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UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 FOUSP - MINISTRY OF HEALTH, BRAZIL

Oral Health in the Gestational Period The oral health of women during pregnancy can and should be accompanied with proper treatment and safety for mother and baby. Chapters 1. Preventive Aspects a. Nutrition b. Oral Hygiene Page 1

Updating and Illustrating 2. Healing Aspects (Treatment of Oral Problems) a. Physiological Alterations in the Period b. Better Moment for Dental Treatment

2. Healing Aspects (Treatment of Oral Problems) c. Local Anesthetics and Pregnancy d. Medication e. Interactions in the Gestational Period

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2. Healing Aspects (Treatment of Oral Problems) e. Oral Problems in Pregnancy

a. Nutrition !

A pregnant woman can and should take care of their oral conditions in order to stay healthy and preserve the health of your baby

! Hypoglycemia is frequently associated to pregnancy. The demands of carbohydrates by the fetus may be increased so that there is a drop in the sugar levels in the mother’s blood. (Hypoglycemia means low level of glucose in blood. When glycemia is below 60 mg, symptoms of a hypoglycemic reaction may occur. This varies among individuals. There is an

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

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1. PREVENTIVE ASPECTS

Pregnancy causes fatigue in the carbohydrate metabolism. Insulin demands in the pregnant woman are increased and may transform subclinical asymptomatic Diabetes Mellitus into clinical diabetes. (Gestational diabetes is the alteration of sugar index in blood that starts or is detected for the first time in pregnancy. It may persist or disappear after delivery. There are several criteria to diagnose GDM, but the recommendation is to use that from the World Health Organization (WHO).www.diabetes.org.br/diabetes/ hipog.php in Jul 2012). Wikipedia in Nov 2007.).

6. References and Credits

acute hunger sensation, difficulty to think, weakness with extreme tiredness, pronounced sweating, fine or rough extremity trembling, yawning, sleepiness, double vision, confusion that may lead to unconsciousness, that is, coma. It is important friends and relatives know the person is using insulin or oral hypoglycemic drug. This way, they can diagnose hypoglycemia. www.diabetes.org.br/diabetes/hipog.php in Jul 2012). Morning sickness is attributed to a rise in chorionic gonadotropin and hypoglycemia. The recommendation is to eat several meals a day – at least 6: breakfast, morning snack, lunch, afternoon snack, dinner and supper. (Barbosa CP, 2003 - human chorionic gonadotropin (hCG) is a hormonal glycoprotein produced by the placenta. In the beginning of pregnancy the hCG concentrations in the woman’s serum and urine increase rapidly and this is a good marker in pregnancy 1


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tests. Seven to ten days

clean parts of the floss in a new

after conception, the hCG

cleaning.

concentration reaches 25 mUI/mL and increases to a peak of

!

37.000-50.000 mUI/mL between eight

use a soft bristle toothbrush (hard

and eleven weeks. It is the only hormone

bristles may cause gingival bruises

exclusive to pregnancy, providing for a correct hCG analysis in almost 100%. It is the only test that confirms pregnancy exactly. Wikipedia in Jul 2012).

b. Oral Hygiene

Figure 1 – holding the dental floss

For brushing it is necessary to

and do not penetrate the spaces to be

After this, thumbs and index efficiently cleaned) with a small head fingers help to introduce the dental (to brush tooth by tooth efficiently) floss between teeth (in the and round handle to prevent embrasures) taking it below the

accidents. gingival limit (fig. 2) and rubbing the During this period there is an increase lateral parts (proximal aspects) of ! The dentifrice can be in blood supply on the mucosa that each tooth to be cleaned. eliminated if it means a high cost to should not be mistaken for gingival the patients, according to their edema. financial possibilities; if possible, Oral hygiene must be complete instruct them to choose a fluoride including the use of dental floss besides dentifrice and apply a small part on brushing after every meal plus morning and evening hygiene. It is interesting to

the toothbrush before introducing it

remember that the quality of oral

into the oral cavity.

hygiene characterizes the cases prone to periodontal disease.

