Considerations in Orthodontic Treatment During Pregnancy
Pregnancy is an important period of woman’s life. Pregnancy changes a woman’s status and perspective toward her surroundings, which is why having a beautiful smile and improved appearance at the same time is important. Since women demand a better and younger appearance more than men, encountering a female patient who became pregnant during orthodontics is more likely.
In general and as a principle, there is no health concern to prevent pregnant women from using orthodontic appliances (fixed or removable).
Orthodontics and Pregnancy
There are factors, however, there are a variety of factors orthodontists should consider while treating a pregnant patient.
- Pregnancy causes gingivitis and periodontal disease.
- The hormonal changes of this period affect tooth movements.
- Pregnant women have various food habits and desires that can disrupt the orthodontic treatment.
- One should also consider the effect of various drugs used during pregnancy on tooth movements.
The Patient’s Medical, Dental, and Psychosocial History
As in all medical and dental treatments, obtaining a complete medical, dental and psychosocial history of the patient is required, as it may change the treatment plan. Regarding the pregnant woman, it is necessary to consult gynecologists in case of any medical issues. The patient’s current medicinal history is additionally very valuable, since some drugs can have side effects on the tooth cavity along with orthodontic movements. For example, nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen reduce tooth movements during orthodontic treatment. Also, any medical history, such as diabetes and possible pregnancy difficulties, should be evaluated before any orthodontic treatment.
Orthodontic Considerations During Pregnancy
Hyperplasia aka growth of gingival tissues occurs during puberty and pregnancy. Several known systemic and local factors lead to hyperplasia. With the most important systemic factor being hormonal changes during pregnancy. Although the presence of orthodontic brackets doesn’t alone cause gingivitis, factors such as pregnancy and poor dental hygiene can together contribute to acute gingivitis and even its advancement to other periodontal diseases. It is logical to delay the start of orthodontic treatment to after the pregnancy if the patient has poor oral hygiene and gingivitis. Since orthodontic brackets can act as a place for microbial plaques to gather, together with mild gingivitis in the pregnant women caused by hormonal changes, they could lead to deteriorating gingival conditions. Orthodontics is not incompatible with pregnancy if oral hygiene is observed.
Periodontal disease in this period has the following symptoms:
- Gingival enlargement or gingivitis
- Gingival recession
Educating and informing patients
There are approximately 6 million annual pregnancies in the United States, of which around a quarter of these individuals receive various types of dental care. Women who are not sufficiently informed don’t visit dentists during pregnancy, and many people wait for this period to end before visiting the dentist.
It is very important to consider the following points for a pregnant patient:
- Obtaining the patient’s medical, dental and psychosocial history
- Consulting with a gynecologist in case of problems during pregnancy as well as previous pregnancies
- Recording the patient’s motivation and enthusiasm for oral hygiene before and during pregnancy
- Avoiding the prescription of nonsteroidal anti-inflammatory drugs (as much as possible)
- Checking the teeth removed from the patient and their reason (lack of hygiene, trauma, etc.)
- Accurate gingival examination and recording any hemorrhage
- Giving appointments in shorter periods to better control the gingival tissue
- Avoiding prescription of radiography during pregnancy
- Most women get bad food habits and nausea in the morning in the initial three months of pregnancy, which is why appointments should not be given to pregnant patients in the morning.