Spirit Dental Resources

It’s totally normal to be nervous when you have to see the dentist. Ask around and you’re sure to find that a good percentage of people will tell you that they dread trips to the dentist, and they may even postpone making appointments because they get so anxious. But the truth is that you do need to see your dentist regularly to keep your teeth and gums clean and healthy for many years to come. Dental appointments are a part of life, but they don’t need to be terrifying, and you can rest assured that you don’t have to feel anxiety when you go to the dentist. With the tips below, you could overcome your fear and receive the care necessary to maintain that gorgeous smile. Be Upfront If your dentist knows that you’re feeling really anxious about your appointment, he or she will take your feelings into consideration and take some extra steps to help you feel as comfortable and secure as possible. You may even be able to figure out hand signals that you could use during a procedure to let your dentist know that you’re uncomfortable and you need a minute to regroup. So don’t be afraid to share your feelings with the staff, as they will surely understand where you’re coming from, and they’ll be happy to help you feel more at ease. Choose a Calming Dentist Some dentists specialize in working with fearful patients, and they even design their exam rooms to be more serene and relaxing for those who have anxiety. Generally, these dentists might make it a point to ask for your permission prior to continuing with a procedure, and they might also explain what’s happening and what you should expect to feel. Plus, they might even give you the chance to take a break if you need to. Bring a Friend Have no shame whatsoever in taking a trusted friend or family member to the dentist with you, as having a buddy there for support may help ease your fears. Bonus points if you can find someone who isn’t afraid of dentists and who has had their own dental work done in the past, as that person might be able to convince you that it isn’t a big deal after all. Get Zen You could also practice simple breathing exercises that are designed to calm you down. For example, it’s normal to discover that you hold your breath or start to breathe quickly whenever you’re nervous. You might also notice that your breath is shallow when you’re anxious. By focusing on your breath, you could increase oxygen flow throughout your body and decrease those stressful feelings. Try this: breathe into the count of four and breathe out to the count of four in an effort to elongate and deepen the breath and slow it down. Like meditation, breathing techniques like this one may help you find your center, so go ahead and practice them before and during your appointment. Bring Your Favorite Tunes Ask your dentist if you could listen to some music using a pair of headphones while he or she is working on your teeth. Closing your eyes and focusing on the music may help take your mind out of the environment that you’re in and help you relax. Ask About Sedation and Less Invasive Treatments Hey, sometimes we need to be sedated a bit in order to be truly relaxed in the dentist’s chair. And that’s why sedation dentistry exists. You could ask your dentist about what options are available to you, such as an oral sedative, an IV sedative, general anesthesia, or the famous “laughing gas.” Discuss the benefits, as well as the potential risks, for any type of sedation that you’re thinking about using so that you and your dentist can make the wisest and safest choice for your body. Also, consider asking your dentist about less invasive options for treating teeth and gum ailments. For example, air abrasion is a technique that can be used to treat small amounts of tooth decay without having to use the dreaded drill. Woohoo! And another drill-free and an anesthesia-free option for small cavities and white stains could be resin infiltration. If your dental problems are minor enough, these conservative—and far less scary—approaches might be right for you. Sounds fantastic, right?   Give Yourself a Reward Yes, that’s correct: reward yourself for going to the dentist. If it works on kids, it can work on you too, right? So is there a designer bag that you’ve been eyeing up? Or have you been thinking about splurging on some new clothes or maybe something special for your home? Reward yourself with whatever it is that you want after you successfully go to the dentist and get through your appointment. You might be surprised by how motivated you become when you know that there’s a reward to enjoy in the end. Is Nothing Working? So let’s say you’ve tried all of the tips above but you’re still shaking at the thought of having to go to the dentist, and you’re even considering living with the pain of a decaying tooth because you’d rather not get in that dental chair. In this case, it may be best to see a psychologist. These professionals could help you find new ways of facing, and ultimately overcoming, your fears of the dentist for good. Remember: It Might Not Be as Bad as You Think! Many people who have dental phobias find that the experience turns out to be less painful and less intense than they imagined that it would be. Finding the right dentist who could help you work through your fear is definitely the first step, as he or she will know what to do to calm you down and make you feel more in control. Like anything else in life, facing your fears at the dentist’s office is the best way to tackle your anxiety and come out stronger. Hopefully, the tips above will help you do just that! Sources: https://www.deltadentalins.com/oral_health/anxiety_visit.html   https://www.webmd.com/oral-health/features/dont-fear-the-dentist#1 https://www.kyrenefamilydentistry.com/blog/10-tips-overcoming-dental-fear/ https://www.webmd.com/oral-health/guide/air-abrasion#1 https://www.dentalproductsreport.com/view/new-cavity-treatment-could-replace-drilling-and-filling

