U P D A T I N G O F T H E B A S I C O R A L C A R E N O T E B O O K 2 0 1 2F O U S P - M I N I S T R Y O F H E A L T H , B R A Z I L

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health 1

Oral Health in the Gestational Period

1. PREVENTIVE ASPECTS

a. Nutrition

! 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.).

! 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

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

The oral health of women during pregnancy can and should be accompanied with proper treatment and safety for mother and baby.

1. Preventive Aspectsa. Nutritionb. Oral Hygiene

Page 1

2. Healing Aspects (Treatment of Oral Problems)a. Physiological

Alterations in the Period

b. Better Moment for Dental Treatment

Page 2

6. References and Credits

Page 4

Chapters Updating and Illustrating

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

your baby

2. Healing Aspects (Treatment of Oral Problems)c. Local Anesthetics

and Pregnancyd. Medicatione. Interactions in the Gestational Period

Page 2

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

Pregnancy

Page 2

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UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health 2

tests. Seven to ten days after conception, the hCG

concentration reaches 25 mUI/mL and increases to a peak of 37.000-50.000 mUI/mL between eight and eleven weeks. It is the only hormone 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

During this period there is an increase in blood supply on the mucosa that should not be mistaken for gingival edema.

Oral hygiene must be complete including the use of dental floss besides brushing after every meal plus morning and evening hygiene. It is interesting to remember that the quality of oral hygiene characterizes the cases prone to periodontal disease.

If the pregnant woman cannot stand the use of dentifrice that may cause nausea, she can clean only with the toothbrush, dental floss and mouth rinse.

! 30cm to 50cm (half a meter) of floss should be removed from package (raffia thread can be used: the same material used in Hawaiian Carnival skirts. Reel off the raffia strip forming thin threads and use as described below).

! The floss should be caught on the middle fingers of both hands leaving index fingers and thumbs free to move the floss between teeth (fig. 1).

Illustrations – obtained Sept 2012 in: www.pgr.mpf.gov.br/pgr/saude/odonto/escovando.htm

Figure 1 – holding the dental floss

After this, thumbs and index fingers help to introduce the dental floss between teeth (in the embrasures) taking it below the gingival limit (fig. 2) and rubbing the lateral parts (proximal aspects) of each tooth to be cleaned.

Figure 2 – how to use the dental floss

It is important to follow a

sequence so that no teeth is missed

in this procedure; example: start by

the central incisor and go to the right

up to the last molar, go back to the

central incisor and follow to the left

up to the last molar. The same

procedure should be done in the

lower teeth.

! At each cleaned embrasure

the floss should be rolled up on the

middle fingers to release and use

clean parts of the floss in a new

cleaning.

! For brushing it is necessary to

use a soft bristle toothbrush (hard

bristles may cause gingival bruises

and do not penetrate the spaces to be

efficiently cleaned) with a small head

(to brush tooth by tooth efficiently)

and round handle to prevent

accidents.

! The dentifrice can be

eliminated if it means a high cost to

the patients, according to their

financial possibilities; if possible,

instruct them to choose a fluoride

dentifrice and apply a small part on

the toothbrush before introducing it

into the oral cavity.

! Populations that cannot buy

individual toothbrushes and

members of one family that share the

same toothbrush should be

instructed to clean it with common

bleaching products to be reused by

other members of the family.

It is necessary to establish a

procedure to use the toothbrush:

start by right upper molars and go

up to the left upper molars. Adopt

the same criteria to the lower teeth.

The bristles must be positioned at

45º with the palatal or lingual and

buccal aspects to be brushed turned

to the gingival groove. They should

vibrate in short movements from

distal to mesial as massaging the

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gingiva (fig. 3).

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

parallel to the long axis of the tooth,

vibrating from distal to mesial (fig.

4).

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

cleaned and this procedure can be

performed by brushing the upper

aspect with the toothbrush.

