Good oral health vital during pregnancy and early childhood

by Dr. Prasanna Jayasekara

Pregnancy is an important period in a woman’s life where many physical and physiological changes take place, which have significant impact on almost every organ system of the body, including the oral cavity. Hormonal and immunogenic changes inside the body, changing dietary habits, increased vomiting and acid reflux tendency are some changes occurred during pregnancy those can have impacts on oral health of pregnant women.

Dental caries, gingivitis, dental pain, loose teeth, tooth erosion and gingival epulis or pregnancy tumour are common oral health problems during pregnancy.

The already existing oral health problems can be aggravated during pregnancy. Complications from these diseases would create unwanted problems.

Therefore, it is very important for pregnant women to maintain good oral health.

Studies have found that bacteria responsible for causing dental caries can be transmitted from the mother to the newborn.

Hence, it is very important for the mother to keep her oral health at maximum level to reduce the transmission of these cariogenic bacteria.

There is growing evidence that the periodontal disease of pregnant women may be associated with adverse pregnancy outcomes like low birth weight and preterm birth.

Why do pregnant women have a higher risk for oral diseases? Pregnant women are having a risk of developing swollen and bleeding gumsdue to hormonal changes in the body.

Pregnancy gingivitis

Due to nausea and vomiting and due to frequent consumption of sweet and sour food, an acidic environment is created inside the mouth.

It will dissolve the tooth enamel causing tooth erosion. It will also increase the risk of developing dental caries.

Oral health condition will also be affected by the brushing difficulties especially in the mornings.

When plaque isn't removed, it can cause gingivitis - red, swollen, tender gums that are more likely to bleed. So-called “pregnancy gingivitis” affects 60 - 70 percent of pregnant women to some degree and generally begins to surface as early as the second month of pregnancy. Existing gingivitis can worsen during pregnancy. Untreated gingivitis can lead to periodontitis, a more serious form of gum disease that includes bone loss. Proper tooth brushing and cleaning by the dental surgeon will help control plaque and prevent gingivitis.

Gingival epulis

Pregnant women are at risk for developing gingival epulis / pregnancy tumours - inflammatory, non-cancerous growths that develop between the teeth or when swollen gums become irritated. These localised growths or swellings are believed to be related to excess plaque. Normally, the tumours are left alone and will usually shrink on their own after the baby's birth; however, if a tumour is uncomfortable and interferes with chewing, brushing, or other oral hygiene procedures, the dental surgeon may decide to remove it.

How can the risk for oral health problems be reduced?

Eating healthy foods

It is necessary to eat a variety of healthy foods such as fruits; vegetables; whole-grain products like cereals; and dairy products such as milk, cheese, or unsweetened yoghurt. Meats, fish, chicken, eggs, beans, and nuts are also good choices.

Limiting intake of foods high in sugar such as candy, cookies, cake, and dried fruit, and acidic foods is important.

Drinking fewer beverages high in sugar like juice, fruit-flavoured drinks, or soda is also advisable.

It is desirable to choose foods low in sugar, such as fruits, vegetables, cheese, and unsweetened yoghurt as snacks.

If a pregnant woman is having problems with nausea, she may eat small amounts of healthy foods throughout the day.

Drinking water or milk is preferred over soft drinks, juice or fruit flavoured drinks.

Practice good oral hygiene at home

It is recommended to brush teeth with fluoridated toothpaste twice a day using a toothbrush having soft bristles.

Toothbrush should be replaced every 3 or 4 months or more often if the bristles are bent / frayed. Sharing toothbrushes is advisable. Cleaning between teeth daily with floss or an inter dental cleaner is important.

Rinsing every night with a fluoridated, mouth rinse may reduce the risk for dental caries.

Rinsing the mouth with a teaspoon of baking soda in a cup of water after vomiting, will stop acid from attacking the teeth.

Obtain professional oral health care

Obtaining professional oral health care is important for the pregnant woman as well as for the baby to be born. Delaying necessary treatment for the dental problems could result in significant risk to the other and the baby.

Oral health care, including use of X-rays, pain medication, and local anaesthesia, is safe throughout pregnancy.

It is recommended to have a compulsory dental check-up during the pregnancy and pregnant mothers need to adhere to the suggested treatment and advice given by the dental surgeon. The best period to obtain dental treatment is during the second trimester of pregnancy.

After the baby is born

By informing the dental surgeon about the relevant details of the pregnancy, the pregnant mother will be able to obtain the best oral health care she needs. Mothers are advised to continue taking care of their mouths after the baby is born.

She should have a balanced diet with variety of vegetables together with fruits. Limiting sugary foods is also important to maintain good oral health. Mothers also need to continue practicing good oral hygiene.

The first milk tooth erupts around the age of 6-9 months to the baby. Usually lower anterior teeth appear first. Eruption of all 20 teeth will be completed around the age 30 months.

Rarely teeth may be present at birth. These may give rise to breastfeeding difficulties and if these teeth are shaky, there is a chance for them to get dislodged and obstruct the airway.

Brushing baby’s teeth should be started as soon as they erupt into the mouth. Finger brush can be used initially especially when the baby is having a bath. Baby brush is recommended to be used when there are four teeth erupted into the mouth.

It is recommended to use fluoridated toothpaste when the child is 12 months of age.

Initially a very small amount (smear layer) of toothpaste can be used. By the age of around three years to the child, the amount of toothpaste can be increased to a size of a green gram. It is compulsory to brush twice a day, morning and night, before bedtime. Washing mouth thoroughly after brushing is not advisable as it may remove all the fluoridate toothpaste deposited on the teeth.

Even when the child is capable of brushing alone, parental supervision is very important. Brushing with family members will encourage the child not only to brush his or her teeth but also to spit out after brushing.

