|Where There Is No Dentist (Hesperian Foundation, 1983, 210 p.)|
Pregnancy and Dental care - an example
People everywhere have a tradition of teaching with stories. Many of the things we believe, we learned through stories we heard from parents, friends, and teachers. This is good, except when a story teaches something that isnt true! When a woman gets pregnant, for example, she hears many stories, and she wants to learn whatever she can from these stories. Unfortunately, some traditional beliefs about pregnancy are partly wrong. An example is the belief that one must always have dental problems during pregnancy.
Here is a story you can tell to help people see that they are partly right about pregnancy and dental problems, but that there is more to understand.
A Story: Bertines teeth
Bertine was the dental worker in her village. She was a young woman, but the villagers respected her because she was such a careful worker, and because she knew how to fill cavities and pull teeth without hurting people. She also spent a lot of time teaching people how to avoid dental problems. Clean your teeth every day! she often said, at her clinic, at the schools, at village meetings. Eat a mixture of foods, especially a lot of fruits and vegetables! Avoid candy and sweet, sticky foods!
When Bertine was 23 years old, she got married and became pregnant. She also began to have some tooth problems of her own. She saw that her gums were bleeding when she cleaned her teeth, and she had small cavities in two of her teeth. As the dental worker, she was embarrassed to have tooth problems, but an older woman told her, Its natural to lose teeth when you have babies, Bertine. As we say, For each child, a tooth.
One day Lucie, a dental worker from a nearby village, came to see her friend Bertine. Lucie had a young baby, and Bertine asked her a lot of questions about babies and about pregnancy. Then Bertine said, Of course, Im having lots of problems with my teeth. Why do you say of course? asked Lucie. Well, Bertine replied, For each child, a tooth.
But thats not true! Lucie cried. You think you are having tooth and gum problems because you are pregnant, but I bet you are having these problems for all the usual reasons.
The usual reasons? asked Bertine.
Yes, said Lucie. How often do you eat now that you are pregnant? Well, a lot more than I used to - I have two persons to feed! And do you still eat sweet foods sometimes? Lucie asked. I guess I do, said Bertine, and more sweets than before, because I eat more often.
How about teeth cleaning? asked Lucie. Do you clean as often as you did before you were pregnant? No, Bertine admitted, I heard I was going to have tooth problems anyway, and I have been so tired lately .... Oh! Do you suppose that these are the only reasons I am having these problems? How do you know so much about this, Lucie?
Because I had the same problems, Bertine. I learned the truth the hard way. I had an infected tooth, and the infection passed to my kidneys. At the health clinic, they told me it is not necessary to have tooth problems during pregnancy - and it is even dangerous. I am lucky I did not lose my baby! That can happen, you know, when a tooth problem is not treated. We must fill your cavities right now.
You mean I can be treated now, before I have my baby?
Yes, and you should! said Lucie. And you can take better care of your teeth. It is true that because of the pregnancy, your gums are weaker, and they can get infected. But this means you should take even more care than usual to: (1) clean regularly and (2) eat the right foods. You need to have strength when you are pregnant. An infection in your mouth does not help that. Because your gums are weak, it is also good to (3) rinse your mouth every day with warm salt water*, and if you cannot get fresh fruits and vegetables, then (4) take a tablet of Vitamin C every day.
* See Sore bleeding gums.
Lucie then offered to clean Bertines teeth and to fill her cavities. When she touched Bertines gums, they bled, and Lucie said, They will bleed at first, but after you clean them regularly for a while, they will be stronger. Bleeding gums are dangerous to a pregnant woman. The bleeding can increase anemia, which is a serious problem.
If a pregnant womans tooth has an abscess, is it safe to pull it before she has the baby? asked Bertine. Yes, said Lucie, you just must be gentle. A woman gets tired sitting in a dental chair for a long time, and sometimes you must give some extra anesthetic so she does not feel any pain.
GIVING DENTAL TREATMENT TO A PREGNANT WOMAN
As we see from the story of Bertine and Lucie, it is possible - and good -to treat a pregnant womans dental problems before she has her baby.
In two situations, it is sometimes better to wait for the baby:
(1) Sometimes the womans gums become swollen and the swelling does not go down even after cleaning with a soft brush and rinsing with salt water.
These swellings must be cut away. She should have this small operation after the baby is born.
(2) During the last month of pregnancy, a woman may be too uncomfortable to have her tooth taken out. Control the infection with a 5-day course of penicillin, and take out the tooth after the baby is born. It is also better to wait if the woman has high blood pressure, because she may bleed too much when you take out the tooth.
Train midwives to examine womens mouths. When they send them to you for dental care, they can give you any information you need.
Caring for a pregnant woman - a guide for dental workers
1. Ask her how many months she has been pregnant, and find out if she has high blood pressure. Any person with blood pressure over 150/100 may bleed excessively after an extraction. To get this information, encourage all women to use the Mother and Child clinics.
2. Do not take X-rays of teeth unless absolutely necessary. X-rays are dangerous to the unborn baby inside. Before an X-ray, always cover the mothers midsection with an apron lined with lead.
3. Always give a careful and complete mouth examination. Tell her what treatment she needs and how to prevent tooth problems.
4. Be gentle. Show the woman that you care, that you want her to be comfortable, and that you can treat her without hurting her.