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

Common Dental Problems

Periodontal infections Dental caries Pulpal infections Periapical infections

Cosmetic dental problems

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

DURING PREGNANCY

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

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

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 tissues>> gingivitis • Progression to hard tissue : Periodontitis Bone loss >> tooth mobility >> potential premature

tooth loss

Healthy Gums & Periodontal Tissues

Severe Periodontal(Gum) Disease & Severe Gum Disease with Recession

PTLBW

• PTLBW - <2500 gm• LBW - Short gestational period - Gestational age < 37 weeks Factors : High > (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

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 )

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 ?

TREATMENT PLAN

• Scaling and root planning

• Treatment in early stage of pregnancy --- Yield Promising results

• Use of CHX based mouth washes

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

DENTAL CARIES

PULPITIS

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

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…

Periapical Abscess

Management of the lesion

Conventionally – surgical endodontics

Current concept – non-surgical endodontic management

Recent – Apexum procedure

Non-surgical management of Periradicular lesion

Apexum procedure

Radiography – Conventional

RVG

Digital image enhancement

Radiography – Advanced

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

ENAMEL EROSION

• Vomiting• Palatal surfaces of maxillary teeth• Thermal sensitivity• Dentin exposure

• Recommended Therapy• Avoid tooth brushing• Use of neutral NaF mouth rinse

Drugs that can be Prescribed and Those that are Contraindicated During Pregnancy Source:www.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

Thank You