Oral and maxillofacial surgery for the pregnant patient

Severe Odontogenic Infections during Pregnancy and Related Adverse Outcomes. Case Report and Systematic Literature Review

Odontogenic infections have the potential to develop into deep-space infections and may cause severe diseases with possible life-threatening complications. Dental infections during pregnancy require special attention in terms of possible complications and treatments due to the potential to affect the lives of two individuals. A case of a 36-year-old pregnant patient with a submandibular abscess caused by an odontogenic infection is reported, followed by a comprehensive systematic review of the literature in order to retrieve information regarding severe odontogenic infections and adverse pregnancy outcomes. The review was conducted according to the PRISMA guidelines using PubMed, Scopus, and Google Scholar databases. A total of 69 cases were included in the qualitative analysis. The mean age was 27.72 years. Patients were managed with surgery in combination with antibiotics. Nine infectious-related cesarean sections were detected, and preterm birth was associated in 3 cases, low birth weight in 2 cases, death of the fetus in 9 cases (13%), and maternal death in 4 cases (5.8%). The possible compromise of oral health during pregnancy is well known; however, severe odontogenic infections are rarely considered in the literature, and they may be associated with severe and life-threatening complications for both mother and the fetus.

Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures

Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.

Odontogenic cervico-facial cellulitis during pregnancy: about 3 cases

Pregnancy is considered as a risk factor for development, severity, and complications of odontogenic infections. Without adequate treatment, the infection can spread and threaten both the mother's and the foetus lives. We aim to analyze the predisposing factors, diagnostic and therapeutic aspects of cervico-facial cellulitis during pregnancy, through a descriptive retrospective study conducted at oral and maxillofacial surgery department of Mohamed VI university hospital center at Marrakesh, between June 2017 and June 2019. A total of three patients; all patients were at their last trimester were recruited. Every patient was immediately given intravenous antibiotics, drainage was carried out under local anesthesia, and the causing tooth was removed. During hospitalization, one patient was referred to the gynaecology department for preterm labor, while the remaining two patients were discharged after the pus drainage has stopped. The possible compromise of oral health during pregnancy is well known, however severe odontogenic infections are rarely considered in the literature. It is essential to aggressively treat the gravid patient to minimize the risk of infection spreading to the facial spaces. Moreover, poor oral health in pregnancy has been implicated in adverse birth outcomes, specifically prematurity. We recommend upgrading communication between obstetrician and dentists so that regular routine dental visits are planned for pregnant patients during early stages of pregnancy in order to identify and manage the problem as early as possible.

Maxillofacial trauma in a pregnant patient: Contemporary management principles with a case report & review of literature

Trauma during pregnancy deserves special attention because of its management objectives, i.e. well-being of both pregnant woman and foetus. Maxillofacial trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth opening, mastication and breathing. Hence early restitution of form and function of maxillofacial skeleton is essential. However, the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment. A careful scrutiny of the patient's systemic and gestational status is absolutely essential before, during and after instituting any interventional procedures. We present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester (32 weeks). She was treated with inter maxillary fixation using orthodontic brackets & elastics. After successful restitution of occlusion, the patient was advised aggressive physiotherapy which ensured normal mouth opening. Two weeks later, the patient delivered uneventfully. The patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion, mouth opening and lower facial height. This article aims at analyzing the contemporary principles in management of maxillofacial trauma in a pregnant woman and clarifying the common misconceptions.

Preventive hygiene protocol of University of Milan for women during pregnancy: A qualitative and quantitative bacterial plaque analysis prospective original study

Introduction

The aim of this article is to describe the preventive hygiene protocol of University of Milan for women during pregnancy analyzing the bacterial plaque quantitatively and qualitatively.

Materials and methods

A sample of 35 pregnant women following a protocol of periodic visits starting from the first month of pregnancy until the childbirth and in follow up controls were analyzed. Several samples (n = 4) of bacterial plaque for quantitative and qualitative analysis were taken, from the lingual surface of the lower first molar, during the first visit (T0), during the first trimester (T1), during the second or third trimester of pregnancy (T2), and one month after childbirth (T3).

