Hyperemesis gravidarum- Consequences in teeth and dental treatment

Vomiting during pregnancy is a common symptom, especially in the first trimester.

It can cause dental problems because vomit contains stomach acids that can erode the teeth.

Vomiting in pregnancy is usually short-lived. As a result, the damage to the teeth is limited compared to the damage caused by bulimia, for example.

If vomiting during pregnancy is severe, a condition called hyperemesis gravidarum, can cause dehydration and deprive the pregnant woman’s body of valuable nutrients, while at the same time posing a serious threat to the health of her teeth.

The greater the amount and frequency of vomiting, the greater the risk of tooth erosion.

Today I present the case of a patient who suffered from hyperemesis gravidarum during two pregnancies.

The patient’s teeth were severely eroded, especially on the palatal side of the anterior teeth and on the occlusal surface of the posterior teeth, as shown in the following photographs.

We can see the characteristics of dental erosion, such as the stronger colour of the teeth at the points where the enamel was lost and the changes in the morphology of the teeth.

Dental erosion starts with the enamel, the most superficial layer of the tooth, which is attacked by stomach acids and slowly dissolves.

As teeth lose the superficial protective layer of enamel, the underlying dentin, which is more susceptible to erosion and abrasion, is exposed to the oral environment, increasing the rate of loss of tooth structure.

The condition usually affects the palatal surfaces of the upper anterior teeth. In the early stages, the damage is difficult to detect because the location of the eroded surfaces is not easily visible to the patient.

Gradually, however, the loss of dental substance extends to the cutting edge of the front teeth, which become thinner, wear out and create an unattractive smile.

In the advanced stages of the disease, there are usually changes in the posterior teeth, which develop morphological changes, sometimes leading to the loss of the vertical dimension of the face.

In the case presented here, the lesions were not significant in the lower teeth, which retained their morphology compared to the upper teeth.

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The patient decided to seek dental treatment when the cutting edges of the front teeth broke, lost their shape and the aesthetic problem became more pronounced.

The purpose of treatment in such a case is to repair the eroded teeth while preserving as much dental substance as possible. In the past, we used to prepare the teeth and place crowns, which caused additional loss of dental tissue.

Today, with dental bonding, we can place small restorations on the teeth that cover the exposed dentin and replace the lost tooth structure without further removal of tooth tissue.

In order to cover the exposed dentin and replace the tooth structure lost through erosion, we need to slightly increase the vertical dimension of the face. In this way, we create the space needed to place the restorative materials on the teeth.

In our case, we started the treatment with a diagnostic technique called a mock-up. Think of the mock-up as a test smile that allows us to see the final result we want to achieve and gives us the opportunity to explain the treatment to our patient.

The picture below shows the mock-up in the mouth before any dental work is done.

The final restorations of the teeth can be made of composite or porcelain, depending on the patient’s preference and finances.

In this case, we used composite onlays to restore the posterior maxillary teeth, while the two central incisors were restored with porcelain veneers on the buccal side and composite veneers on the palatal side.

These types of prostheses are very conservative restorations and are chemically bonded to the surface of the teeth after minimal preparation of the tooth structure.

The following photos show some of the posterior onlays on the working model (note how thin they can be!), while the following image shows the posterior teeth before and after bonding of the composite onlays.

Bonding the onlays to the posterior teeth also increases the vertical dimension of the occlusion. This creates the necessary space to fabricate and bond restorations on the palatal side of the anterior teeth in the next step of the treatment.

The following pictures show the anterior restorations placed on the working model and bonted to the anterior teeth.

as well as the results of the treatment on the teeth before and after bonding the restorations.

Στο στάδιο αυτό της θεραπείας έχουμε επιτύχει την βελτίωση της ανατομίας των δοντιών και την κάλυψη της ευαίσθητης οδοντίνης.

Η φθορά των δοντιών σε μήκος περιοριζόταν στην περίπτωση μας μόνο στους δύο κεντρικούς τομείς, και για αυτό τον λόγο αυτά ήταν και τα μοναδικά δόντια που χρειάστηκαν όψεις πορσελάνης.

Ακολούθησε η κατασκευή των όψεων στους δύο κεντρικούς τομείς, τις οποίες βλέπουμε στην φωτογραφία που ακολουθεί τοποθετημένες στο εκμαγείο και συγκολλημένες στο στόμα.

The treatment was very succesfull.

Posterior teeth and the occlusal surfaces of the anterior teeth were restored, the exposed dentin was covered and teeth became less sensitive to thermal stimuli.

Soon we’ll restore the missing molar with a dental implant and the occlusion will be finalized.

The only teeth with porcelain veneers are the two central ones.

We made a kind of “sandwich” for the most compromised teeth.

We used a composite veneer on the palatal side and a porcelain veneer on the buccal side.

The tooth structure left by the erosion was left intact between the restorations.

Porcelain venneers gave to our patient a new healthy and cofident smile.

To protect your teeth from the effects of pregnancy vomiting, follow these tips

• Do not brush your teeth right after vomiting.
• Wait at least an hour before brushing your teeth.
• Rinse your teeth with a solution of water and baking powder after vomiting.
• Use fluoride toothpaste to strengthen your teeth after brushing.
• Avoid fizzy drinks and carbonated drinks
• In some cases, such as the one just described, preventive measures are not enough and the effects on the teeth become visible.

In these cases, modern dentistry can repair the damage and give our patients the dental health they need to smile with confidence.

Even in more complex cases, such as the bulimia tooth erosion case we recently analysed, proper dental care greatly improves the prognosis of eroded teeth.

Don’t be discouraged, look for solutions and find the right treatment for you.