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Pregnant and managing acute Tooth Infections

 

Ladies looking to fall pregnant should take time off to see their local dentist in order to minimise acute dental infections from occurring once they become pregnant.

Good oral hygiene before and during pregnancy in good practice to prevent tooth cavities. Regular brushing, minimising glucose intake and a good balanced diet are important in preserving healthy teeth and help prevent dental related complaints and worsening tooth infections.

 

Tooth infections occur when bacteria enters the tooth pulp (nerve part) through tooth cavities. Holes within the enamel lead to the influx of contaminants into the pulp area.

Severe infections can occur when these infections disseminate beyond the local tooth to other areas. An abscess can develop that may involve nearby bone and soft tissues, which we call cellulites. The inflammation can affect the airway directly and cause local swelling which can present breathing problems and death in severe cases.

 

Dental symptoms present as:

* Tooth and gum pain with or without biting and teeth and gums may be sore to touch.
* Swelling within the mouth and the outside jaw areas (dangerous).
* Limited mouth opening (dangerous).
* Loose teeth.
* Pus drainage.
* Limited swallowing (dangerous).
* Cellulites and inflammation of soft tissue infection (dangerous).
* Airway swelling with breathing abnormalities and voice (very dangerous).
* Septic shock where organs begin to shut down (very dangerous).

 

It is essential that pregnant ladies recognise potential tooth problems early on in order to prevent the infection from disseminating and causing life threatening situations from developing. Dangerous symptoms should be treated with the upmost seriousness and urgent medical care should be sort at all times!

 

Teeth infections are commonly caused by a streptococci bacteria though some strains are less commonly Anaerobic streptococci, Prevotella and Fusobacteria.

 

It is important to note that early dental intervention is essential as it minimises the need to use antibiotics all together, though they may be needed if the infection begins to spread away from the local tooth area.

 

You will need to be guided by your Clinician regarding what antibiotics are safe for you during your pregnancy. Amoxicillin or Erythromycin if you suffer from a Penicillin allergy.

Metronidazole may be necessary only if the bacteria show resistance to a basic penicillin antibiotic, but is has shown in animal studies failed to reveal evidence of fetal harm though there is remoter evidence of cleft lip in 1st trimester dosing, but please get advice from your clinician regarding this matter.

If bacteria show signs of resistance i.e. may have what we call beta lactamase positive, then the likes of Amoxicillin and Clavulanic Acid (Co-Amoxiclav or Augmentum) may be indicated to treat the tooth infection.

 

Clindamycin may be indicated in treating cellulites or systemic septicaemia, but your clinician will need look at the overall picture and make the best decisions for you and your baby. Gentamycin has shown to be dangerous while taking while pregnant or breast-feeding.

 

Antibiotics may be limited capacity in treating pulp pain caused by tooth infections; this is where dental treatment may be more effective in achieving pain relief.

If you can avoid them all together, this would be the best result for you.

 

Clinical diagnosis may be important in order to reduce Dental X-rays exposures during pregnancy.

Dentists tend to use orthopantomograms that gives them wide-angle views of your jaw & teeth. Your dentist will be able to make these clinical decisions whether you may or may not require the exposure.

Pulp infections of the teeth tend to cause a pressure build up within this section of the tooth that tends to result in pain; the dentist may use hot and cold stimulation techniques in order to diagnose these types of pulp infections.

Ultrasound and Magnetic Resonance (MRI) may be helpful in showing whether infections have disseminated beyond the local tooth area and affected the gums, bones and other soft tissue areas.

Routine blood full blood count and U&E tests (specifically CRP) will help in determining if infections have disseminated and become systemic.

 

These tests can be expensive if you do not have a medical aid scheme in place that would cover these expenses.

 

Surgical intervention may be indicated together with antibiotic treatment and could consist of subsequent dental incision and drainage that may prove beneficial in minimising the local tooth infection.

Treating tooth abscesses with incision and drainage, root intervention and or extraction can be effective and may minimize unnecessary courses of antibiotics if these interventions are applied early on within the disease process.

Some previous randomised trials have shown that acute dental infections respond well to surgical dental treatment without the use of antibiotics. Therefore when travelling early diagnosis and treatment is essential!

 

Drug and surgical treatment may be needed, but often patients may have expectations that a simple course of antibiotics may be all that are required, which may be premature. Tooth issues should be investigated further so a mere course of antibiotics is usually just a tempory measure.

With cases where patients develop serious signs and systemic symptoms a maxillofacial surgeon’s expertise may be indicated for an opinion.

 

Regarding pain relief, non-steroidal drugs (NSAIDS) should be avoided during pregnancy. Paracetemol may also provide you with some analgesia and could be used as an alterative while being pregnant.

 

Do not delay and sit and wait for your mouth picture to worsen because it could complicate your treatment, the duration of it and endanger your life in worse case scenarios.

This is key: Good oral hygiene and regular check up’s are essential before you fall pregnant, so to prevent any cavities or tooth ailments from developing while you are pregnant, so take the initiative today.

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