Pregnancy Counseling

The course for a child’s health – including oral health – is set during pregnancy. Early counseling of the expectant mother should reduce the risk of premature birth and prevent the child from developing caries (tooth decay) in early childhood. The focus of pregnancy counseling is therefore not only on the oral health of the expectant mother herself. The consultation should also benefit the unborn child in the sense of primary prophylaxis. On the one hand, oral diseases of the pregnant woman that carry the risk of premature birth should be avoided. On the other hand, informing pregnant women about caries as an infectious disease contributes significantly to preventing their child from developing early childhood caries (ECC).

The procedure

The procedure consists of education about oral health risks during pregnancy. The education includes the following topics:

1. gingivitis and periodontitis

Increased concentrations of estrogen and progesterone in the blood cause an increased tendency of the gingiva (gums) to bleed, as well as gingival swelling with the formation of pseudo-pockets (the gingival pocket is supposedly deepened by the swelling of the gingiva. A real pocket, on the other hand, is formed by inflammatory bone recession and subsequently by a subsidence of the pocket floor). The gingival swelling favors the formation of niches and the accumulation of biofilm (plaque, bacterial plaque). Thus, bleeding of the gums may occur during dental hygiene. If the mistake is now made of reducing dental care in order to avoid renewed bleeding, the biofilm increases and leads to inflammatory gingivitis (inflammation of the gums) with even more gum bleeding. A vicious circle is established, which can and must be interrupted by appropriate education, prophylactic measures such as professional tooth cleaning (PZR), intensified home tooth brushing techniques and aids for daily oral hygiene. However, if oral hygiene is increasingly neglected, periodontopathogenic germs (germs that damage the periodontium) can gain the upper hand in the pseudo-pockets. If this develops into severe periodontitis (inflammation of the soft tissues of the periodontium and the surrounding bone compartment), the risk of premature birth (before 32 weeks gestation) is significantly increased.

2. pain and stress

The fact that pain can trigger stress needs no further explanation. In the worst case, this can also lead to premature labor. Acute pain conditions in the dental, oral and maxillofacial region occurring during pregnancy should therefore be treated – as painlessly as possible.

3. early childhood caries – modes of transmission

Many parents are not aware that caries (tooth decay) is an infectious disease. The natural oral cavity environment is composed of a variety of microorganisms that colonize the oral cavity during the first years of life. If colonization by caries-causing bacteria can be delayed beyond the fourth year of life, the ecological niche suitable for them is already occupied by other microorganisms. The supposed “cleaning” of a dropped teat licked for this purpose by a caregiver infected with caries bacteria or the tasting from the same spoon are consequently tantamount to a live inoculation with caries bacteria. This realization means for mother, father, siblings, grandparents and all other persons entrusted with the care of the infant: Spoons, pacifiers, teats and the like are only used by the toddler for whom they are intended! In conjunction with prophylaxis, nutritional control and dental care, the chances for the toddler to start life free of caries and also to go through life increase enormously.

4. lowering the germ load of the expectant mother

No recommendation would go so far as to advise a mother against kissing her child. This is precisely why it makes sense to reduce cariogenic (tooth decay-causing) bacteria in the oral cavity of the expectant or young mother:

  • Already after the pregnancy is known, a dental examination can be performed in the third month, as well as a professional dental cleaning (PZR), which is accompanied by education about a home oral hygiene adapted to the pregnancy.
  • In the second trimester/third trimester of pregnancy (12th to 25th SSW), carious lesions (tooth cavities) can be removed and non-surgical periodontitis treatment can be performed. Disinfectant pocket rinses and / or antibacterial chips with the active ingredient chlorhexidine (CHX) inserted into the pockets reduce the risk of periodontitis.
  • In the third trimester (29th SSW to 40th SSW), any existing pregnancy gingivitis has its strongest expression. It makes sense now to renew professional dental cleaning. In addition, mouth rinses with chlorhexidine (CHX) and chewing gum with as high a proportion as possible of the sugar substitute xylitol are recommended to reduce the bacterial load in the weeks before the birth. Cariogenic bacteria absorb xylitol and perish when they try to break it down.

5. nutrition of mother and child

A balanced diet benefits both mother and child during pregnancy. Among the most important vital substances (micronutrients) for the healthy development of the teeth, which are already put on in the first weeks of pregnancy, are calcium and vitamins A, C and D. If there are deficiencies, dietary supplements are recommended for pregnant and nursing women. In addition to the micronutrients mentioned, these should also contain folic acid, iodine, iron, omega-3 fatty acids and magnesium. In order to prevent caries-causing foods, it is important to keep the sugar content of foods and beverages low. This applies equally to mother and child, of course. If breastfeeding is increasingly supplemented by bottles and porridge meals, parents cannot avoid taking a close look at the ingredients of baby and toddler foods. Cariogenic sugars (saccharides (mono- and disaccharides/single and double sugars) and also the trade name for sucrose (disaccharide/double sugar) are contained in:

  • Instant teas
  • Diluted and undiluted fruit juices
  • Baby porridge
  • Fruit puree
  • Milk porridge
  • Breast milk (7% lactose content)
  • U. v. m.

However, not only the sugar content per se, but also the dietary behavior itself affects the risk of caries:

  • Excessive breastfeeding, especially if it is done at night at will, leaving a residue of breast milk behind the incisors each time, carries a very high risk of caries. Hence the recommendation to wean after the eruption of the first teeth.
  • Continuous sucking on nipple bottles with sugary drinks is now considered the main risk for early childhood caries. Therefore, these bottles should ideally be offered only with water or unsweetened herbal teas (no instant products!) and be made of glass and thus too heavy for the child to help himself with it. However, the safest recommendation is to transition an infant from the breast directly to drinking from an open cup.
  • From the beginning, the child should be accustomed only to foods and drinks that are not very sweet.