Everyone loves a big, bright, white smile. And everyone can have a brilliant smile, thanks to the many whitening products and treatments that are on the market today. But what’s better: your typical over-the-counter whitening strips, or the professional whitening treatment that your dentist offers? We break down the pros and cons of each of these popular options below so that you can make the right choice for your teeth. Whitening at Home with Strips Whitening strips give you the ability to brighten your teeth in the comfort of home, and they’re also much more affordable than professional whitening treatments. Here are a few things to consider if you’re thinking about taking this route towards a brighter smile: Whitening strips typically use carbamide peroxide or hydrogen peroxide to whiten your chompers. Once the strips are applied, the whitening gel will press against your teeth so that the peroxide can effectively penetrate and remove stains. It will take, on average, about a week before you start to see the results of whitening strips, although advanced products claim that you might notice a difference after just one use. How long you need to use the strips will depend upon the product that you’re using and the results that you’re hoping to attain. And, of course, your results will also depend upon just how badly stained your teeth are, to begin with. Whitening strips might not be able to give you even results. This is because the strips may not be placed exactly the same way each time you use them, and they may not cover every spot on every tooth perfectly. How long will the results last? Well, if you take care of your teeth and use a whitening toothpaste daily while also limiting the foods and drinks that can cause stains, your results might last anywhere from six months to a full year. Not bad. Not bad at all. Another great thing about whitening strips is the fact that they’re easy to use. They’re pretty much foolproof because all you have to do is use one strip on your top teeth and another on your bottom teeth. When it’s time to take them off, they come off easily, and you’re done! Really simple overall. When it comes to side effects, you might use whitening strips without any consequences. However, some people find that, after prolonged use, the teeth start to become increasingly sensitive. This side effect could be worse if you already have sensitive teeth before you even start whitening. If this occurs, though, stopping the use of the strips for a few days should make the discomfort go away. However, in addition to tooth sensitivity, the ingredients in whitening strips might irritate the gums. Experts recommend avoiding contact between the strip and your gums, but this is really hard to do. Plus, excessive use of whitening strips could even cause your tooth enamel to erode, and you may become more prone to tooth decay. Yikes! This is why it’s important to use these products as directed. Leaving It Up to Your Dentist with Professional Treatments If you’re hoping for dramatic results, whitening strips may not give you what you’re looking for. Instead, you might need to go to your dentist to have your teeth whitened professionally. But there are still a few things to consider before opting for a professional whitening service: First, you may want to consider the cost. Compared to whitening strips that you can buy in-store and online, a professional procedure will be much more expensive. We’re talking hundreds of dollars for a professional treatment versus just a few dollars for at-home strips. If you’re aiming to make your teeth several shades whiter after just one treatment, this is the way to go. Your dentist will have access to a more powerful bleaching gel that works faster than the low-dose bleaching agents that are found in whitening strips that you use at home. As you probably already guessed, a professional whitening treatment could also cause irritation of the gums, as well as tooth sensitivity. After all, if at-home products could do it, then more powerful treatments could do it too. So if you already have sensitive teeth, your dentist may not recommend professional treatment. During what’s referred to as chairside bleaching, your dentist will use a rubber shield or a special gel in order to protect your gums as best as possible. Then he or she will apply the whitening solution to your teeth. You’ll wait a few minutes, and you might get the results that you want after a single session. In addition to applying the whitening solution to your teeth, your dentist may also use a special light or laser in order to brighten your smile even