!

individual

If the pregnant woman cannot stand the

toothbrushes

and

members of one family that share the

use of dentifrice that may cause nausea,

same

she can clean only with the toothbrush, dental floss and mouth rinse.

Populations that cannot buy

Figure 2 – how to use the dental floss

toothbrush

should

be

instructed to clean it with common

It is important to follow a

bleaching products to be reused by sequence so that no teeth is missed of floss should be removed from other members of the family. package (raffia thread can be used: in this procedure; example: start by It is necessary to establish a the same material used in Hawaiian the central incisor and go to the right procedure to use the toothbrush: Carnival skirts. Reel off the raffia up to the last molar, go back to the start by right upper molars and go strip forming thin threads and use as central incisor and follow to the left described below). up to the left upper molars. Adopt up to the last molar. The same the same criteria to the lower teeth. ! The floss should be caught on the middle fingers of both hands procedure should be done in the The bristles must be positioned at leaving index fingers and thumbs lower teeth. 45º with the palatal or lingual and free to move the floss between teeth ! At each cleaned embrasure buccal aspects to be brushed turned (fig. 1). the floss should be rolled up on the to the gingival groove. They should Illustrations – obtained Sept 2012 in: middle fingers to release and use vibrate in short movements from www.pgr.mpf.gov.br/pgr/saude/ !

30cm to 50cm (half a meter)

odonto/escovando.htm UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

distal to mesial as massaging the 2


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gingiva (fig. 3).

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performed by brushing the upper diastolic arterial pressure. Wikipedia in aspect with the toothbrush.

Jul 2012. ! !

2. Healing Aspects – Treatment of oral problems

content in the aorta, the energy is the greatest, generating maximum force and,

a. Phisiological alterations in the period !

The moment the heart ejects its

as

a

consequence,

maximum

pressure. This phase in the cardiac cycle is called systole and the pressure in this

During pregnancy there is an moment

is

called

systolic

arterial

increase of 10 heartbeats/minute in pressure). the cardiac rate from the 14th. up to ! the 30th. week. The arterial blood !

Hypertension in pregnancy

pressure is stable up to the 30th. occurs when the systolic arterial Figure 3 – position of toothbrush bristles to clean the smooth aspects of teeth (lingual or palatal and buccal)

!

The occlusal surfaces should

be brushed with the toothbrush

week when the diastolic arterial pressure is higher than 140mmHg pressure (low) may slightly decrease and

the

diastolic

higher

than

and the systolic (high) may slightly 90mmHg in two measurements at increase

(Arterial

pressure

is

the rest with an interval of 4h or when

parallel to the long axis of the tooth,

pressure exerted by the blood against the there is an increase greater than

vibrating from distal to mesial (fig.

internal surface of the arteries. The 30mmHg in the diastolic compared

4).

original force comes from the heartbeat. to the normal values previous to The arterial pressure varies at each pregnancy (Silva et al. 2006). moment following a cyclic pattern. The The vital respiratory capacity is various cycles overlap but the most increased leading to a larger oxygen visible is the one determined by cardiac consumption beats.

and

increase

in

Cardiac cycle is the group of respiratory rate.

situations from one cardiac beat up to ! the next beat. Wikipedia in Jul 2012. Figure 4 – position of the toothbrush to brush the occlusal aspects

!

More attention should be

given to the distal of upper and lower last molars and the lingual of lower incisors. !

The tongue must be also

!

!

The

Immediately before the next metabolism

alteration of

in

the

carbohydrates

heartbeat, the energy is very little and demands changes in eating habits the least force is exerted on the arteries and more meals are recommended, in the whole cycle, generating the lowest putting at risk the dental health if arterial pressure of the cardiac cycle. eating is not followed by quality This phase is called diastole and the hygiene. Read the text about Oral pressure in this moment is called Hygiene (link in the text) (Barbosa

cleaned and this procedure can be UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

CP, 2003). 3


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Appointments

b.The best moment for dental treatment

scheduled

N

P

should

not

be metabolism) and new applications

dentist

or may stress the patient and increase

when

the

R

E

assistant have flu or cold.