2. Healing Aspects – Treatment of oral problems

a. Phisiological alterations in the period

! During pregnancy there is an

increase of 10 heartbeats/minute in

the cardiac rate from the 14th. up to

the 30th. week. The arterial blood

pressure is stable up to the 30th.

week when the diastolic arterial

pressure (low) may slightly decrease

and the systolic (high) may slightly

increase (Arterial pressure is the

pressure exerted by the blood against the

internal surface of the arteries. The

original force comes from the heartbeat.

The arterial pressure varies at each

moment following a cyclic pattern. The

various cycles overlap but the most

visible is the one determined by cardiac

beats. Cardiac cycle is the group of

situations from one cardiac beat up to

the next beat. Wikipedia in Jul 2012.

! Immediately before the next

heartbeat, the energy is very little and

the least force is exerted on the arteries

in the whole cycle, generating the lowest

arterial pressure of the cardiac cycle.

This phase is called diastole and the

pressure in this moment is called

diastolic arterial pressure. Wikipedia in

Jul 2012.

!

! The moment the heart ejects its

content in the aorta, the energy is the

greatest, generating maximum force

and, as a consequence, maximum

pressure. This phase in the cardiac cycle

is called systole and the pressure in this

moment is called systolic arterial

pressure).

!

! Hypertension in pregnancy

occurs when the systolic arterial

pressure is higher than 140mmHg

and the diastolic higher than

90mmHg in two measurements at

rest with an interval of 4h or when

there is an increase greater than

30mmHg in the diastolic compared

to the normal values previous to

pregnancy (Silva et al. 2006).

The vital respiratory capacity is

increased leading to a larger oxygen

consumption and increase in

respiratory rate.

!

! The alteration in the

metabolism of carbohydrates

demands changes in eating habits

and more meals are recommended,

putting at risk the dental health if

eating is not followed by quality

hygiene. Read the text about Oral

Hygiene (link in the text) (Barbosa

CP, 2003).

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b.The best moment for dental treatment

! The best moment for dental

treatment is between the 4th. and

6th. month of pregnancy, avoiding

the periods that are considered

critical by the physicians.

Schedule and duration of appointments and anesthetic dosage used during the dental procedure

! Appointments should be

short, preferably in the second half

of the morning when sickness is less

common. Appointments should also

be scheduled in different hours from

those of the children who visit the

clinic, preventing possible viral

infections common in childhood

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

2003 - Rubella is a disease caused by the

rubella virus that is transmitted by the

airways. Usually it is a benign disease

but it may cause malformations in the

embryo in pregnant women. Wikipedia

in Jul 2012.

! Measles is a disease caused by

the measles virus and transmitted by the

airways. Generally there is resolution

without problems, but this disease is still

one of the most frequent causes of death

in children in many regions, mainly in

countries where mass vaccination is not

satisfactory. Wikipedia in Nov 2012).

Appointments should not be

scheduled when the dentist or

assistant have flu or cold.

The maximum amount of anesthetic

should not exceed two cartridges of

a 2% lidocaine solution per

appointment, avoiding the risk of

adverse reactions and toxicity to the

mother and fetus (Lidocaine or

Xylocaine® is a class I antiarrhythmic

drug (subgroup 1B) and the local

anesthetic that is used in the treatment

of cardiac arrhythmia and local pain (as

in surgeries). Low toxicity. Wikipedia in

Nov 2012).

Can the baby be affected by the mother’s lack of oral care?

! Yes! Not only is the mother’s

health in danger but also the baby’s.

Oral infection in the tooth, tongue,

gingiva and/or mucosa must be

treated as soon as possible. These

may lead to several health problems

in the baby including preterm labor.

c. Local Anesthetics and Pregnancy

A n e s t h e t i c s w i t h o u t vasoconstrictors

! It is not recommended the

use of anesthetics without

vasoconstrictors for their duration is

brief (from 15 to 30 minutes

depending on the patient’s

metabolism) and new applications

may stress the patient and increase

the toxic potential in the body (An

agent (generally a substance) that

narrows the blood vessel lumen

reducing absorption capacity. Digital

Dictionary of Medical Terms in

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

! If the woman has instructions

from the physician who follows her

neonatal about the use of anesthetics

without vasoconstrictors or

anesthetic agents, get in contact with

the doctor to explain the nature of

the oral intervention and the amount

of anesthetics to be applied in each

treatment. The amount of

vasoconstrictor is minimal and if

stress is controlled during treatment,

no discomforts will occur to the

patient and the baby.