more quickly. A typical treatment will take anywhere from 30 to 60 minutes. Quick and painless! Although you could get awesome results after one professional whitening treatment, depending upon your expectations, you might need to receive the treatment more than once after all. And results aren’t permanent either. After a year, it’s likely that you’ll start to notice staining again. Bummer. Before You Whiten… The American Dental Association (ADA) recommends that you have your teeth and gums examined prior to having your teeth whitened, whether you’re thinking about whitening at home or in the dentist’s chair. Your dentist can make sure that your chompers are healthy enough for a bleaching treatment, and he or she will also be able to determine which options would reduce or remove the staining best. Just remember: although an occasional whitening treatment is a great way to boost the brilliance of your smile, brushing with whitening toothpaste, flossing, and going for dental cleanings regularly will help you maintain beautiful, healthy teeth for the long run. After all, a healthy smile is just as important as a white smile! Sources: https://www.colgate.com/en-us/oral-health/teeth-whitening/are-teeth-whitening-strips-your-best-option   https://www.dynamicdentalinc.com/blog/what-you-should-know-before-using-teeth-whitening-strips https://www.colgate.com/en-us/oral-health/teeth-whitening/professional-teeth-whitening-cost https://www.mouthhealthy.org/en/az-topics/w/whitening https://www.webmd.com/oral-health/teeth-whitening-and-bleaching#1 https://www.colgate.com/en-us/oral-health/teeth-whitening/how-to-whiten-teeth

Updated Jan. 22 Dentures are a great option if you need to replace missing teeth. When fitted properly, they’ll be comfortable and allow you to enjoy your favorite foods. But once you get your dentures, it’s up to you to take steps daily to keep them as clean as possible. Doing so can help prevent problems like irritation, infections, and gum disease.   The good news is denture care isn’t complicated. And once you get the hang of things, cleaning your dentures will become a part of your routine. Then, when you see your dentist for a checkup, they’ll be impressed with the awesome job you did keeping your mouth healthy and your dentures in good shape! How to care for dentures: a basic guide If you have partial dentures, you’ll need to take care of your dentures and natural teeth. So, after removing your dentures before heading to bed, you can brush and floss your natural teeth. Then, you can work on cleaning your dentures. Simple enough!     What if you have full dentures? Well, the steps are the same, but you obviously won’t need to brush and floss your teeth. Before heading to bed each night, be sure to remove the dentures and clean them thoroughly.   How to clean partial dentures and full dentures Knowing how to clean dentures properly is ultra-important, and your dentist can help you figure it all out, even if you have no clue where to begin.  To get a general idea of what to expect when it comes to keeping dentures clean, check out the brief guide below on how to care for partial dentures and full dentures.  1.) After removing your dentures, rinse them with cool water. You could fill a sink with water or place a folded towel in the sink, as doing so may help prevent damage to your dentures if you accidentally drop them.  2.) With a soft-bristled toothbrush designed for dentures, brush them gently to remove plaque and food particles that stuck to them. 3.) Soak your dentures in a solution that’s designed to clean them, following the directions closely. Talk to your dentist about which cleaner is ideal for the type of dentures you wear. Alternatively, you might just need to soak them in water. Leave the dentures in the solution overnight to cleanse them and keep them moist until you put them back in your mouth the next morning. 4.) If you wear partial dentures, brush your teeth, gums, tongue, cheeks, and palate, and floss to clean between the teeth. On the other hand, if you wear full dentures, gently brush your gums, tongue, cheeks, and palate. Taking the time to do this twice a day—in the morning and before bed—can help keep your whole mouth fresh and healthy.  5.) To freshen your mouth even more and take an additional step to remove bacteria, you can rinse with salt water or an antiseptic mouthwash. Your dentist can help you select the right mouthwash for your needs if you aren’t sure which one is best. 6.) Every morning, brush your gums, tongue, palate, and teeth again. Then, rinse the dentures carefully and completely after removing them from the cleaning solution so you can safely place them in your mouth for the day ahead.  Tip #1: In addition to giving your dentures a thorough cleaning each night, it’s a good idea to rinse them with water after you eat.  Tip #2: If you use denture adhesive, take care to remove it completely from your dentures and gums each night.  Don’t neglect proper gum care after dentures People with dentures shouldn’t only focus on keeping the dentures themselves clean. You also need to take care of any remaining natural teeth and, of course, your gums. After all, without healthy gums, you can’t have a healthy mouth! You can clean the gums with a soft toothbrush or some gauze. Let them breathe while your dentures are soaking overnight. This helps reduce the risk of problems like irritated, red, or sore gums.   