Results

By performing a quantitative analysis, it was calculated that the average plaque index (Fig. 1) was n = 48.1% (T0), n = 14.7% (T1), n = 18.4% (T2) and n = 18.9% (T3). The plaque index score presents a downward trend, passing from 48.1% (T0) to 18.9% (T3). The number of total cocci (Fig. 2) was n = 205.39 (T0), n = 57.5(T1), n = 74.6 (T2) and n = 75.4(T3). The number of total bacilli (Fig. 3) was n = 62.7 (T0), n = 23.1 (T1), n = 25.3 (T2), n = 27.1(T3). The total values of cocci and bacilli were correlated and the average trend of the various samples was calculated. By performing a qualitative analysis, the value of G+ cocci (Fig. 5) was n = 2.7 (T0), n = 1.4 (T1), n = 1.4 (T2) and n = 1.5 (T3). The value of G− cocci (Fig. 5) was n = 2.3 (T0), n = 0.7 (T1), n = 1.1 (T2) and n = 1.1 (T3). The value of G+ bacilli (Fig. 6) was n = 1.6 (T0), n = 0.9 (T1), n = 1.2 (T2) and n = 1.2 (T3). The value of G− bacilli (Fig. 6) was n = 1.3 (T0), n = 0.3 (T1), n = 0.7 (T2) and n = 0.7 (T3).

Conclusions

The preventive hygiene protocol used in the Dental Hygiene Department of the University of Milan, during the gestation period, is a suitable method for the control of the bacterial plaque. A considerably decrease of the plaque index and bacterial components between the first visit and the subsequent check-ups was calculated.

Severe odontogenic infection in pregnancy: a timely reminder

Dental practitioners often treat patients that are pregnant. Understanding the altered physiology in the pregnant patient, especially changes in immune function, is vital in effective management of orofacial infections. We present a case of rapidly spreading odontogenic infection in a pregnant patient requiring surgical management. We also discuss the physiological changes of pregnancy relevant to dentistry, and the principles of managing such infections in the gravid patient.

Dental considerations in pregnancy-a critical review on the oral care

Pregnancy is a dynamic physiological state which is evidenced by several transient changes. These can develop as various physical signs and symptoms that can affect the patients health, perceptions and interactions with others in the environment. The patients may not always understand the relevance of the adaptations of their bodies to the health of their foetuses. A gestational woman requires various levels of support throughout this time, such as medical monitoring or intervention, preventive care and physical and emotional assistance. The dental management of pregnant patients requires special attention. Dentists, for example, may delay certain elective procedures so that they coincide with the periods of pregnancy which are devoted to maturation versus organogenesis. At other times, the dental care professionals need to alter their normal pharmacological armamentarium to address the patients' needs versus the foetal demands. Applying the basics of preventive dentistry at the primary level will broaden the scope of the prenatal care. Dentists should encourage all the patients of the childbearing ages to seek oral health counseling and examinations as soon as they learn that they are pregnant. This article has reviewed some of the physiologic changes and the oral pathologies which are associated with pregnancy, and how these alterations can affect the dental care of the patient.

Management of severe odontogenic infections in pregnancy

BACKGROUND

The objective of this study was to review the management of patients presenting with severe odontogenic infections and who are also pregnant.

METHODS

A retrospective clinical audit was conducted of all female patients admitted to the Royal Adelaide Hospital by the Oral and Maxillofacial Surgery Unit from 1999 to 2009 with severe odontogenic infections. Pregnant patients were identified and their age, medical history, previous obstetric and gynaecological history, stage of current pregnancy, presenting infection, diagnosis and management were recorded, as well as the outcome of the pregnancy.

RESULTS

A total of 346 female patients were admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with an admission diagnosis of severe odontogenic infection and five were pregnant. Besides surgical and anaesthetic assessment, mother and foetus were assessed by the Obstetric and Gynaecology Unit. In all, five with severe infection were successfully resolved and four proceeded to a normal delivery with a healthy child. The remaining patient had an already planned therapeutic abortion.

CONCLUSIONS

Pregnant patients with severe odontogenic infections require urgent referral to a tertiary hospital with full surgical, anaesthetic and obstetric services. This allows appropriate management of the complex requirements of mother and foetus.