DENTAL PROLEM DURING PREGNANCY

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DENTAL PROLEM DURING PREGNANCY ITS MANAGEMENT

• Prof. Dr. S. Ignatius Rex MDS
• Prof. HOD. Rajas Dental College
• Senior Consultant Endodontist
• Dr. Anto ENT Hospital. Nagercoil

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Common Dental Problems

• Periodontal infections
• Dental caries
• Pulpal infections
• Periapical infections
• Cosmetic dental problems

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DURING PREGNANCY

• Infections - Having
  influence on pregnancy
• Periodontal diseases
• Gingivitis
• Pregnancy Gingivitis
• Periodontitis

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PERIODONTAL INFECTIONS

• Oral infections
• Caused by anaerobic bacteria in the plaque
  bio-film that forms on dental surfaces
• Gingivitis -Inflammation and infection of the
  gums
• Periodontitis-inflammation and infection of gums
  and bone

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PREGNANCY GINGIVITIS

• Inflammation of gums
• Redness, swelling, heat and pain
• Caused by plaque, bacteria on tooth surfaces
  adjacent the gum tissue
• Commonly observed in second trimester due to rise
  in estrogen levels in blood
• Preventable with 2x daily brushing with F tooth
  paste and flossing

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PERIODONTITIS

• All pregnant women are at risk
• Risk is no greater than for women who are not
  pregnant
• Gram-negative anaerobic bacteria
• Infection and inflammation of soft tissuesgtgt
  gingivitis
• Progression to hard tissue Periodontitis
• Bone loss gtgt tooth mobility gtgt
  potential premature tooth loss

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Healthy Gums Periodontal Tissues
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Severe Periodontal(Gum) Disease Severe Gum
Disease with Recession
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PTLBW

• PTLBW - lt2500 gm
• LBW - Short gestational period
• - Gestational age lt 37 weeks
• Factors
• High gt (34 years) Low (17 years)
  maternal age
• Low socioeconomic status
• Inadequate pre natal care
• Drug use, Alcohol use, tobacco use.,
• Hypertension
• Diabetes mellitus
• And now Periodontal Infection

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WHAT IS THE LINK

• Throughout pregnancy, levels of
  prostaglandins and cytokines steadily increase
  until a critical threshold level is reached
  inducing labor, cervical dilation and delivery
• Periodontitis - Gram negative infection
• The bacteria associated with periodontatal
  disease are capable of stimulating excessive
  production of cytokines and prostaglandins
  initiating preterm labor and delivery (
  offenbacher, et al )

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HOW TO SCREEN

• Do your gums bleed, especially when you brush or
  floss your teeth ?
• Do you have bad breath ? or been told you have
  bad breath ?
• Do you have a bad taste in your mouth that won't
  go away ?
• Do you have pain and discomfort while chewing ?

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TREATMENT PLAN

• Scaling and root planning
• Treatment in early stage of pregnancy --- Yield
  Promising results
• Use of CHX based mouth washes

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DENTAL CARIES IN PREGNANT WOMEN

• All pregnant women are at risk
• Risk is no greater than for women who are not
  pregnant
• Desire for sugar sweetened food and beverage
• Risk factor
• Frequent ingestion for fermentable
  carbohydrate
• Presence of SM
• Compromised salivary flow

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DENTAL CARIES
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PULPITIS

• Acute
• Chronic
• Inflammation of the pulp due to
  infection
• Treatment plan
• Pulpectmy
• Root canal treatment
• Antibiotics ?
• NSAIDS ?

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Periapical Abscess
Acute Alveolar Abscess Localized collection of
pus in the alveolar bone at the root apex
following death of the pulp Severe throbbing
pain with attendant swelling of the overlying
soft tissue May progress to sinus tract,
cellulitis, osteomyelitis
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Management of the lesion
Conventionally surgical endodontics Current
concept non-surgical endodontic
management Recent Apexum procedure
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Non-surgical management of Periradicular lesion
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Apexum procedure
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Radiography Conventional
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Radiography Advanced
Digital image enhancement
RVG
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Apex locator

• Electronic method of determining working length
• Working length is the length of the root
  canal space from coronal reference point to the
  point at which canal preparation obturation
  should terminate
•  based on electrical resistance
• NO RADIATION HAZARD

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ENAMEL EROSION

• Vomiting
• Palatal surfaces of maxillary teeth
• Thermal sensitivity
• Dentin exposure
• Recommended Therapy
• Avoid tooth brushing
• Use of neutral NaF mouth rinse

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Drugs that can be Prescribed and Those that are
Contraindicated During Pregnancy
Sourcewww.agd.org/consumer/topics/pregnancy/main.
html
Drugs that can be prescribed during pregnancy Drugs that are Contraindicated during pregnancy
Antibiotics Penicillin, Cephalosporin, Amoxicillin, Clindamycin, Erythromycin (except estole form) Tetracycline, Doxycyclines, Erythromycin estolate form
Analgesics Acetaminophen, Acetaminophen with codeine (in small doses) Aspirin, Difunisl, Etodolac
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Thank You