What to avoid after getting dentures We can’t stress this enough: your dentist can give you personalized guidance when you get dentures. Generally, however, there are some things you should avoid.  Be careful about the products you use to clean dentures. Products that are too abrasive are a big no-no because they may cause damage. Using toothpaste, whitening products, or household cleaners isn’t a good idea. Even using water that’s too hot might cause warping. So, stick with cleaning solutions recommended by your dentist and designed for the dentures you wear.   Also, even though you might be tempted to leave your dentures in your mouth overnight, it isn’t wise. Taking them out of your mouth gives your gums a chance to rest after being covered all day.   You still need to see the dentist, even with dentures You might think that, because you have dentures, you no longer need to worry so much about seeing a dentist regularly. But the opposite is true.   Whether you have partial or full dentures, it’s still necessary to see your dentist so they can examine your mouth and look for signs of disease. Plus, your dentist can professionally clean the dentures and check them to be sure they’re still in good condition. If your dentures are no longer fitting comfortably or you need to replace them because they’re old or broken, your dentist will provide the appropriate solution.  With the right dental insurance, you won’t need to worry about expensive appointments to keep your dentures and mouth clean and healthy. Spirit Dental offers plans that can help cover the cost of checkups, cleanings, and dentures so you won’t have to break the bank to restore your smile.       Sources: https://www.mayoclinic.org/denture-care/expert-answers/faq-20058375 https://familydentistottawa.com/important-dos-donts-denture-care/ https://www.healthgrades.com/right-care/oral-health/caring-for-your-mouth-and-gums-with-dentures https://www.webmd.com/oral-health/guide/common-denture-problems https://www.dentureliving.com/en-us/advice-tips/living-with-dentures/pain-irritation/denture-pain-sores 

Updated July 2021 Everyone wants a perfect smile, but not everyone is born with it. Thankfully, modern dentistry offers multiple solutions that can help improve the way your pearly whites look so you can be more confident. Two of those solutions are crowns and veneers.  What are the similarities and differences between porcelain crowns and veneers? Continue reading to learn a bit about these options so you can get a better idea of which one would be best for you.  Dental Crowns and Veneers: What Are They? Both porcelain dental crowns and veneers can be used to restore a smile after an injury or extensive decay. Or, if you simply aren’t happy with the appearance of your teeth as they are naturally, these options might be just what you need.  Although they can be used to restore or improve the look of teeth, there are some notable differences between veneers and crowns.  Crowns are caps that are set over teeth. A crown will look like a real tooth, and once it is set into place, it will completely cover your natural tooth, so it will function just like your other teeth too.  Veneers are ultra-thin and designed to sit on the front of teeth. Like crowns, they can be used to change the way teeth look, and because they are capable of resisting stains, they can help you maintain a beautiful smile for the long run.  Why Do People Get Crowns or Veneers? There are a lot of reasons why your dentist might recommend a porcelain crown or a veneer. By weighing their pros and cons, while considering your needs and the health of your teeth and gums, your dentist can also help you decide which one of these would be the right choice.  Here are some of the reasons why you might opt to get a dental crown: If you need to restore a tooth that’s become too weak because of injury, wear and tear, or decay. If you don’t like the way a tooth looks (e.g. its color or shape). If you needed a root canal or a large filling. If you’re getting a bridge or implant. Here are some of the reasons why you might opt to get dental veneers: If you want to change the way your teeth look (e.g. get rid of a gap between teeth, change the shape of a tooth, cover up damage such as chips, or fix minor alignment issues). If your enamel is worn and you want to strengthen one or more teeth. If you want to hide discoloration, make your teeth appear whiter, and prevent future stains.  Crowns vs. Veneers Cost Comparison: Which Option Is More Affordable? We’re not gonna lie: both crowns and veneers are expensive! So, this is something that you definitely want to consider before taking the plunge.   A dental crown might cost, on average, anywhere from $800 - $3,500. The final cost may depend on several factors, such as the type of material that’s used to make the crown (e.g. porcelain or porcelain-fused-to-metal), where you’re located, and the dental professional that you use. A veneer might cost, on average, anywhere from $250 - $2,500. Like crowns, different factors, such as where you’re getting a veneer and the material that it’s made of (e.g. porcelain or composite), may influence the final price.   