If the doctor insists on the use of

anesthetics without vasoconstrictors,

ask a written recommendation and

follow it.

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

! The preferred local anesthetic

for pregnant women is 2% lidocaine

with vasoconstrictor (which is

noradrenaline – a substance present

in the body that is noxious only in

high concentrations, that is, applying

many anesthetic cartridges)

Vasoactive drug that increases

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cardiac contraction and

c a rd i a c s t i m u l u s

conduction. Digital Dictionary of

M e d i c a l T e r m s i n

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

! The amount to be applied

should be controlled as to the

anesthetic (according to the

literature, up 2 cartridges per

session).

Anesthetics in the fetus bloodstream

! Local anesthetics are highly

soluble in lipids and they cross the

placenta reaching the fetus (Lipids are

biomolecules non soluble in water and

soluble in organic solvents, such as

alcohol, benzene, ether and chloroform.

Lipids have a biological importance on

several levels, acting as energy reserve

with structural, protective, vitamin and

hormonal functions. They are part of the

cell membrane formation and can also be

found inside the cells as substances of

nutrient reserve and source of energy.

Lipids may form some hormones,

vitamins and pigments. Wikipedia in Jul

2012).

The amount of circulating drug will

depend on: the ability of protein

binding; the degree of dissociation of

the drug and its metabolism rate.

Most of local anesthetics usually

employed in Dentistry have a high

ability of protein binding, low

degree of dissociation and quick

metabolism in plasma, decreasing

the fetal potential effects.

d. Medication Interaction in the gestational period (Moore PA, 1998)

! The literature reports some

negative interactions in the

gestational period that may cause

possible problems related to the fetal

formation (teratogenic action - also

called Teratogenicity, is the ability some

drugs have in producing congenital

malformations mainly when given in the

period of organogenesis (between the

2nd. and 10th. week of gestation).

www.derma.epm.br in Jul 2012) and

labor.

It is advisable to avoid systemic

medication, but if necessary (when

the clinical procedure is not

sufficient to control pain),

paracetamol (Analgesic antithermic

indicated to the patients allergic to acid

acetyl salicylic (AAS) and/or intolerance

to dipyrone. Digital Dictionary of

Medical Terms in www.pdamed.com.br

in Jul 2012) should be used for

analgesia (500 to 700mg) or dypirone

(500mg - Analgesic-antithermic.

Digital Dictionary of Medical Termsem

http://www.pdamed.com.br em Jul 2012)

3 times a day at each 4 hours. The

best antibiotic choice is synthetic

penicillin (less toxic - may have small

spectrum (resistance to penicillinases)

and broad spectrum. Penicillins have the

highest selective toxicity bactericidal

activity, being atoxic to human cells.

www.forp.usp.br in Jul 2012).

Metronidazole for severe infections

(Metronidazole derives from

nitroimidazole and has antiprotozoan

activity. This compound also has

antibacterial activity against anaerobic

gram negatives bacilli, against

sporulated gram positive bacilli and

against all anaerobic cocci. It is indicated

to treat giardiasis, amoebiasis,

trichomoniasis, vaginitis by Gardnerella

vaginalis and infections caused by

anaerobic bacteria as Bacteroides fragilis

and other bacteroids, Fusobacterium sp,

Clostridium sp, Eubacterium sp and

anaerobic cocci. Wikipedia in Jul 2012).

! Considering the local

anesthetic groups, peripheral and

central action analgesics, antibiotics

and anxiolytics, different and

important risk actions can be

observed as follows:

Regarding local anesthetics,

bupivacaine and mepivacaine may

cause fetal bradycardia

(Bupivacaine is an amide type local

anesthetic that provides prolonged

anesthesia, mainly in the 0.50% and

0.75% concentrations. It is advocated by

the FDA (Food and Drug

Administration) to be used as spinal and

epidural anesthesia (when there is the

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inside the cerebral-spinal-

fluid in the lumbar space)

and epidural anesthesia (when the

anesthetic is injected in the space

confined by the yellow pigment in the

posterior part, by the spinal periosteum

laterally and by dura mater in the

anterior part) and may be used in the

sacral hiatus (epidural sacral block), in

the cervical, lumbar or thoracic regions.

