BY: MALIHA TAHIR

Pregnancy has been considered an impediment to dental treatment However, preventive, emergency, and routine dental procedures are all suitable during various phases of a pregnancy, with some treatment modifications and initial planning.

 Before

embarking a dental treatment the possibility of pregnancy should be considered. Considerations for dental treatment should be made throughout the phase of pregnancy and subsequent breast-feeding. Pregnancy represents a relative contraindication to elective dental care, especially during the first trimester. Consultation with the patients physician before commencing any treatment is indicated, especially if there are any problems with this or prior pregnancies.

1ST TRIMESTER (1-12 WEEKS):

Fetal

organ formation and differentiation.

Most

susceptible to adverse effects of teratogens.

Avoid

all elective care but provide care as needed.

2ND TRIMESTER (13-24 weeks):

Fetal

growth and maturation. Safest period to provide dental care.

3RD TRIMESTER (25-40 weeks): Fetal growth continues. Focus of concern is risk to upcoming birth process and safety and comfort of pregnant woman.

Flat position may cause hypotension and hypoxia

Place a small pillow under right hip - left lateral displacement Head above feet

Pregnancy Gingivitis Pregnancy Epulis Increased Tooth Mobility Dental Caries Dry mouth Excessive salivation Tooth erosions associated with severe GERD or hyperemesis Dental Problems in relation to Labor and Delivery

Occurs commonly in the 2nd to 8th months Tendency to bleed very easily Treatment: Scaling, root-planing, currettage, OHI.

Occurs in up to 5% of women. Most common in buccal maxillary anterior areas. Usually starts in an area of gingivitis.

Treatment
Scaling

and root planing Excision if it is too large or bleeds too easily May regress spontaneously after pregnancy

Hormonal Affects

Increased tooth mobility Saliva changes

Increased bacteria
Gingival problems

Salivary changes

Decreased buffers Decreased minerals Decreasing flow first and last trimester Increased flow second trimester More acidic

Do NOT brush immediately after vomiting Rinse with

Water with baking soda Antacid Plain water

Eat some cheese

Timing of treatment for pregnant patients Dental radiation exposure Use of local anesthetics Prescription of common antibiotics and analgesics Nitrous oxide gas administration

 First

Trimester

Spontaneous miscarriages naturally occur more often in 1st trimester Avoid elective treatment that can be delayed Offer anticipatory guidance

Second

Trimester

The optimal time for dental treatment Organogenesis complete, fetus not large Easier to prevent than treat established disease

Third

Trimester

Late in term very uncomfortable (short visits) Position slightly on left side

First Trimester

Plaque control Oral hygiene instruction Avoid elective treatment; urgent care only

Second Trimester

Plaque control Oral hygiene instruction Scaling, polishing, curettage Routine dental care

Third Trimester
Plaque

control Oral hygiene instruction Scaling, polishing, curettage Routine dental care (after middle of third trimester, elective care should be avoided)

Although radiographs in the region of the jaws dont cause direct irradiation of the abdominal area, these should be restricted to clinical necessity, as should all radiographs. (Avoid X-Rays)

(General dental treatment): Avoid dental radiographs unless information about tooth roots or bone is necessary for proper dental care.
If radiographs must be taken, use proper shielding. use both abdominal aprons and thyroid collars, whenever practical, to minimize radiation exposure

 (Surgery)

In case of imaging, use of protective aprons and taking digital periapical films of only the areas requiring surgery can accomplish this. should be reassured that the risk is minimal. (When radiographs are necessary) is most susceptible to radiation between the 2nd and 6th week of gestation

Patients

fetus

A: Controlled human studies - no risk found B: Animal studies do not show risk, human studies not adequate or complete yet. C: Animal studies show risk but benefits outweigh risks. D: Evidence of fetal risk, benefits may outweigh risks X: Risk outweighs benefits

 idocaine + vasoconstrictor: most common local L anesthetic used in dentistry extensively used in pregnancy with no proven ill effects accidental intravascular injections of lidocaine pass through the placenta but the concentrations are too low to harm fetus prilocaine might cause methemoglobinemia Drug classes: B: lidocaine, prilocaine, etidocaine C: mepivacaine, bupivacaine Not yet assigned: Procaine

 Dental

procedures requiring general anesthesia or sedation should also be avoided due to the risk of fetal hypoxia. Avoid sedatives and Hypnotics as there may have deleterious effects on the fetus. All sedative drugs are best avoided in pregnant patients. Nitrous oxide should not be used during the first trimester but if necessary can be used in the second and third trimester as long as it is delivered with at least 50% oxygen, and not more that 9hr in a week

 penicillin

V and amoxicillin is preferred drug for mild to moderate infections widely used for many years with no ill effects no studies show penicillin to be teratogenic amoxicillin extensively used without harming the fetus Drug classes: B: penicillin, cephalosporins, erythromycin, clindamycin D: Tetracycline

 acetaminophen

is the analgesic of choice for all stages of gestation used to treat mild to moderate pain and fevers short term usage is believed to be safe avoid chronic and large doses of acetaminophen Drug Class: Not yet assigned

 ASA

is nonteratogenic but may cause maternal and fetal hemorrhage

and chronic doses during last trimester may result in premature closure of ductus arteriosus, fetal hypertension, anemia, and low birth weight ibuprofen in 3rd trimester because of possible adverse circulatory effects term use of codeine seems safe

large

avoid

short avoid

codeine late in gestation because of possible fetal respiratory depression and withdrawal symptoms

Fluoride No increased risk during pregnancy Xylitol No studies; no harm reported Chlorhexidine No increased risk during pregnancy

 Daily

2.2 mg tablet of sodium fluoride during 3rd through 9th months decreases caries rate in offspring. Safe and effective.