G

N

A

N

C

Y

the toxic potential in the body (An

The best moment for dental The maximum amount of anesthetic agent (generally a substance) that treatment is between the 4th. and should not exceed two cartridges of narrows the blood vessel lumen !

6th. month of pregnancy, avoiding a 2% lidocaine solution per reducing absorption capacity. Digital the periods that are considered appointment, avoiding the risk of Dictionary of Medical Terms in adverse reactions and toxicity to the www.pdamed.com.br in Jul 2012).

critical by the physicians.

mother

and

fetus

(Lidocaine

or !

If the woman has instructions

Xylocaine® is a class I antiarrhythmic from the physician who follows her

Schedule and duration of appointments and anesthetic drug (subgroup 1B) and the local neonatal about the use of anesthetics dosage used during the dental anesthetic that is used in the treatment without vasoconstrictors or procedure of cardiac arrhythmia and local pain (as anesthetic agents, get in contact with

!

Appointments

should

be in surgeries). Low toxicity. Wikipedia in the doctor to explain the nature of

short, preferably in the second half Nov 2012).

the oral intervention and the amount

of the morning when sickness is less

of anesthetics to be applied in each

common. Appointments should also

The amount of Can the baby be affected by treatment. be scheduled in different hours from the mother’s lack of oral care? vasoconstrictor is minimal and if those of the children who visit the

Yes! Not only is the mother’s stress is controlled during treatment, clinic, preventing possible viral health in danger but also the baby’s. no discomforts will occur to the infections common in childhood Oral infection in the tooth, tongue, patient and the baby. !

(rubella, measles, etc.) (Barbosa CP,

gingiva and/or mucosa must be If the doctor insists on the use of 2003 - Rubella is a disease caused by the treated as soon as possible. These anesthetics without vasoconstrictors, rubella virus that is transmitted by the

may lead to several health problems ask a written recommendation and airways. Usually it is a benign disease in the baby including preterm labor. follow it. but it may cause malformations in the

embryo in pregnant women. Wikipedia in Jul 2012. !

c. Local Anesthetics Pregnancy

and A n e s t h e t i c s vasoconstrictor

Measles is a disease caused by

the measles virus and transmitted by the A n e s t h e t i c s airways. Generally there is resolution

without

vasoconstrictors

It is not recommended the

one of the most frequent causes of death use

of

anesthetics

without

in children in many regions, mainly in vasoconstrictors for their duration is

satisfactory. Wikipedia in Nov 2012).

(from

depending

15 on

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

The preferred local anesthetic

for pregnant women is 2% lidocaine

without problems, but this disease is still !

countries where mass vaccination is not brief

!

with

to

30

the

minutes patient’s

with

vasoconstrictor

(which

is

noradrenaline – a substance present in the body that is noxious only in high concentrations, that is, applying many Vasoactive

anesthetic drug

cartridges) that

increases 4


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cardiac contraction and degree of dissociation and quick spectrum (resistance to penicillinases) cardiac

s t i m u l u s metabolism in plasma, decreasing and broad spectrum. Penicillins have the

conduction. Digital Dictionary of the fetal potential effects.

highest selective toxicity bactericidal

Medical

activity, being atoxic to human cells.

Te r m s

in

www.pdamed.com.br in Jul 2012). !

d. Medication Interaction in www.forp.usp.br in Jul 2012). the gestational period Metronidazole for severe infections The amount to be applied (Moore PA, 1998)

should be controlled as to the anesthetic literature,

(according up

2

(Metronidazole

the !

to

cartridges

from

The literature reports some nitroimidazole and has antiprotozoan

per negative

interactions

in

the activity.

