While primary prophylactic measures start in healthy individuals with the aim of preventing disease from the outset, primary prophylaxis goes one step further by providing education during pregnancy and taking therapeutic measures in the expectant mother, thus already protecting the health of the unborn child. During pregnancy, the course is set not only for the general health of a child, but also for its oral health. For this reason, early dental health promotion by caring for expectant mothers already begins here, pursuing the following goals:
- Reducing the risk of premature birth: expectant mothers who suffer from severe untreated periodontitis (inflammation of the periodontium) have a more than seven times higher risk of suffering a premature birth before the 32nd SSW (week of pregnancy).
- Lowering the risk of having an underweight premature baby: the weight of the premature baby also correlates with the periodontal health of the mother
- Influencing the oral health of the child by improving the oral health of the mother.
- Preventing infection of the child with cariogenic and periodontopathogenic (causing caries and periodontitis) germs by educating the mother about possible routes of infection.
To promote the oral health of the mother, various therapeutic measures are taken depending on the progress of pregnancy, for which the following applies:
- In the first and third trimester (third trimester of pregnancy) should not be elective dental procedures.
- However, treatment of acute pain is indicated at any stage of pregnancy.
- Analgesia for acute treatment should be given with articaine (alternatively bupivacaine, etidocaine) and an epinephrine supplement of max 1:200,000.
- All other therapies during pregnancy serve to reduce the germ count.
First trimester
Around the third month, a dental examination should already take place. If this reveals a need for treatment, the first thing that can be done is professional teeth cleaning and oral hygiene training for prophylaxis (prevention) against pregnancy gingivitis (inflammation of the gums) and caries (tooth decay). In addition, education about the special importance of good oral hygiene during pregnancy is necessary. This is because the increased concentrations of estrogen and progesterone increase the tendency of the gingiva (gums) to become inflamed, which increases already existing plaque-related gingivitis (inflammation of the gums). The inflammatory swelling of the gingiva causes the formation of so-called pseudo-pockets, which in turn promote the increased adhesion of plaque (microbial plaque), thereby increasing the risk of caries.
Second trimester (12-25 SSW)
Urgently needed dental procedures can be performed most safely at this time. These include caries therapy (removal of carious lesions/holes) and nonsurgical periodontal therapy, for example, with disinfecting pocket rinses or insertion of antibacterial chips to reduce germ counts, and root canal treatments with disinfecting calcium hydroxide insertion. Excision (surgical removal) of a pyogenic granuloma (synonyms: pregnancy epulis, epulis gravidarum, pregnancy tumor) can also be performed during this period if it is obstructive to eating or bleeds profusely. If there are no symptoms, excision of the granuloma is not performed until after pregnancy, if it does not spontaneously regress anyway.
Third trimester
In the eighth month, any existing pregnancy gingivitis has its strongest manifestation. Renewed prophylaxis (preventive measures) in the form of professional tooth cleaning (PZR) are now sensible. Mouth rinses with chlorhexidine (CHX) and xylitol chewing gums can be recommended for an additional reduction of the germ load before birth. Cariogenic (tooth decay-causing) bacteria perish when they attempt to metabolize the sugar substitute xylitol. In the weeks leading up to delivery, re-education of the expectant mother in terms of primary prophylaxis is critical.
1. education about modes of transmission
Within the first four years of life, the oral cavity ecosystem is gradually colonized by a wide variety of germs, without them necessarily being pathogenic (causing disease).The longer the colonization of the child’s oral cavity with cariogenic (caries-causing) germs can be delayed or, better, completely prevented during these years, the greater the probability that all ecological niches in the ecosystem will already be occupied by other, non-cariogenic germs. The recommendations do not go so far as to deny parents the right to kiss their child, especially since this involves rather little saliva transfer from the parental side. However, the mother must also educate all other close caregivers (siblings, grandparents, babysitters, educators) to avoid transmitting bacteria from their own oral cavity to the child, such as.
- By licking a pacifier
- Eating from the same spoon
- Pre-tasting/pre-tempering food on the same spoon
- Pre-tasting from a teat bottle
- Use of the same toothbrush
2. nutrition education
In order to deprive caries causers of the food basis, it is important to keep the sugar content of foods and beverages low. Here, parents cannot avoid taking a close look at the ingredients in convenience foods. Cariogenic sugar is contained in
- Instant teas
- Diluted and undiluted fruit juices
- Baby porridge
- Fruit puree
- Milk porridge
- Breast milk (7% lactose / milk sugar content).
- U. v .m.
However, not only the sugar content itself, but also the dietary behavior itself affects the risk of tooth decay:
- 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 also one of the causes of early childhood caries. Therefore, these bottles should be offered only with water or unsweetened herbal teas 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.
3. oral hygiene education
- Dental care takes place from the eruption of the first tooth!
- For this purpose, a baby toothbrush or special cloth fingerlings can be used.
- Until the age of two years is brushed once a day, then twice a day with a small pea-sized amount of children’s toothpaste with a fluoride content of 500 ppm (parts per million).
- In the process, the child is playfully accustomed to the fixed ritual of brushing teeth.
- From the age of two, the child is so independent that he wants to brush himself. Toddler-friendly toothbrushes with thick handles are suitable for the first own attempts. However, parents must continue to brush consistently into school age. Clue: only when a child has mastered the handwriting, he has the necessary fine motor skills.
- Parents should take advantage of the imitative instinct of their child and let it watch again and again when brushing teeth, to let brushing become a matter of course
4. the first visit to the dentist
The first presentation of the toddler to the dentist should certainly take place when the first teeth erupt. The purpose of the visit is to provide assistance to the mother after her own first experiences with child oral hygiene, to refresh her knowledge, but also to exclude the risk of early childhood caries. The dentist will have a children’s dental passport/examination booklet available for the mother for further information.