Can Dental Insurance Help You Get a Crown or Veneer? Having the right dental insurance might make a big difference when it comes to affording crowns and veneers, but it’s wise to read the fine print carefully. For example, a plan might only cover a certain percentage of the cost of these procedures. Or, if you’re getting either of these solely for cosmetic reasons, insurance might not help cover the cost at all.  Bottom line: you don’t have to live with an imperfect smile! Veneers and porcelain crowns are two options that are definitely worth exploring.         Sources: https://www.healthline.com/health/dental-and-oral-health/veneers-vs-crowns    https://www.webmd.com/oral-health/guide/veneers https://www.colgate.com/en-us/oral-health/veneers/dental-veneers-pros-and-cons https://my.clevelandclinic.org/health/treatments/10923-dental-crowns https://www.yourdentistryguide.com/veneer-procedure/  

Whether you play sports or your kids play sports, it’s important to know that there is a risk for dental injuries with these activities. Below we’ve listed out some helpful information so you can have a better understanding of the risks, as well as what you can do to take the appropriate precautions to prevent these injuries. Dental Sports Injuries: A Few Quick Facts and Stats Dental injuries that are related to sports are common. For example, experts have reported that anywhere from 13% to 39% of all dental injuries are the result of patients being involved in sports. On top of that, roughly 80% of the injuries that dentists treat affect the upper front teeth, although damage to the cheeks and tongue are also seen often. Some of the more common dental injuries that are related to sports include tooth fractures. However, fully dislodged teeth, as well as loosened teeth, are also common. Extensive bleeding and pain could occur even in the case of a tooth fracture if the crack extends through the whole tooth. Ouch! Teenagers are prone to suffering from dental injuries that are related to the sports that they play. In fact, preteens and teens tend to exhibit the highest number of these dental injuries. While these stats certainly shouldn’t dissuade you from playing your favorite sports with your friends, they might inspire you to take an extra step to keep your mouth safe. Your Biggest Risk: Contact Sports As you probably already guessed, contact sports will put you at greater risk of suffering from a serious dental injury. If you play any of the following sports, consider using a mouthguard to protect those chompers and keep them where they belong: in your mouth! Boxing Wrestling Martial Arts Hockey Football Baseball Basketball Soccer Rugby Lacrosse Even if a sport doesn’t require that you wear this protection, experts highly recommend wearing one as it can help protect your smile. After all, even a minor mouth injury could be painful and costly. Safety Gear: A Must-Have Accessory Wearing protective gear could help you reap all of the benefits that come with playing sports without risking the health of your teeth. The type of safety gear that you will need will depend upon the sport that you participate in. Generally, helmets can help protect you if you are dealing with impact and speed (think: biking, skating, hockey, and football). They can protect your head, your eyes, and your mouth when they are designed well and fit properly. As mentioned above, mouthguards could help protect your lips, tongue, and teeth, especially when they are custom-fitted. And remember, they could be used for just about every sport, from football and basketball to boxing and hockey. Mouthguards: They Aren’t All Created Equal Not keen on the idea of wearing a mouthguard? You might change your mind once you realize that the simple act of wearing one while you play could dramatically reduce your risk of getting hurt, regardless of the sport you prefer. The key, though, is to wear the right mouthguard, such as one that has been customized to fit your mouth perfectly. Here is a basic breakdown of the most common types of mouthguards available: A ready-made mouthguard, also known as a stock mouthguard, is one that you can purchase already formed and ready to wear. While these products may be convenient, they typically are not the ideal choice. Oftentimes, one size does not fit all, so you will notice that the guard fits your mouth poorly. This translates to inadequate protection for your teeth. Ultimately, the mouthguard will not really do much to reduce your risk of injury. A boil-and-bite mouthguard is a step up from a stock mouthguard, and it could be your best option if you can’t get a customized guard. These are easy to find in sporting goods stores. All you have to do is put the product in some boiling water to soften the plastic. Once you bite down, the plastic will form a mold around your teeth. And if you don’t get the fit right the first time, you can do it again. Because this guard will fit your teeth more accurately, it could provide better protection. The best (but most expensive) option would be a custom mouthguard, as it will offer the highest level of defense. Your dentist can make this mouthguard for you, and he or she can ensure optimal protection and comfort, thanks to a perfect fit. Got Hurt? See Your Dentist Right Away!