This

compound

also

has

gestational period that may cause antibacterial activity against anaerobic

session).

possible problems related to the fetal gram

Anesthetics in bloodstream !

derives

negatives

bacilli,

against

fetus formation (teratogenic action - also sporulated gram positive bacilli and

the

called Teratogenicity, is the ability some against all anaerobic cocci. It is indicated

Local anesthetics are highly

drugs have in producing congenital to

treat

giardiasis,

amoebiasis,

soluble in lipids and they cross the

malformations mainly when given in the trichomoniasis, vaginitis by Gardnerella

placenta reaching the fetus (Lipids are

period of organogenesis (between the vaginalis and infections caused by

biomolecules non soluble in water and

2nd. and 10th. week of gestation). anaerobic bacteria as Bacteroides fragilis

soluble in organic solvents, such as

www.derma.epm.br in Jul 2012) and and other bacteroids, Fusobacterium sp,

alcohol, benzene, ether and chloroform.

labor.

Clostridium sp, Eubacterium sp and

Lipids have a biological importance on

It is advisable to avoid systemic anaerobic cocci. Wikipedia in Jul 2012).

several levels, acting as energy reserve

medication, but if necessary (when !

with structural, protective, vitamin and hormonal functions. They are part of the cell membrane formation and can also be

the

clinical

sufficient

procedure to

paracetamol

is

control

(Analgesic

Considering

pain), central action analgesics, antibiotics

antithermic and

anxiolytics,

different

indicated to the patients allergic to acid important

nutrient reserve and source of energy.

acetyl salicylic (AAS) and/or intolerance observed as follows:

Lipids

to dipyrone. Digital Dictionary of Regarding

form

some

hormones,

local

not anesthetic groups, peripheral and

found inside the cells as substances of

may

the

risk

actions

local

and

can

be

anesthetics,

vitamins and pigments. Wikipedia in Jul

Medical Terms in www.pdamed.com.br bupivacaine and mepivacaine may

2012).

in Jul 2012) should be used for c a u s e

The amount of circulating drug will

analgesia (500 to 700mg) or dypirone (Bupivacaine is an amide type local

depend on: the ability of protein

(500mg

-

fetal

Analgesic-antithermic. anesthetic

that

bradycardia

provides

prolonged

binding; the degree of dissociation of

Digital Dictionary of Medical Termsem anesthesia, mainly in the 0.50% and

the drug and its metabolism rate.

http://www.pdamed.com.br em Jul 2012) 0.75% concentrations. It is advocated by

Most of local anesthetics usually

3 times a day at each 4 hours. The the

employed in Dentistry have a high

best antibiotic choice is synthetic Administration) to be used as spinal and

ability

penicillin (less toxic - may have small epidural anesthesia (when there is the

of

protein

binding,

low

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

FDA

(Food

and

Drug

5


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inside the cerebral-spinal- known

T

H

I

that

fluid in the lumbar space) opioids

the

such

N

P

central

as

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E

G

N

A

N

action moderate

codeine

C

Y

pain.

www.msd-

with brazil.com in Jul 2012.

and epidural anesthesia (when the acetaminophen used in the 3rd. Hydrocodone

bitartrate

anesthetic is injected in the space quarter of pregnancy may cause acetaminophen

-

with

Analgesic

confined by the yellow pigment in the multiple birth defects and neonatal association to relieve moderate pain. posterior part, by the spinal periosteum r e s p i r a t o r y

d e p r e s s i o n . www.msd-brazil.com in Jul 2012.

laterally and by dura mater in the Hydrocodone

bitartrate

anterior part) and may be used in the acetaminophen, sacral hiatus (epidural sacral block), in bitartrate

bitartrate

with

hydrocodone ibuprofen - Analgesic association to

with

the cervical, lumbar or thoracic regions. oxycodone

with Hydrocodone

ibuprofen

with

and relieve moderate pain. www.msd-

acetaminophen brazil.com in Jul 2012.

