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
DURING PREGNANCY
Infections - Having influence on pregnancy
Periodontal diseases

Gingivitis

Pregnancy Gingivitis

Periodontitis
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 ?
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…
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
Radiography – Advanced
Digital image enhancement
RVG
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