新生待：孕期牙齿的那些事儿

不少准妈妈在怀孕期间饱受智齿发炎、牙龈肿痛、牙神经疼的折磨，在最需要
营养和休息的时候，吃不香睡不着。准爸爸们也被各种牵连。
应该是在怀孕前，就进行彻底的牙科检查，消除隐患。
但万一怀孕期间牙疼了怎么办?能拍片吗?能打麻药吗?能治牙吗?
美国妇产科医生协会于2013年向妇产科医生发布了孕妇口腔健康指导意见，并于2015年进行了修订。

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虽然这是一份洋文件，是给美国大夫看的，但其中有一些很有价值的意见，我把该报告的建议部分翻译了一下，供大家参考。
后附英文原文和全文链接。

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建议：
和所有的患者探讨口腔健康问题，包括正在怀孕的和处于产后期的。
告知女性患者口腔健康保健可以促进全身健康，并可以减少母婴之间的致龋菌传播。
在首次产检时就要安排患者进行口腔检查。
要帮助患者打消顾虑，在怀孕期间，进行口腔预防、诊断和治疗，包括拍摄x光片(在腹部和甲状腺受保护的前提下)，以及进行局部麻醉(使用加肾或不加肾的利多卡因)都是安全的。
告知女性当口腔中出现需要立即治疗的情况，比如拔牙、根管治疗、充填未经治疗的龋洞(使用银汞或者树脂) ，在怀孕的任何阶段都是可以接受处理的。延误治疗会带来更加复杂的问题。
当患者出现了妊娠反应导致的呕吐或孕晚期的消化道反流，使用抗酸药物或用苏打水漱口(一茶匙苏打溶解在一杯水中)可以帮助中和消化道内酸性物质对牙齿的腐蚀。
要留意患者的牙科保险情况，以便将她转诊至适当的牙科诊所，要注意每一个州对于医保的政策是不一样的。
要和附近的牙医建立良好的工作关系，就像和其它临床专科医师合作一样，通过电话或转诊单将患者转诊至牙科诊所。
提倡扩大妇女在孕前、孕中、孕后的牙科保险报销范围。怀孕是女性所经历的特殊时期，在此时期应该获得更多的牙科保健支持。
强化患者的定期口腔保健意识，包括少吃甜食和饮料，每天刷牙两次，用含氟牙膏，每天用一次牙线，每年看两次牙医。

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Recommendations
Discuss oral health with all patients, including those who are pregnant or in the postpartum period.
Advise women that oral health care improves a woman’s general health through her lifespan and may also reduce the transmission of potentially caries-producing oral bacteria from mothers to their infants.
Conduct an oral health assessment during the first prenatal visit.
Reassure patients that prevention, diagnosis, and treatment oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) and local anesthesia (lidocaine with or without epinephrine), are safe during pregnancy.
Inform women that conditions that require immediate treatment, such as extractions, root canals, and restoration(amalgam or composite) of untreated caries, may be managed at any time during pregnancy. Delaying treatment may result in more complex problems.
For patients with vomiting secondary to morning sickness, hyperemesis gravidarum, or gastric reflux during late pregnancy, the use of antacids or rinsing with a baking soda solution( ie, 1 teaspoon of baking soda dissolved in 1 cup of water)may help neutralize the associated acid.
Be aware of patients’ health coverage for dental services during pregnancy so that referrals to the appropriate dental provider can be made. Note that each state’s Medicaid coverage for oral health may vary considerably.
Develop a working relationship with local dentists. Refer patients for oral health care with a written note or call, as would be the practice with referrals to any medical specialist.
Advocate for broader oral health coverage of women before, during, and after pregnancy. Pregnancy is a unique time when women may gain access to oral health coverage.
Reinforce routine oral health maintenance, such as limiting sugary foods and drinks, brushing twice a day with fluoridated toothpaste, flossing ocne daily, and dental visits twice a year.
全文链接：Oral Health Care During Pregnancy and Through the Lifespan