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 will speak about preventing and treating periodontal diseases during pregnancy in the upcoming 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 oral-health intervention.
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.
Dr. Tatia Rokhvadze is a periodontist and president of the Georgian association of periodontology. As a certified iTOP lecturer she trains colleagues and dental students in oral prophylaxis and implements iTOP in dental schools. She regularly speaks at national and international dental congresses. Currently, Dr. Rokhvadze is also responsible for the implementation of a national programme for oral care of pregnant women, and she actively promotesthe importance of oral health to both the public and dental community.
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 ineither 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.
“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.”