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The Pregnant Dental Patient

Nine Months! Then they make you take it home with you!  Yeah, I know there’s a little more to it than that.  A whole lot more.  We actually break pregnancy down into pre-conception and  three distinctive trimesters:

Pre-conception:

  • Stop smoking
  • Stop drinking
  • Stop waiting!
Seriously, if you are thinking of or trying to conceive you need to make sure your body is ready.  Lowering your stress levels, eating right, taking vitamin supplements (folic acid) and getting plenty of sleep will go a long way toward having a healthy baby.

 

First Trimester (weeks 1-12)

  • Conception: This is a very critical time in the development of your baby physically speaking.  Of course, everyone knows you need to cut out bad habits like smoking (low birthweight problems), drinking alcohol(fetal alcohol syndrome),  recreational drugs (even if you think you might have “Californian glaucoma”), certain prescription medications (consult your medical doctor first), stressherbs (consult your medical doctor), and yes, caffeine(miscarriages).
  • Folic Acid: The importance of a good diet and multi-vitamin supplements cannot be over stressed before and during pregnancy.  Lack of folic acid has been linked to midline disorders such as  neural tube (spinal bifida) and  cleft lip/palate.
  • Weight: If you are planning to get pregnant, it is a good idea to get yourself in shape before you conceive.  Weight gain is a problem for many women.  Eating sugary sweets can not only be a problem for your general health, but can be a problem for your teeth as well. It takes four factors to get a cavity: tooth, bacteria, sugar, time. If you let your teeth bathe in sugar long enough for the bacteria to eat and excrete acid you have a higher chance of developing a cavity.
  • Tooth Development: No tooth buds are developing in this trimester.
  • Dental Treatment: This is routinely not a good time to have elective dental work done.  This reason for this is because the babies body is forming critical parts and we simply do not want to interfere with any of these processes.  Dental emergencies unfortunately do not wait for anyone and can be addressed during this trimester under the guidance of the patient’s OB physician.  Dental x-rays can be take at this time, but with a leaded apron.  Nitrous Oxide should be avoided.

Second Trimester (weeks 13-26)

  •  Dental Treatment: If you are going to have dental treatment during a pregnancy, this is the best trimester to have it in.  The baby has already developed all of its critical systems and is in the process of growing bigger.
  • Tooth Development: This is the time when the baby teeth are beginning to develop.

Third Trimester (week 27-42)

  • Dental Treatment:  This is a relatively safe time to have dental treatment, but is routinely avoided during this trimester because of the fear of stimulating premature delivery. Again, dental emergencies can be addressed under the guidance of your OB physician.
  • Tooth Development: The first permanent teeth (upper and lower 1st molars) are beginning to develop at the time of birth.

Wives Tales:

  • “My teeth are bad because when I was pregnant my baby just sucked the calcium right out of my teeth.”  You would be surprised how many times I have heard that.  A patient once said she was told that by several dentists!  Of course, this was an attempt to make me believe her story (which I did not).  The simple fact is that there is no evidence pregnant mother’s TOOTH calcium levels are affect by pregnancy.
  • “I’ve lost a tooth for every child I’ve had.” Again, this must imply that the baby has diminished the calcium in the mother’s teeth somehow?  Indeed, some mothers do loose teeth around the time they have their children.  This has more to do with the timing than with the actual pregnancy.  Practically everyone goes through a break in their dental care to one degree or another some time in their life.  A common break is between the time that your parents are taking care of you (0-18 years old) and the time when you learn to take care of yourself.  Unfortunately, this is about  the mid twenties and they go to the dentist for a problem such as a toothache.  This also corresponds to the time when most women begin having their babies.

References:

1. Atherosclerosis. 2011 Aug 22. [Epub ahead of print] Maternal smoking during pregnancy and risk factors for cardiovascular disease in adulthood. Horta BLGigante DPNazmi ASilveira VMOliveira IVictora CG. Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodora 1160 – 3 andar, 96090-790 Pelotas, RS, Brazil.

2. J Perinat Med. 2011 Jul 29. [Epub ahead of print] Determinants of folic acid use in a multi-ethnic population of pregnant women: a cross-sectional study. Baraka MASteurbaut SLeemans LFoulon WLaubach MCoomans DJansen EDupont AG. Department of Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, Belgium.

3. Birth Defects Res A Clin Mol Teratol. 2011 Jan;91(1):50-60. doi: 10.1002/bdra.20740. Epub 2010 Dec 1. Folate pathway and nonsyndromic cleft lip and palate. Blanton SHHenry RRYuan QMulliken JBStal SFinnell RHHecht JT. University of Miami Miller School of Medicine, Miami, Florida, USA.

4. J Womens Health (Larchmt). 2011 Sep 6. [Epub ahead of print] The Association Between Maternal Alcohol Use and Smoking in Early Pregnancy and Congenital Cardiac Defects in Infants. Mateja WANelson DBKroelinger CDRuzek SSegal J. 1 Delaware Division of Public Health , Dover, Delaware.

5. Clin Chem. 2010 Sep;56(9):1442-50. Epub 2010 Jul 13. Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth. Gray TREiden RDLeonard KEConnors GJShisler SHuestis MA. Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.

6. Am J Obstet Gynecol. 2011 Apr 21. [Epub ahead of print] Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008. Mitchell AAGilboa SMWerler MMKelley KELouik CHernández-Díaz SNational Birth Defects Prevention Study. Slone Epidemiology Center at Boston University, Boston, MA.

7. Demography. 2011 Aug 26. [Epub ahead of print] The Effect of Maternal Stress on Birth Outcomes: Exploiting a Natural Experiment. Torche F. Department of Sociology, New York University, New York, NY, USA, florencia.torche@nyu.edu.

8. Complement Ther Clin Pract. 2011 Aug;17(3):147-51. Epub 2010 Oct 5. Use of herbal drugs during pregnancy among 600 Norwegian women in relation to concurrent use of conventional drugs and pregnancy outcome. Nordeng HBayne KHavnen GCPaulsen BS. Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway. h.m.e.nordeng@farmasi.uio.no

9. Eur J Obstet Gynecol Reprod Biol. 2011 May 31. [Epub ahead of print] Maternal caffeine consumption and sine causa recurrent miscarriage. Stefanidou EMCaramellino LPatriarca AMenato G. Department of Obstetrics and Gynecology, University of Turin, Sant’Anna Hospital, Via Ventimiglia 3, 10126 Turin, Italy.

10. Clin Calcium. 2011 Sep;21(9):1335-46. [Bone and Calcium Metabolism in the Female Life Cycle. Metabolic change of bone and calcium in pregnancy and puerperium]. [Article in Japanese] Kurabayashi T. Department of Obatetrics and Gynecology, Niigata City General Hospital, Japan.

11. Arch Oral Biol. 1989;34(7):491-8. Effects of a low calcium maternal and weaning diet on the thickness and microhardness of rat incisor enamel and dentine. Lozupone EFavia A. Institute of Human Anatomy, University of Bari, Italy.

12. J Am Dent Assoc. 1976 Sep;93(3):606-9. Congenital anomalies and inhalation anesthetics. Bussard DA.

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