1. 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

3. Common Dental Problems
Periodontal infections
Dental caries
Pulpal infections
Periapical infections
Cosmetic dental problems

4. DURING PREGNANCY Infections - Having influence on pregnancy
Periodontal diseases
Gingivitis
Pregnancy Gingivitis
Periodontitis

5. 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

6. 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

7. 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

8. Healthy Gums & Periodontal Tissues

9. Severe Periodontal(Gum) Disease & Severe Gum Disease with Recession

10. 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

11. 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 )

12. 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 ?

13. TREATMENT PLAN Scaling and root planning
Treatment in early stage of pregnancy --- Yield Promising results
Use of CHX based mouth washes

14. 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

16. DENTAL CARIES

17. PULPITIS Acute Chronic Inflammation of the pulp due to infection
Treatment plan
Pulpectmy
Root canal treatment
Antibiotics ?
NSAIDS ?

20. 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…

21. Management of the lesion
Conventionally – surgical endodontics
Current concept – non-surgical endodontic management
Recent – Apexum procedure

22. Non-surgical management of Periradicular lesion

23. Apexum procedure

28. Radiography – Conventional

29. Radiography – Advanced
Digital image enhancement
RVG

30. 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

31. ENAMEL EROSION Vomiting Palatal surfaces of maxillary teeth
Thermal sensitivity
Dentin exposure
Recommended Therapy
Avoid tooth brushing
Use of neutral NaF mouth rinse

32. Drugs that can be Prescribed and Those that are Contraindicated During Pregnancy Source:
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

33. Thank You