It can also be used as local anesthetic by may produce neonatal respiratory Oxycodone with acetaminophen infiltration, loco-regional, dental block depression (Acetyl Salicylic Acid Analgesic and

sympathetic

nerve

block. analgesic,

antithermic

Mepivacaine is a drug that blocks the inflammatory

with

and

association

to

relieve

anti- moderate pain.www.msd-brazil.com

antithrombotic in Jul 2012.

nerve conduction activity preventing the action. Do not use in surgical post-op. About antibiotics, it is known that start and propagation of nerve impulse. Digital Dictionary of Medical Terms in chloramphenicol is a high risk drug It is the ability to act as local anesthetic. www.pdamed.com.br in Jul 2012. Bradycardia - Decrease in cardiac rate. Ibuprofen

-

Non-steroidal

In the human being the normal cardiac inflammatory

drugs

for the mother and the fetus and anti- may cause Gray Syndrome with fetal

(NSAIDs) death due to its highly toxic action.

rate is between 60 and 100 heartbeats frequently used to relieve the symptoms Doxycycline per

minute.

Rates

below

60

may

cause

dental

are in headaches (migraines), toothaches, discoloration and inhibition of bone

bradycardia. Bradycardia may cause low muscle pain (myalgia), menstruation growth. Erythromycin estolate may pressure due to the decrease in the disorders (dysmenorrheas), fever and cause reduction or interruption of cardiac muscle effort. Bradycardia may post-surgery pain. It is also used to treat the maternal biliary flow (hepatic cause damages to the body due to less inflammations,

such

as

arthritis, cholestasis). Gentamicin is ototoxic

blood circulation that transports less reumatoid arthritis (RA) and gout to the fetus. Antibiotic therapy is not oxygen to the cells. Wikipedia in Jul arthritis. Digital Dictionary of Medical recommended 2012

and

ANVISA

tetracycline-

i n Terms in http://www.pdamed.com.br in based drugs as they may cause

www.cvs.saude.sp.gov.br in Jul 2012). !

with

Jul 2012.

alterations in the osseous and dental

Regarding peripheral action Naproxeno

-

Anti-inflammatory development

(Chloramphenicol

-

analgesics used in the 3rd. quarter of (reduces inflammation) with analgesic Broad spectrum antibiotics, efficient pregnancy, acetyl salicylic acid may action (pain relief) and antithermic against Gram-negative, Gram-positive cause hemorrhage post labor and action posterior

maternal

and

(reduces

fever)

http:// and rickettsia. Wikipedia in Jul 2012.

fetal bulario.bvs.br in Jul 2012.

complications; ibuprofen may delay Codeine labor, as well as naproxen. It is Analgesic

with

acetaminophen

association

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

Doxycycline

to

- antibiotic

-

that

a

broad belongs

spectrum to

the

relieve tetracycline group. It has a high 6


O

degree

R

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A

L

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H

of

liposolubility spontaneous

I

N

P

abortion

R

E

G

N

A

N

C

and Considering

Y

cosmic

irradiation

and low calcium binding. retardation of the female fertility (which we are naturally subjected to www.gross.com.br in Jul 2012. Erythromycin Bacteriostatic.

(Anxiolytics and Benzodiazepines- during a normal day), the irradiation

estolate Against

- Drugs with the property of acting on of a radiograph is 5 times less.

spirochetes anxiety and stress. Also used to treat Mandatory biosafety measures must

(treponema and leptospira), rickettsia, insomnia, being also called hypnotic be taken into account, such as campylobacter, mycoplasma, ureaplasma drugs, that is, drugs that induce wearing a lead apron in the patient, (urethritis),

legionella,

chlamydia, sleep. www.unifesp.br in Jul 2012.

covering the thyroid, adequate room

gardnerella, actinomycetes and cholera. Nitrous oxide -- Given together with and the necessary amount of X-rays Moderate action against anaerobes but Oxygen,

it

has

analgesic

and to

provide

an

efficient

dental

Bacteroides fragilis is resistant. Gram- sedative effect. In general anesthesia, treatment. negative from the enterobacteria and the addition of nitrous oxide to If there is need of a minor oral pseudomona group are resistant to oxygen allows a reduction in the surgery (for example, extraction of a erithromycin. It has been observed the most expensive anesthetic agent, third resistance

of

S.

