Throughout a dental nurse's career, it is likely you will be looking after many pregnant patients. Giving them the appropriate care during this time is paramount to helping them and their unborn baby stay healthy. During pregnancy, the lady goes through physiological changes which occur in response to the increase in hormones. The main hormones, oestrogen and progesterone increase their levels by 10-fold and 30-fold, respectively to prepare organs like the uterus and breasts to accommodate and support the growth of the baby. The hormonal secretions and the foetal growth affect pretty much every system in the body and subsequently, these changes also affect the oral cavity and impact its health.
Why is oral health important for pregnant patients?
- Periodontal Disease - Periodontitis has been associated with a higher risk for pregnancy complications. The presence of bacteria in the mouth can spread through the blood affecting the fatal-placental unit and cause inflammatory responses that are associated with adverse effects for the pregnancy. This can cause potential complications like; low birth weight, preterm birth, gestational diabetes, pre-eclampsia, miscarriage and/or still birth.
- Pregnancy Gingivitis - During pregnancy, the hormonal changes increase the vascular permeability in the gingival tissues, reduce keratin ingress which makes these more sensitive to dental plaque. This results in gingival inflammation which can be localised and presented as epulis or generalised. Pregnancy gingivitis starts in the 2nd month and patients need to be informed that this is normal and will disappear after birth. It’s important that patients maintain daily brushing and flossing and to not decrease this when they see the red, bleeding and swollen gums. Lack of brushing will worsen the gingivitis.
- Dental caries - During pregnancy, you may experience food cravings and typically these cravings are around foods high in carbohydrates. Saliva flow and pH reduces and the combination of a diet high in sugar and inadequate tooth cleaning (in relation to food consumption), the risk of developing caries increases. Additionally, morning sickness which can affect some people throughout pregnancy leads to dental erosion which also makes teeth weaker.
- Dental erosion - Morning sickness in pregnancy affects 70-80% of women. It typically occurs during the 4th and 7th week of pregnancy and takes place at any time of the day. Acidic stomach contents can cause yellow teeth, sensitivity, and wear. Whenever this occurs, pregnant women should drink water or diluted sodium bicarbonate in water to neutralise the acid. Or rinse the mouth with alcohol-free fluoride mouthwash, allowing one hour after the episode to prevent further mechanical damage to the teeth and replenish the minerals lost.
When is it safe to treat pregnant women?
During the first trimester (week 1-12) the foetus is developing and a woman is in a more fragile state therefore, any non-urgent treatments are best avoided. Oral health education and prevention are recommended during this time. Pregnant women are safest getting dental treatment during the second trimester (weeks 13-28) because many vital structures of the foetus have finished developing.
What procedures are safe to carry out during pregnancy?
Research has shown periodontal therapy is safe during pregnancy, especially in the second trimester. Monitor plaque, bleeding, and pocket depths during pregnancy. Similarly, local anaesthesia, extractions and dental x-rays are safe during pregnancy. Although, patients may be more cautious and refuse the latter procedure. Wherever possible non-urgent treatment should be delayed until after the birth of the baby.
What is contraindicated during pregnancy?
There are some treatments that are not advised during pregnancy, such as:
- Invasive procedures like surgeries
- non-urgent treatment like change of fillings
- Dental amalgam is no longer allowed for treatment in pregnant patients, under the law introduced in 2018.
Medications that aren't permitted during pregnancy:
- Miconazole (teratogenic)
- Fluconazole (teratogenic)
- Felypressin and Articaine aren't allowed as local anaesthetics.
How dental nurses support pregnancy in dentistry
- Educate patients about the changes that occur with pregnancy and those that affect the oral cavity: dental erosion, gingival inflammation, risk of caries and how to avoid or manage them.
- Give advice: - Diet is important for the good development of the baby and health of the mother. Ensuring a varied diet throughout the pregnancy is vital. This is especially important during the first trimester where the unborn requires nutrients like calcium and folate for the development of the cranium and teeth.
- Maintaining good oral health is paramount too. Encouraging pregnant patients to brush teeth twice a day and interdentally once a day. See the dentist regularly to allow for dental care monitoring.
- Encourage them to see midwives and receive adequate advice throughout the pregnancy.
- Care with positioning during third trimester. Avoid positioning the patient fully supine to avoid supine hypotensive syndrome. Place a pillow to raise right hip by 10- 12cm, this will avoid the weight of the unborn compressing the inferior vena cava and cause sudden drop in blood pressure.
In summary, many changes occur during pregnancy and dental professionals need to ensure their knowledge is up to date so they can educate patients about the potential oral health complications. Maintaining good oral health throughout this period is vital for the health of both mother and that of the baby. There are pregnancy resources available for dental professionals, so you are able to ensure the information you hold is relevant.