Mothers-to-be are a special group of patients for all health professionals. Dr. Tatia Rokhvadze is a periodontist and president of the Georgian association of periodontology who specialises in the subject, and is currently working on the implementation of a national programme for oral care of pregnant women. She speaks about preventing and treating periodontal diseases during pregnancy in the Curaden Academy’s webinar. In this interview, she explains why dentists should ask their female patients about their pregnancy planning, and mentions the specifics of treating pregnant patients to avoid oral health problems during this exceptional period of woman’s life.
Should dentists ask their female patients if they are planning a pregnancy?
When evaluating the oral health of any female patient of childbearing age, oral-health professionals should always ask whether she is pregnant or is trying to become pregnant, and they should always consider pregnancy status before recommending any dental procedure.
All women should be informed about the importance of oral and periodontal health during pregnancy and the relevance of adequate therapy to treat existing periodontal diseases before becoming pregnant. Periodontal therapy is more effective if it is performed before conception, and there is also a higher probability of avoiding the complications that accompany periodontal inflammation during pregnancy.
What other dental issues have to be solved before a patient gets pregnant?
If women have periodontal inflammation – gingivitis, periodontitis or caries – it is necessary to treat it immediately. Third molars that are hard to maintain in good hygiene due to the difficult area and which are causing constant inflammation of the gum, should also be taken out before a patient gets pregnant.
What should dental professionals focus on during preventive check-ups of a pregnant patient?
According to guidelines of the European Federation of Periodontology (EFP), oral health professionals should:
a. Identify the stage of pregnancy;
b. Confirm a medical history – with an emphasis on any history of adverse outcomes from previous pregnancies, hypertension, diabetes, cardiovascular disease, etc. – along with details of medications taken;
c. Assess risk factors, including smoking status.
d. Perform a comprehensive oral evaluation including a periodontal examination, which should include evaluation of plaque accumulation, gingival inflammatory status (bleeding on probing), and periodontal probing. Depending on the result of this periodontal examination, a periodontal diagnosis of healthy, gingivitis, or periodontitis should be identified and specific measures should be implemented.
How many check-ups are advised during pregnancy?
The most important period in which a pregnant women should visit the dentist is from the 13th to 21st weeks of gestation, the next check-ups are determined by every doctor individually.
You have mentioned gingivitis and periodontitis. But are there any other oral health problems that are common during pregnancy?
Pregnancy epulis or pregnancy granuloma, which means localised gingival enlargement, is quite common too. Typically it occurs in the second or third trimester, sometimes even appearing for the first time in the final month of the pregnancy. A pregnancy epulis often bleeds easily and looks red and inflamed, however they are generally not painful. If it is left without any treatment, the epulis usually becomes smaller or disappears after childbirth.
“Over the years several studies have looked into how fluoride-use impacts pregnancy, but there is no scientific proof that fluoride causes any type of birth defect or health problems in either the mother or child.”
What treatments should dentists avoid during a patient’s pregnancy?
If possible, surgical manipulation – i.e. periodontal surgery, tooth extraction, implantation – should be avoided during pregnancy. It is also better to avoid doing teeth whitening procedures, although, no studies specifically indicate there are problems with whitening the teeth of pregnant women, but most dentists do recommend avoiding it.
What is the recommended home dental care for pregnant women?
Pregnant women should use safe oral care products such as toothpaste without sodium lauryl sulfate (SLS). They should brush their teeth with a soft, super-soft or ultra-soft toothbrush twice a day, and definitely also use a correctly sized interdental brush and dental floss once a day.
Other than SLS which you’ve already mentioned, are there any other ingredients in toothpastes or mouthwashes that pregnant women should avoid?
As well as SLS, pregnant women should avoid products with nitrates and alcohol. Many mothers-to-be are concerned about using fluoride because some articles claim that fluoride-use can be directly linked to premature births, birth defects and even cancer. Over the years several studies have looked into how fluoride-use impacts pregnancy, but there is no scientific proof that fluoride causes any type of birth defect or health problems of either the mother or child. So pregnant women can use toothpastes or mouthwashes with fluoride.
Are there any vitamins, minerals or other supplements that dental professionals should recommend to their pregnant patients in order to keep their teeth and gums healthy?
The only source of food for the baby during pregnancy is its mother, so the pregnant woman should eat a balanced diet, rich in vitamins and trace elements. Calcium is essential for the development of the fetal skeletal system and teeth. The daily norm for calcium intake during pregnancy is twice that of normal. One of the richest sources of calcium is dairy products – low-fat cottage cheese, cheese, low-fat milk and yoghurts are recommended. The obstetrician-gynecologist should also recommend taking extra minerals if the analysis reveals any severe deficiency.
It’s quite common for women to say that “my teeth have gone bad during pregnancy”. Many women don’t realise that they can keep their oral health under their own control, even during pregnancy. Have you ever heard this from your patients? What’s your answer?
Yes. My pregnant patients say it often. It is important to explain to pregnant women the real reasons for the development of diseases that spread in the oral cavity. The main reason is bacteria from the dental plaque, which can easily be removed by performing proper home hygiene. This includes mechanical plaque control – brushing teeth thoroughly and cleaning interdentally. Also visiting dental professionals at least twice a year can reduce influence of risk-factors (genetics, hormones etc.) on the development of a disease. So pregnant women really have their oral health under their own control, and we as oral health professionals should teach them so.