aureus

and

molar),

two

periapical

S. obtaining the same effect. Wikipedia radiographs and one occlusal can be

epidermidis and streptococcus (viridans in Jul 2012).

taken.

and

Endodontic treatment demands an

pneumoniae)

to

erythromycin.

www.tudoresidenciamedica.hpg.ig.com.b Endodontic Treatment

initial X-ray to see anatomy and the

r in Jul 2012.

installed pathology, one to confirm

Gentamicin - Antibiotics given by parenteral line, active against grampositive and gram-negative bacteria. www.kinghost.com.br in Jul 2012. Ototoxic - Toxicity to the auditory system. Tetracycline-based drugs - Antibiotics

!

Pregnancy does not exclude

root

canal

treatment:

needed, one should intervene to avoid

infection

taken

as

to

and

affects

anesthetics

radiographic examinations.

Radiographic infections. It is efficient against many (X-rays) gram-negative

that

the

mother and the baby. Care should be

used in the treatment of bacterial

species,

whenever

and

the working length and one final with the filling material that is important to posterior control of the therapy success. These 3 X-rays are the minimum for a good endodontic treatment.

The

prenatal

doctor

should know about the necessary Xrays and that proper care will be

Examinations taken as to biosafety.

gram-

X-rays are detrimental to some ! e. Oral Problems in pregnancy health if used indiscriminately in protozoans. Wikipedia in Nov 2012). Caries ! Anxiolytics a n d excessive irradiation amounts. In the ! The highest incidence in this benzodiazepines under prolonged morning, when you stay in the sun period (99.38% of pregnant women intake may be associated to palatal at a Brazilian beach you are much Paula e Silva et al. 2006) is related to clefts. Nitrous oxide used in more exposed to noxious irradiation the intake of cariogenic food conscious sedation may be related to than taking an X-ray. positive

and

even

against

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

7


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The highest incidence in bleeding

T

H

and

I

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gingival

P

R

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G

N

A

N

C

Y

tissue calculus). It is a non-neoplastic

this period (99.38% of tumefaction. The first and most proliferative lesion that is more pregnant women - Paula e Silva et al. effective treatment to this problem is commonly located in the gingiva at 2006) is related to the intake of brushing associated to the use of the anterior region of the maxilla. cariogenic

food

frequently dental floss, as the stimulus is the Clinically it is a slow growth nodular

(carbohydrates in sweetened juices increase in the amount of bacterial mass, reddish, soft to palpation and and soft drinks and sweets) and also plaque. the

decreased

secretion

and !

prone to spontaneous hemorrhage.

A more severe scenario of Treatment

consists

of

surgical

alteration in the saliva composition gingivitis that usually occurs from removal and elimination of any local that characterizes the gestational the 3rd. month on is the so called factor that may irritate and cause period

(reduction

in

the

buffer pyogenic granuloma that looks like relapse of the lesion, although it is

capacity - Paula e Silva et al. 2006). mulberry Caries

is

prevented

if

for

the

granular reported

that

it

may

recede

you appearance and the dark red color spontaneously after the baby is born.

recommend no sugar in milk or (depending on the hormonal conditions Surgical removal is indicated only in juices or by replacing the sugar for of the pregnant woman, it is an the first months of pregnancy and if artificial sweeteners when necessary. inflammatory response to the bacterial it impairs correct feeding, affects The installed caries should be treated plaque; usually it shows up after the esthetics or teeth maintenance in the as soon as possible following the third month pregnancy as a flat mass oral cavity, but it may relapse if done criteria addressed here (anesthetics – protruding from the interproximal space before

delivery.

radiographs) so that the problem or gingival margin. It is dark red, a recommended

Removal

is

labor

(if

post

may not progress and root canal has bright and smooth surface with many possible) if there is no risk of losing to be done.

clear

red

dots.

