不少準媽媽在懷孕期間飽受智齒髮炎、牙齦腫痛、牙神經疼的折磨，在最需要
營養和休息的時候，吃不香睡不着。準爸爸們也被各種牽連。
應該是在懷孕前，就進行徹底的牙科檢查，消除隱患。
但萬一懷孕期間牙疼了怎麼辦?能拍片嗎?能打麻藥嗎?能治牙嗎?
美國婦產科醫生協會於2013年向婦產科醫生髮布了孕婦口腔健康指導意見，並於2015年進行了修訂。
雖然這是一份洋文件，是給美國大夫看的，但其中有一些很有價值的意見，我把該報告的建議部分翻譯了一下，供大家參考。
後附英文原文和全文鏈接。
建議：
和所有的患者探討口腔健康問題，包括正在懷孕的和處於產後期的。
告知女性患者口腔健康保健可以促進全身健康，並可以減少母嬰之間的致齲菌傳播。
在首次產檢時就要安排患者進行口腔檢查。
要幫助患者打消顧慮，在懷孕期間，進行口腔預防、診斷和治療，包括拍攝x光片(在腹部和甲狀腺受保護的前提下)，以及進行局部麻醉(使用加腎或不加腎的利多卡因)都是安全的。
告知女性當口腔中出現需要立即治療的情況，比如拔牙、根管治療、充填未經治療的齲洞(使用銀汞或者樹脂)，在懷孕的任何階段都是可以接受處理的。延誤治療會帶來更加複雜的問題。
當患者出現了妊娠反應導致的嘔吐或孕晚期的消化道反流，使用抗酸藥物或用蘇打水漱口(一茶匙蘇打溶解在一杯水中)可以幫助中和消化道內酸性物質對牙齒的腐蝕。
要留意患者的牙科保險情況，以便將她轉診至適當的牙科診所，要注意每一個州對於醫保的政策是不一樣的。
要和附近的牙醫建立良好的工作關係，就像和其它臨牀專科醫師合作一樣，通過電話或轉診單將患者轉診至牙科診所。
提倡擴大婦女在孕前、孕中、孕後的牙科保險報銷範圍。懷孕是女性所經歷的特殊時期，在此時期應該獲得更多的牙科保健支持。
強化患者的定期口腔保健意識，包括少吃甜食和飲料，每天刷牙兩次，用含氟牙膏，每天用一次牙線，每年看兩次牙醫。
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.
全文鏈接：Oral Health Care During Pregnancy and Through the Lifespan
簡單來說，不管是孕期還是哺乳期，牙齒該看就看。這部分知識需要被科普的對象不光是公衆，也包括牙醫和婦產醫生。當然，很多醫生並不是不知道，而是不敢，是大環境下無奈的自保之舉。希望醫患間能更多些理解和信任，惠及廣大患者。