It can also be used as local anesthetic by

infiltration, loco-regional, dental block

and sympathetic nerve block.

Mepivacaine is a drug that blocks the

nerve conduction activity preventing the

start and propagation of nerve impulse.

It is the ability to act as local anesthetic.

Bradycardia - Decrease in cardiac rate.

In the human being the normal cardiac

rate is between 60 and 100 heartbeats

per minute. Rates below 60 are

bradycardia. Bradycardia may cause low

pressure due to the decrease in the

cardiac muscle effort. Bradycardia may

cause damages to the body due to less

blood circulation that transports less

oxygen to the cells. Wikipedia in Jul

2012 and ANVISA in

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

! Regarding peripheral action

analgesics used in the 3rd. quarter of

pregnancy, acetyl salicylic acid may

cause hemorrhage post labor and

posterior maternal and fetal

complications; ibuprofen may delay

labor, as well as naproxen. It is

known that the central action

opioids such as codeine with

acetaminophen used in the 3rd.

quarter of pregnancy may cause

multiple birth defects and neonatal

r e s p i r a t o r y d e p r e s s i o n .

Hydrocodone bitartrate with

acetaminophen, hydrocodone

bitartrate with ibuprofen and

oxycodone with acetaminophen

may produce neonatal respiratory

depression (Acetyl Salicylic Acid

analgesic, antithermic and anti-

inflammatory with antithrombotic

action. Do not use in surgical post-op.

Digital Dictionary of Medical Terms in

www.pdamed.com.br in Jul 2012.

Ibuprofen - Non-steroidal anti-

inflammatory drugs (NSAIDs)

frequently used to relieve the symptoms

in headaches (migraines), toothaches,

muscle pain (myalgia), menstruation

disorders (dysmenorrheas), fever and

post-surgery pain. It is also used to treat

inflammations, such as arthritis,

reumatoid arthritis (RA) and gout

arthritis. Digital Dictionary of Medical

Terms in http://www.pdamed.com.br in

Jul 2012.

Naproxeno - Anti-inflammatory

(reduces inflammation) with analgesic

action (pain relief) and antithermic

action (reduces fever) http://

bulario.bvs.br in Jul 2012.

Codeine with acetaminophen -

Analgesic association to relieve

moderate pain. www.msd-

brazil.com in Jul 2012.

Hydrocodone bitartrate with

acetaminophen - Analgesic

association to relieve moderate pain.

www.msd-brazil.com in Jul 2012.

Hydrocodone bitartrate with

ibuprofen - Analgesic association to

relieve moderate pain. www.msd-

brazil.com in Jul 2012.

Oxycodone with acetaminophen -

Analgesic association to relieve

moderate pain.www.msd-brazil.com

in Jul 2012.

About antibiotics, it is known that

chloramphenicol is a high risk drug

for the mother and the fetus and

may cause Gray Syndrome with fetal

death due to its highly toxic action.

Doxycycline may cause dental

discoloration and inhibition of bone

growth. Erythromycin estolate may

cause reduction or interruption of

the maternal biliary flow (hepatic

cholestasis). Gentamicin is ototoxic

to the fetus. Antibiotic therapy is not

recommended with tetracycline-

based drugs as they may cause

alterations in the osseous and dental

development (Chloramphenicol -

Broad spectrum antibiotics, efficient

against Gram-negative, Gram-positive

and rickettsia. Wikipedia in Jul 2012.

Doxycycline - a broad spectrum

antibiotic that belongs to the

tetracycline group. It has a high

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degree of liposolubility

and low calcium binding.

www.gross.com.br in Jul 2012.

Erythromycin estolate -

Bacteriostatic. Against spirochetes

(treponema and leptospira), rickettsia,

campylobacter, mycoplasma, ureaplasma

(urethritis), legionella, chlamydia,

gardnerella, actinomycetes and cholera.

