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 Periodontitis - Gram negative infection 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 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

Electronic method of determining working length 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

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