Oral Health in Pregnancy

Article by Dr. Simone Stori

Importance of oral health in pregnancy

Expecting a baby is certainly a magical and fundamental moment in a woman's life. In this delicate period, mouth and oral hygiene should not be neglected, which if neglected can lead to important problems both for the future mother and for the baby.

In fact, during pregnancy and breastfeeding a clear increase in odontostomatological problems is demonstrated. Frequent are the appearance of gingivitis, spontaneous and provoked bleeding, increased dental sensitivity and other discomfort of various kinds. These signs and symptoms should not be underestimated to avoid development of more serious pathologies such as periodontitis, a bacterial infection that affects the supporting tissues of the tooth and can lead, if not treated adequately, to marked bone resorption and in extremis to the loss of one or more dental elements. periodontitis in the expectant mother can put procreation at risk, as a new association between periodontitis and female infertility has recently been demonstrated. In an Australian study published in August 2011 it is precisely shown that women with periodontal infections require on average 2 months more to get pregnant, with the same risk factor I therefore of obese women.

During pregnancy, the woman's body undergoes changes necessary to adapt to the new situation and allow the correct development of the fetus. Of particular importance is the increase in blood circulation, which leads to a marked vasodilation and which at the gingival level leads to swelling and greater redness of the same. If the bacterial plaque is not eliminated correctly, this normally paraphysiological situation quickly leads to marked gingivitis and sometimes the appearance of rather annoying growths, which are eliminated by the dentist possibly with the laser, thus avoiding the administration of anesthetic, which can be dangerous for the pregnant woman.

Another important factor is the appearance of numerous hormonal changes (high concentrations of progestins, 10 to 30 times higher than the menstrual cycle) which also affect the immune system, which temporarily becomes weaker. In patients predisposed to periodontal diseases, or with mild periodontitis, this moment, combined with gingivitis gravidarum and incorrect oral hygiene, can quickly lead to the onset of full-blown periodontitis with serious damage to the dental support (even in the presence of a minimum amount of bacteria), with increased tooth mobility and even with the loss of some teeth.

The presence of pyorrhea in pregnancy has been correlated in recent years, by numerous clinical studies, with an increased risk of premature birth (about 37 days before term) and birth of an underweight baby (2.5 kg, below the average). What is this correlation due to? It has been shown that antigens of del Porphyromonas Gingivalis, a bacterium closely related to periodontal infection, a sign that the placenta can be bypassed by these microorganisms which, upon coming into contact with the amniotic barrier, produce toxins. The body, responding with the production of inflammatory substances, can lead to increased stress physical enough to lead to childbirth in advance. It should also be noted as the presence of periodontitis, therefore of an "infection in the mother's mouth. it can lead to premature contamination of the mouth of the newborn baby with annoying consequences.

Neglected gingivitis, in addition to its transformation into pyorrhea, can lead to more serious but fortunately rare localized lesions, such as "epulis gravidarum which must be removed surgically or with a high-powered laser. It is therefore clear how important it is to treat the" oral hygiene in pregnancy to prevent problems with the gums but also with the teeth, as it also significantly increases the risk of dental caries. For this reason, if possible, it would be a good idea to carry out a complete check-up of the mouth before planning the pregnancy , in order to eliminate and prevent any problems that may arise.

What To Do During Pregnancy

It is necessary to contact the dentist and plan an oral hygiene and prophylaxis session during the 2nd or 3rd month; during the session it is necessary to check for the presence of some dental problems (caries or other), which can be safely treated during the second trimester of pregnancy or kept under control until the end of the pregnancy. The state of health of the gums must therefore be carefully checked, with a millimeter probe, in order to check for the presence of periodontal pockets larger than 4mm.

In the presence of signs of periodontitis, a more in-depth diagnostic investigation (complete survey, genetic and microbiological analysis) must be planned, clearly omitting radiology, and a non-invasive therapy planned as soon as possible. The approach with laser and microscope, as non-surgical and practically painless, it can be performed safely and with excellent results even in pregnant patients, as well as in elderly patients or with systemic diseases.

If there are no signs of periodontitis, a second check-up and hygiene session will be scheduled towards the 8th month of gestation. It is however necessary to contact the dentist immediately in case of frequent bleeding, excessive gum swelling or other discomfort. In fact, it is not necessary to be afraid of dental visits during pregnancy, as even if anesthesia and radiological investigations are necessary, the advent of digital radiology and the use of vials without adrenaline have significantly reduced all possible risks.

Some Practical Tips

Here are some practical tips to follow:

• Not smoking. Active and passive smoking should be avoided for at least 9 months of waiting.
  Smoking leads to a reduction in oxygen reaching the fetus, damaging its formation. Furthermore, smoking, combined with a high genetic predisposition, increases the risk of developing periodontitis by almost 8 times.
• Take fluoride. Fluorine strengthens the teeth against the action of caries bacteria.
  Fluoride can be taken with mineral water (check the fluoride content on the label) and with toothpaste and mouthwash (ask the dentist for the most suitable aids). Sometimes it may be indicated to perform one or two sessions of professional fluoride prophylaxis during pregnancy to strengthen the teeth, a painless process lasting about 45 minutes.
• Take care of oral hygiene. Brush your teeth at least twice a day for two minutes, using a soft toothbrush, dental floss and a mouthwash containing fluoride or essential oils to reduce plaque. The dentist or hygienist will be happy to give From the 7th month onwards, it may be useful to rinse daily for one minute with a 0.12% chlorhexidine-based mouthwash.
• Use xylitol-based chewing gum, 2 a day, which have benefits on the development of the unborn child's teeth, as well as those of the mother.
• Take care of your diet. It is very important to correctly integrate vitamins C (citrus fruits, kiwis, tomatoes), D and A, and minerals such as iron and calcium (milk, cheese, yogurt) important for the mineralization of bones and teeth. In particular, in pregnancy, the need for calcium increases to about 1500mg per day.