changes in the Body Majorly Deteriorate Body’s Response Mechanisms Increased Susceptibility to Dental Plaque and Oral Bacteria Increased Risk of Developing Oral and Dental Diseases Spread of Infection from the Mouth to the Body and to the Developing Foetus

3. Two Most Common Dental Issues During Pregnancy Gingivitis & Periodontitis (Gum Diseases) Dental Caries (Tooth Decay)

4. Gingival & Periodontal Diseases • Research has found a considerable link between gingival diseases in pregnant women and premature, low birth weight babies. • “Up to 18 out of every 100 premature birth could be linked to severe gum infection (periodontal disease).” • Babies who are born prematurely may be at an increased risk of developing a range of health conditions -- cerebral palsy, brain injuries or hearing and visual deficits.

5. Gingival DiseasesSigns & Symptoms “Nearly 60 to 75% of pregnant women have gingivitis, an early stage of periodontal disease, that occurs when the gums become red and swollen from inflammation that may be aggravated by changing hormonal levels during pregnancy.” Pregnancy Gingivitis (First-Second Trimester) • Gingival Inflammation • Gingival Bleeding, Especially During Toothbrushing and Flossing

6. Periodontal Diseases Signs & Symptoms Infection of the structures supporting the tooth including gums, ligament and bone is known as “Periodontitis”, caused by undiagnosed or untreated gingivitis and can lead to tooth loss. • Loss of Attachment • Gingival Recession • Tooth Mobility • Alveolar Bone Loss Periodontitis Healthy Gums Gingivitis Periodontitis

7. Pregnancy Tumor? • Don't let the word ''tumor'' worry you. These growths are not cancerous and can't spread. • A pregnancy tumor is an extreme inflammatory reaction to a local irritation (such as food particles or plaque) that occurs on the gingiva, mostly during the third trimester. • The tumors occur in up to 10% of pregnant women and often in women who also have pregnancy gingivitis. Pregnancy Epulis /Pyogenic Granuloma / Pregnancy Tumor

8. Dental Caries & Sugar Cravings • During the first few months of pregnancy, some women may have extreme interest in snacking, especially processed carbohydrates and tooth brushing can be neglected after they eat these kinds of food. • Saliva flow also decreases. Hence, the formation of caries increases during this period. • Women who have a lot of cavity-causing bacteria during pregnancy and after delivery, can transmit these bacteria from their mouth to the mouth of their baby.

9. Dental Caries & Morning Sickness The repeated reflux and associated vomiting can coat the tooth enamel with strong gastric acids and destroy it, thereby causing increased risk of dental caries during pregnancy.

10. How to Care for Your Teeth After Vomiting? • Avoid brushing your teeth immediately after vomiting. While the teeth are covered in gastric acids, the actions of brushing may scratch the tooth enamel. • Rinse your mouth thoroughly with plain tap water. • Follow up with a mouthwash containing fluoride. • If you don't have a fluoridated mouthwash, put a blob of toothpaste containing fluoride on your finger and smear it over your teeth. Rinse thoroughly with water afterwards. • Wait for an hour after vomiting before you brush.

11. Retching or Gagging While Brushing Teeth? Some pregnant women find that brushing their teeth, particularly the posterior teeth, can cause gagging. However, it’s important to brush all of your teeth to avoid tooth decay. Some tips to help prevent gagging include: • Use a toothbrush with a small, soft head such as a brush made for toddlers. • Take your time. Go slowly when you brush. • It may help to close your eyes and concentrate on your breathing. • Try listening to music. • If the taste of the toothpaste causes you to gag, switch to another brand or brush your teeth with water and then use a mouthwash containing fluoride. • Go back to brushing with toothpaste containing fluoride as soon as you can.

12. How To Avoid Dental Problems During Pregnancy? Consult Your Dentist Home Oral Care Regimen

13. Home Oral Care Regimen Thorough tooth brushing twice a day for two minutes, using a proper toothbrushing technique, effectively removes plaque from the teeth. Pregnant women bleed more readily due to the effect of pregnancy hormones (estrogen, progesterone) and may consequently avoid brushing their teeth. As a result, bacterial plaque increases. Therefore, in pregnancy, the mouth needs utmost care.

14. Tooth brushing, alone, only cleans 60% of the total surfaces of the tooth. Cleaning in between your teeth helps to remove plaque and food lodged between teeth and beneath gingiva. These are the areas where toothbrushes cannot reach. Interdental brushes and floss help to dislodge the plaque and bacteria, which may still be present in interdental spaces after thorough tooth brushing. Gargling with non- alcohol based mouthwashes or warm salty waterhelp to remove any lingering, loosened debris.  Warm saline rinses relax the gums and reduce gingival sensitivity. Fluoride mouthwashes can help prevent tooth decay. Therefore, flossing and mouth rinsing must be performed at least once daily.

15. Which Toothbrush To Be Used? And When To Be Replaced? A small sized brush head that can reach into all parts of the mouth, having soft, multi-tufted, round-ended nylon bristles. Soft bristle tooth brush helps to prevent abrasion of teeth & gingival recession. ADA recommends replacing toothbrush every three to four months or even sooner if the bristles are frayed. Which Toothpaste To Be Used? • American Dental Association (ADA) recommends using a fluoridated toothpaste as it helps to prevent dental caries.

16. Avoid Smoking and Alcohol Periodontal inflammation and destruction increases in patients who smoke.  The possibility of abortion or stillbirth or premature low-birth weight babies increases among smokers. Over-consumption of alcohol is teratogenic in babies and can cause fetal alcohol syndrome and various dental anomalies. Smoking & alcohol have hazardous effects on the developing foetus as well as on the expectant mother and must be avoided under all circumstances.

17. Follow A Balanced Diet • Especially rich in Iron, Calcium, Vitamin B12, Vitamin C and Vitamin D. • Calcium helps to protect your bones and fulfill the needs of your developing baby. • Good sources of calcium include milk, cheese, plain yoghurt or sugar-free fruit yoghurt, calcium-fortified soy, almond or other types of milk, almonds. • Vitamin D helps the body to utilize calcium. Good food sources of vitamin D include some fatty fish, eggs, vitamin D fortified milk, breads and cereals. • Your doctor may even prescribe you vitamin supplements.

18. Go Easy On Sugary Snacks • Avoid in-between meal snacking especially refrain from refined and processed carbohydrates, sugary foods and frizzy beverages. • Such food items are known to have higher risk of tooth decay. • Try to snack on foods low in added sugar or fresh fruits instead. • Rinse your mouth with mouthwash containing fluoride or brush your teeth after having sugary snacks.

19. Why Consult a Dentist? For Prevention and / or Timely Management of Complicated Oral Health Issues by : • Routine Dental Check-ups • Prophylactic Scaling • Preventive Restorations • Fluoride Therapies

20. Emergency Dental IssuesDuring Pregnancy & Their Treatment • Undiagnosed or untreated periodontal diseases can lead to tooth loss and subsequent bone loss which can be treated by reconstructive and regenerative surgeries. • Initial dental caries can progress to deep carious lesions necessitating endodontic therapies or in worst cases, may require tooth extraction followed by prosthetic rehabilitation. • Pregnancy tumor may need to be excised surgically.

21. Dental Treatments & Myths During Pregnancy • The benefits of receiving dental care during pregnancy far outweigh the potential risks. • The safest time to undergo dental treatment -- Second Trimester of Pregnancy. • Emergency Dental Procedures -- Tooth Extraction And Root Canal Treatment -- can be performed following strict protocols. • Elective Dental Procedures -- Bleaching, Veneering, Cosmetic Surgeries -- should be postponed until after the delivery.