妊娠与牙科:牙科手术过程中风险管理的文献综述

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

作者信息

Favero Vittorio, Bacci Christian, Volpato Andrea, Bandiera Michela, Favero Lorenzo, Zanette Gastone

机构信息

Unit of Maxillofacial Surgery and Dentistry, University of Verona, 37129 Verona, Italy.

Dental Clinic, Department of Neuroscience, University of Padua, 35129 Padua, Italy.

出版信息

Dent J (Basel). 2021 Apr 19;9(4):46. doi: 10.3390/dj9040046.

Abstract

Pregnancy is a unique moment in a woman's life, accompanied with several physiologic changes that have an impact on oral health. 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. A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators "OR" and "AND". The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. 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.

摘要

怀孕是女性生命中的一个独特时期,伴随着一些会影响口腔健康的生理变化。本研究的目的是对已发表的有关怀孕与牙科的文献进行批判性综述,包括孕期最常见的口腔疾病、它们与不良妊娠事件的关联,以及孕期可进行的安全牙科治疗。使用特定关键词和医学主题词(MeSH)进行了Medline/COCHRANE检索,并结合布尔运算符“OR”和“AND”。检索得到了2000年至2021年间发表的146篇出版物,包括指南、荟萃分析、系统评价和非系统评价。由于怀孕具有炎症和免疫身体反应增强的特点,孕期牙周状况通常会加重,牙周疾病在孕妇中也很常见。关于牙周炎与不良妊娠结局之间的关联,文献中的研究结果存在冲突。牙周治疗并未显示不良结局有显著降低。许多牙医由于缺乏信息,往往不愿为孕妇提供牙科治疗。然而,预防性和修复性牙科治疗在孕期是安全的。如有绝对必要,可在孕中期之后进行诊断性X光检查。镇痛药(如对乙酰氨基酚)和麻醉药(如利多卡因)也被认为是安全的。万一发生感染,也可开具阿莫西林、氨苄西林以及一些头孢菌素和大环内酯类等抗菌药物。器官形成发生在孕早期,在此期间胎儿易受严重畸形(致畸作用)影响。进行牙科治疗的理想时间是孕中期(第17至28周)。然而,急性疼痛或感染使得牙医的干预绝对必要,整个孕期都可进行紧急治疗。

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