It

represents

an teeth.

angiogranuloma, a central mass of ! Gingival inflammation – gingivitis !

Any

untreated

gingival

connective tissue with many neoformed disease may be related to low weight

Brushing and the use of capillaries, with edema and chronic at

birth

demanding

a

guided

dental floss (link to the respective inflammatory infiltrate; it is a superficial treatment and detailed evaluation of texts) should be performed carefully lesion that does not invade subjacent oral hygiene in the patients (Paula e during all the gestational period and bone and generally produces no pain. Silva et al. 2006). during the whole life of the patient. www.odontologia.com.br in Jul 2012). Eating

cariogenic

food

more !

!

Dental caries is a disease that

Paula e Silva et al. (2006) affects deciduous and permanent

frequently increases the potential to observed that this pathology attacks teeth. It is characterized by the attack develop caries (link to the respective 1 to 5% of pregnant women and of

acidogenic

bacteria

that

text) and periodontal disease (link to occurs due to the angiogenesis demineralize the enamel and dentin the respective text). If this is added increased by the plasmatic levels of surfaces causing hard tissue loss and to hormonal alterations, it is possible elevated estrogens associated to local inflammation followed by pulpal to see an unpleasant gingivitis with irritation (trauma, biofilm and dental death (fig. 5). Restorative treatment UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

8


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in the beginning of the disease may hold its !

P

R

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G

N

A

N

C

Y

These bacteria proliferate, attach to the dental

progression; that is why one should see the surface and get their nutrients (substrates) from the food dentist each 6 months.

remnants stuck to the teeth’s surface. !

The installation of dental biofilm in individuals

with poor oral hygiene causes inflammation in the supporting tissues of teeth, characterized by swelling, redness and bleeding in this initial phase (gingivitis – fig. 6).

a

b Figura 6 - Gingivitis

!

If the problem is not immediately treated this

condition evolves to severe inflammation (periodontal disease or periodontitis) and can turn into tooth loss due to the absence of bone attachment (inflammation of all supporting tissues – figs. 7 and 8).

c Figure 5 – evolution of the carious disease 5a – caries in enamel only; 5b – caries in progression to the dentin; 5c – caries reaching and causing the death of pulp tissue with periapical consequences

Figure 7 – calculus formation by calcification of the bacterial

!

plaque or biofilm

A poor oral hygiene may lead to bacterial biofilm

accumulation in the surface of teeth. Dental biofilm is characterized by a bacterial population that interacts to produce tooth enamel decalcification and/or may calcify and produce dental calculus around teeth (Biofilm is a microbial consortium included in the ECP mass (extracellular

polysaccharides)

resulting

from

binding,

multiplication and development of microorganisms on solid surfaces

substrate

in

water

environment. Figure 8 – advanced periodontitis characterized by loss of bone attachment

www.farmaconline.ufg.br in Jul 2012). ! caused UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

Mentioned by some authors, dental erosion by

episodes

of

vomiting

and

the

oral 9


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D

E

B

U

C

A

L

N

A

G

environment acidification usually is seen in Moore PA

E

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T

A

Ç

Ã

O

Selecting drugs for the pregnant dental

the palatal aspects of the upper teeth. The patient. JADA, 129, p.1281- 1286, Sept 1998. patient must learn how to use dentifrices and oral mouth rinses with fluoride so that enamel can Paula

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(2):19-23, ago 2006.

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Credits Updating of the Notebook on Oral Health Basic Care – 2008: Glossary: Mary Caroline Skelton-Macedo - FOUSP CD Marco Kulik - FOUSP

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Medcenter.com Tratamento periodontal não aumenta risco de parto prematuro. Folha Online http:// w w w. o d o n t o l o g i a . c o m . b r / n o t i c i a s . a s p ? id=1166&idesp=15&ler=s Acesso em setembro de 2007.

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

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03 Oral Health of Pregnant Women  

Updating of Primary Health Care Notebook in Oral Health, Ministry of Health/OPAS and University of Sao Paulo, Brazil, 2012.

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