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prevention International magazine for oral health No. 1, 2018

| systemic diseases soft bristles and fluoride toothpaste, and using instruments for interdental care and, if necessary, chemical plaque control are key instruments for the prevention of gingivitis and periodontitis even before pregnancy. That is why, for example, Oral-B recommends electric toothbrushes with oscillating rotations. At the same time, every system of mechanical plaque control is suitable in principle, whether manual or electric, as long as the correct technique is used regularly and with persistence (120 seconds). In the case of gingivitis, toothpastes with antibacterial agents such as stannous fluoride are beneficial, and mouth rinsing solutions are suitable as additional therapy. For acute gingivitis, patients should use chlorhexidine therapeutically for a short time, best in a concentration of 0.1 to 0.2 per cent or 1 per cent. Different meta-analyses have found that chlor - hexidine can be used with confidence during pregnancy. Long-term chemical plaque control is suitable for pregnant women with nausea and poor oral hygiene, particularly in the molar area. Other alternatives, such as tea tree oil and propolis, have not shown any effectiveness in studies. What to keep in mind with periodontal therapy If the practice team has to treat pregnant patients for periodontitis, neither has any special procedures to be considered first. Research shows that non-surgical periodontal therapy is safe and sensible during the sec- ond trimester. Scaling and root planing are quite pos- sible during pregnancy. Radiographs can be taken and local anaesthesia can be administered without additional risk to the foetus or the mother. Articaine is the agent of choice in this case. Periodontal therapy does not reduce the occurrence of negative pregnancy issues. However, it can lower the frequency of negative pregnancy out- comes in women at high risk of pregnancy complications or who respond better to periodontal treatment. Modern pregnancy prophylaxis Professional tooth cleaning as part of modern biofilm management is an indispensable component of gingivitis and periodontal therapy in the context of a prophylaxis session. Professional tooth cleaning, in combination with oral hygiene products and instructions, clearly reduces moderate or severe gingivitis. The second trimester is therefore best suited for professional tooth cleaning. At this point, nausea has usually disappeared and the pa- tient can stay lying down for a whole hour. An optimal pregnancy prophylaxis also includes nutri- tion from a dentistry point of view. Here patients should not limit themselves, but enjoy their pregnancy. Never- theless, patients should forgo acidic foods and bever- ages. A craving for sour and sweet foods, often in high frequency, also increases the risk of caries or an ero- sive change in the tooth enamel. In addition, the buffer- ing capacity and rinsing function of the saliva is reduced during pregnancy; the mouth tends to be dry, which pro- motes the development of dental caries. Even allegedly healthy foods and drinks, like fruits or fruit juices, which are acidic, can quickly damage the tooth enamel. Speaking of erosion, morning sickness also leads to the production of gastric acid, which can again lead to den- tal erosion of varying intensity. Toothbrushing should be avoided after an episode. The pellicle needs two hours to reform after vomiting. Helpful means of neutralising are the consumption of milk, cheese and, above all, chewing gum. Instead of brushing right after, antibacterial mouth rinsing solutions and fluoride rinsing solutions are suitable first. Pregnancy is a major challenge with regard to teeth and gingivae. The main task of periodontal treatment during pregnancy is to improve the periodontal and overall health of pregnant women. Oral hygiene training and nu- trition advice reduce plaque and gingivitis and thus peri- odontitis. With respect to affecting negative pregnancy outcomes, intervention even before pregnancy may be more effective. If the practice team controls the gingivitis and so avoids periodontitis, it has made its contribution to a problem-free pregnancy. In all cases, prevention is better than cure and every tooth counts. Editorial note: A list of references can be obtained from the publisher.

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