It is the responsibility of the parents/caregivers to maintain good oral health of the baby. Frequent consumption of sweets, sugary foods and sticky starchy foods such as biscuits, buns and short eats will cause dental caries. It is advisable to delay the introduction of such food items to the baby to prevent dental caries. If such foods are given to the child, they should be given just after a main meal.

A sip of water should be given to the child after consuming these foods.

Bottle feeding especially with sugar added milk is not recommended when the baby is asleep. The salivary flow is less during sleep. Even after breastfeeding, if the child is having teeth, it is desirable to either give some water to drink or wipe the teeth with a soaked cotton wool.

Parents should be knowledgeable about the early stage of dental caries. This is the only stage which is reversible, if identified and treated properly. This early stage of dental caries is presented as dull and chalky-white patches on teeth especially seen closer to the gum margins. But cavities are not formed in these areas.

The parents need to seek advice from a dental surgeon as soon as they identify such patches on their children’s teeth.

Early stage

Early stage of dental caries can progress to form cavities if they are not managed properly.

Apart from carrying out proper oral health care practices at home, these children should be taken to a dental clinic for necessary fluoride treatment and fillings.

Modern dentistry does not recommend removal of milk teeth as these are needed for the proper alignment of permanent teeth.

But if the child experiences frequent infections such as pain and swelling, tooth removal may be necessary.

Maintaining proper oral health among pregnant women and the new-born will not only reduce the future burden of oral diseases but also pave way to improve their general health.

The writer is a Consultant in Preventive Dentistry, Institute of Oral Health, Maharagama.

Facial recognition technology used to spot genetic disorders

New software will be able to track changes to patients’ features using thousands of photographs

New technology could help doctors to diagnose rare genetic disorders through face-recognition software similar to that used in modern hand-held cameras.

Between 30 and 40 percent of genetic disorders - including Down’s syndrome and the rare Angelman syndrome - involve some kind of change to the face or skull.

The new software is based on studies of thousands of pictures of previously diagnosed patients, and is able to “learn” what facial features to look for and which to ignore when suggesting a diagnosis.

It will also be able to group together patients with unknown disorders who have similar facial features and skull structures - potentially enabling doctors to identify new disorders, and the DNA variations that cause them. The software has been developed at Oxford University, in a successful collaboration between medical researchers and the university’s Department of Engineering Science.

Using the latest in computer vision technology, the software will “learn” from a growing bank of patient photographs from public and clinical databases. So far, the database extends to nearly 3,000 patients.

While genetic disorders are each individually rare, collectively conditions which may involve some change to face or skull affect one person in 17.

The researchers even used an image of Abraham Lincoln, who is thought to have had a rare condition called Marfan syndrome, characterised by long limbs and fingers, as an example of how the machine could help diagnose the syndrome.

Out of 90 possible disorders, Marfan syndrome emerged as among the 10 most likely when Lincoln’s picture was analysed.

The new technology is not intended to replace traditional diagnosis, but to assist it, and in some cases improve diagnosis where in parts of the world local clinicians may lack the required expertise.

Dr Christoffer Nellaker, of the Medical Research Foundation’s Functional Genomics Unit at Oxford, said that diagnosis of a rare genetic disorder was an important step forward for doctors and patients.

“A doctor should in future, anywhere in the world, be able to take a smartphone picture of a patient and run the computer analysis to quickly find out which genetic disorder the person might have,” he said.

“This objective approach could help narrow the possible diagnoses, make comparisons easier and allow doctors to come to a conclusion with more certainty.”

The technology was developed in close collaboration with Prof Andrew Zisserman, of Oxford’s Department of Engineering Science. Like Google, Picasa and other photo software, it recognises variations in lighting, image quality, background, pose, facial expression and identity.

It builds a description of the face structure by identifying corners of eyes, nose, mouth and other features, and compares this against what it has learnt from other photographs fed into the system.

The Independent

A medical first: Quadriplegic man controls arm using chip implanted in brain

The first of its kind procedure used electronics to bypass the patient's spinal injuries and relay signals directly from the brain to the muscles.

A 23-year-old quadriplegic from the US has become the first paralysed man ever to move his hand and fingers using just his own thoughts.

Ian Burkhart, from Dublin, Ohio, was paralysed four years ago during a driving accident and is now the first patient to use Neurobridge - an electronic neural system that bypasses spinal cord injuries to transmit instructions directly from the brain to the muscles.

“It's much like a heart bypass, but instead of bypassing blood, we're actually bypassing electrical signals,” said research leader Chad Bouton.

“We're taking those signals from the brain, going around the injury, and actually going directly to the muscles.” The technology allows for voluntary and functional control of paralysed limbs, using a microchip smaller than a pea implanted in in the region of Burkhart’s brain responsible for arm movements to pick up signals from his brain.

The chip interprets these signals using algorithms that learn to match brain activity to muscle instructions and then sends them to an electrode stimulation sleeve on Burkhart’s arm. This sleeve then directly stimulates the proper muscle movements in a tenth of a second.

Other research in this area has successfully used microchips implanted in the brain to control robotic limbs or used computers to control paralysed limbs - but this is the first to use a patient’s mind. Dr. Ali Rezai, a neuroscience researcher from Ohio State who implanted the chip in Burkhart’s brain, said that in the future the technology could be used to help patients overcome brain and spinal cord injuries such as strokes.

Burkhart said that he participated in the six-month trial at Ohio State’s Wexner Medical Center partly as a chance to help other paralytics: “I've realised, ‘You know what? This is the way it is.

You're going to have to make the best out of it.’ You can sit and complain about it, but that's not going to help you at all. So, you might as well work hard, do what you can and keep going on with life.”

- The Independent