Moderate action against anaerobes but

Bacteroides fragilis is resistant. Gram-

negative from the enterobacteria and

pseudomona group are resistant to

erithromycin. It has been observed the

resistance of S. aureus and S.

epidermidis and streptococcus (viridans

and pneumoniae) to erythromycin.

www.tudoresidenciamedica.hpg.ig.com.b

r in Jul 2012.

Gentamicin - Antibiotics given by

parenteral line, active against gram-

positive and gram-negative bacteria.

www.kinghost.com.br in Jul 2012.

Ototoxic - Toxicity to the auditory

system.

Tetracycline-based drugs - Antibiotics

used in the treatment of bacterial

infections. It is efficient against many

species, gram-negative and gram-

positive and even against some

protozoans. Wikipedia in Nov 2012).

! A n x i o l y t i c s a n d

benzodiazepines under prolonged

intake may be associated to palatal

clefts. Nitrous oxide used in

conscious sedation may be related to

spontaneous abortion and

retardation of the female fertility

(Anxiolytics and Benzodiazepines-

Drugs with the property of acting on

anxiety and stress. Also used to treat

insomnia, being also called hypnotic

drugs, that is, drugs that induce

sleep. www.unifesp.br in Jul 2012.

Nitrous oxide -- Given together with

Oxygen, it has analgesic and

sedative effect. In general anesthesia,

the addition of nitrous oxide to

oxygen allows a reduction in the

most expensive anesthetic agent,

obtaining the same effect. Wikipedia

in Jul 2012).

Endodontic Treatment

! Pregnancy does not exclude

root canal treatment: whenever

needed, one should intervene to

avoid infection that affects the

mother and the baby. Care should be

taken as to anesthetics and

radiographic examinations.

Radiographic Examinations (X-rays)

! X-rays are detrimental to

health if used indiscriminately in

excessive irradiation amounts. In the

morning, when you stay in the sun

at a Brazilian beach you are much

more exposed to noxious irradiation

than taking an X-ray.

Considering cosmic irradiation

(which we are naturally subjected to

during a normal day), the irradiation

of a radiograph is 5 times less.

Mandatory biosafety measures must

be taken into account, such as

wearing a lead apron in the patient,

covering the thyroid, adequate room

and the necessary amount of X-rays

to provide an efficient dental

treatment.

If there is need of a minor oral

surgery (for example, extraction of a

third molar), two periapical

radiographs and one occlusal can be

taken.

Endodontic treatment demands an

initial X-ray to see anatomy and the

installed pathology, one to confirm

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 X-

rays and that proper care will be

taken as to biosafety.

e. Oral Problems in pregnancy

Caries

! The highest incidence in this

period (99.38% of pregnant women -

Paula e Silva et al. 2006) is related to

the intake of cariogenic food

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The highest incidence in

this period (99.38% of

pregnant women - Paula e Silva et al.

2006) is related to the intake of

cariogenic food frequently

(carbohydrates in sweetened juices

and soft drinks and sweets) and also

the decreased secretion and

alteration in the saliva composition

that characterizes the gestational

period (reduction in the buffer

capacity - Paula e Silva et al. 2006).

Caries is prevented if you

recommend no sugar in milk or

juices or by replacing the sugar for

artificial sweeteners when necessary.

The installed caries should be treated

as soon as possible following the

criteria addressed here (anesthetics –

radiographs) so that the problem

may not progress and root canal has

to be done.

Gingival inflammation – gingivitis

! Brushing and the use of

dental floss (link to the respective

texts) should be performed carefully

during all the gestational period and

during the whole life of the patient.

Eating cariogenic food more

frequently increases the potential to

develop caries (link to the respective

text) and periodontal disease (link to

the respective text). If this is added

to hormonal alterations, it is possible

to see an unpleasant gingivitis with

bleeding and gingival tissue

tumefaction. The first and most

effective treatment to this problem is

brushing associated to the use of

dental floss, as the stimulus is the

increase in the amount of bacterial

plaque.