Your body goes through a lot of changes while you’re pregnant. Could these changes affect your oral health? Or can your oral health affect the health of your baby? Get all of the answers you need below. Your Oral Health Is More Important Than You Think If you thought that keeping your teeth and gums clean was only important for maintaining a bright and beautiful smile, think again. Failing to brush and floss daily or neglecting to see your dentist for cleanings regularly could result in frightening problems during your pregnancy. These could include intrauterine growth restriction, preeclampsia, gestational diabetes, and premature delivery. Wow! Gum Disease Might Become a Problem There is evidence that suggests that there’s a link between premature or underweight birth and a mother’s gum disease. In other words, if you have gum disease while you are pregnant, you might increase your odds of delivering a baby who is too small or you might go into labor too soon. Both issues stress the importance of getting your teeth and gums cleaned and treated as usual during your pregnancy. Even if you have never had gingivitis before, you might experience it during your pregnancy. This is actually referred to as pregnancy gingivitis because pregnancy hormones might cause the gums to overreact to irritants that are found in plaque. Basically, the plaque will end up building up and irritating your gums, leading to gums that are inflamed, red, and prone to bleeding. Ouch! Morning Sickness Is Bad News for Your Teeth Morning sickness isn’t any fun at all, but it can also wreak havoc on your pearly whites. To ensure the stomach acid that comes up with your vomit doesn’t eat away at your enamel and increase your risk of cavities, simply rinse your mouth thoroughly before brushing your teeth. Swish and spit some water, a mix of water and baking soda (1 teaspoon of baking soda in 1 cup of water), or a diluted mouthwash. Then brush a half-hour later to refresh your entire mouth. So easy! Your Teeth Might Feel Loose This is pretty scary: during pregnancy, high levels of estrogen and progesterone hormones might cause the bones and the ligaments that hold your teeth in place to loosen. This could occur even if you are not experiencing the symptoms associated with gum disease. Usually, this will just go away after you deliver your baby (phew!), but if you are at all concerned, asking your dentist could help put your mind at ease. And don’t worry, as your teeth won’t fall out just because you’re pregnant. There Are Also These Things Called Pregnancy Tumors While you’re expecting, you might develop what is referred to as a “pregnancy tumor.” But don’t freak out, as these tumors are the result of hormonal changes, and they are benign. These growths will look a lot like raspberries in between your teeth, and they’ll typically pop up within the second trimester. If you want, you can have your dentist remove pregnancy tumors, especially if they’re uncomfortable or really grossing you out. If you choose to leave them alone, though, they will likely go away once your bundle of joy is born. What About Radiation from Dental X-Rays? Should you be concerned about the radiation that you’re exposed to when getting dental x-rays? According to experts, not at all. Just be sure that your dental hygienist or your dentist covers your torso and neck with a protective apron. Keep Your Entire Mouth Healthy and Clean During pregnancy, it’s important to keep your entire mouth clean, so focus on brushing twice a day with a toothpaste that contains fluoride. Flossing once a day will also help to keep your teeth and gums healthy. Beyond following a dental care routine at home every day, it is also important to eat right while you are pregnant. This will not only help ensure the health of your baby but will also help reduce the risk of tooth decay. So focus on limiting your intake of sugary foods and drinks, and try consuming a diet that includes plenty of fruits and vegetables, high-fiber foods, and foods that are high in calcium. Also, if you notice any of the following symptoms, it’s best to contact your dentist as soon as possible to figure out what’s going on: Painful or bleeding gums, or gums that are swollen, sore, shiny, or red Pain anywhere in your mouth, including a toothache Growths, such as lumps or sores, within the mouth Bad breath Loose teeth A Dentist Can Provide the Best Advice During Your Pregnancy! Do you have any questions about your dental care routine while you’re pregnant? Are you worried that you might not be doing everything that you can to maintain strong teeth and gums? Your dentist could steer you in the right direction for a safe and healthy pregnancy. And even if you don’t have any specific questions but you’re scheduled to see your dentist for a standard cleaning and checkup, it’s a good idea to tell him or her that you’re pregnant. In this way, the appropriate steps can be taken to care for your mouth and your baby. Sources: https://www.mouthhealthy.org/en/pregnancy-slideshow https://www.colgate.com/en-us/oral-health/oral-care-during-pregnancy/why-you-need-a-prenatal-dental-care-checkup https://www.colgate.com/en/us/oc/oral-health/life-stages/oral-care-during-pregnancy