! A more severe scenario of

gingivitis that usually occurs from

the 3rd. month on is the so called

pyogenic granuloma that looks like

mulberry for the granular

appearance and the dark red color

(depending on the hormonal conditions

of the pregnant woman, it is an

inflammatory response to the bacterial

plaque; usually it shows up after the

third month pregnancy as a flat mass

protruding from the interproximal space

or gingival margin. It is dark red, a

bright and smooth surface with many

clear red dots. It represents an

angiogranuloma, a central mass of

connective tissue with many neoformed

capillaries, with edema and chronic

inflammatory infiltrate; it is a superficial

lesion that does not invade subjacent

bone and generally produces no pain.

www.odontologia.com.br in Jul 2012).

! Paula e Silva et al. (2006)

observed that this pathology attacks

1 to 5% of pregnant women and

occurs due to the angiogenesis

increased by the plasmatic levels of

elevated estrogens associated to local

irritation (trauma, biofilm and dental

calculus). It is a non-neoplastic

proliferative lesion that is more

commonly located in the gingiva at

the anterior region of the maxilla.

Clinically it is a slow growth nodular

mass, reddish, soft to palpation and

prone to spontaneous hemorrhage.

Treatment consists of surgical

removal and elimination of any local

factor that may irritate and cause

relapse of the lesion, although it is

reported that it may recede

spontaneously after the baby is born.

Surgical removal is indicated only in

the first months of pregnancy and if

it impairs correct feeding, affects

esthetics or teeth maintenance in the

oral cavity, but it may relapse if done

before delivery. Removal is

recommended post labor (if

possible) if there is no risk of losing

teeth.

! Any untreated gingival

disease may be related to low weight

at birth demanding a guided

treatment and detailed evaluation of

oral hygiene in the patients (Paula e

Silva et al. 2006).

! Dental caries is a disease that

affects deciduous and permanent

teeth. It is characterized by the attack

of acidogenic bacteria that

demineralize the enamel and dentin

surfaces causing hard tissue loss and

inflammation followed by pulpal

death (fig. 5). Restorative treatment

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in the beginning of the disease may hold its

progression; that is why one should see the

dentist each 6 months.

a b

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

! 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.

www.farmaconline.ufg.br in Jul 2012).

! These bacteria proliferate, attach to the dental

surface and get their nutrients (substrates) from the food

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).

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).

Figure 7 – calculus formation by calcification of the bacterial plaque or biofilm

Figure 8 – advanced periodontitis characterized by loss of bone attachment

! Mentioned by some authors, dental erosion

caused by episodes of vomiting and the oral

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UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health 10

environment acidification usually is seen in

the palatal aspects of the upper teeth. The

patient must learn how to use dentifrices and oral

mouth rinses with fluoride so that enamel can

remineralize as soon as possible, preventing caries

caused by the development of cavities associated to the

other alterations that are seen in the gestational period.

!

Credits

Updating of the Notebook on Oral Health Basic Care – 2008:

Glossary: Mary Caroline Skelton-Macedo - FOUSP

CD Marco Kulik - FOUSP

References

ANDRADE ED, RANALI J, VOLPATO MC. Pacientes

que requerem cuidados especiais. cap. 9. p.93-140. In:

ANDRADE ED. Terapêutica medicamentosa em

Odontologia. São Paulo: Artes Médicas, 1999. (livro)

ARAUJO-FILHO WR Seleção de Casos para o

Tratamento Endodôntico. In: LOPES & SIQUEIRA JR.

ENDODONTIA – Ciência e Técnica Rio de Janeiro,

Guanabara Koogan, 2a ed., 2004, p. 185-221. (livro)

BARBOSA CP Centro Universitário de Maringá, Pós-

graduação em Farmacologia (2003 – TCC em

Farmacologia)

Medcenter.com Tratamento periodontal não aumenta

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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.

Moore PA Selecting drugs for the pregnant dental

patient. JADA, 129, p.1281- 1286, Sept 1998.

Paula e Silva FWG, Stuani AS, Queiroz AM

Atendimento Odontológico à Gestante - Parte 1:

Alterações Sistêmicas Rev Fac Odontol Porto Alegre, 47

(2):19-23, ago 2006.