Dental Care In Pregnant Patients

“A pregnant women is not be treated as a single patient but as two”

It is the responsibility of a clinician to provide a safe and effective dental care for the mother, while considering the safety of the fetus or newborn. One has to understand the physiology of pregnancy, fetal development, potential complications of pregnancy.

The First trimester is the period of organ formation. Plus, spontaneous abortions do occur during this period. Therefore, the greater risk of susceptibility to stress and teratogens occurs during this time.

The Second trimester is the period when organogenesis is completed and therefore the risk to the fetus is low. Most of the dental procedures are safely accomplished during this period.

The Third trimester in which there is no risk to the fetus during this trimester but the pregnant mother may experience an increasing level of discomfort. Fetal sensitivity to the environment is most critical after the 30th week.

In any case if emergency treatment is indicated, it can be performed anytime during pregnancy to eliminate any sort of physical or emotional stress. The pain and anxiety precipitated by a dental emergency may be more detrimental to a fetus than the treatment itself.

LOCAL ANESTHETICS/G.A. DURING PREGNANCY

• These treatments are safe during pregnancy  such as 2% lidocaine with a vasoconstrictor of epinephrine in a concentration of 1:100,000.
• Lidocaine and prilocaine are category B drugs, whereas mepivacaine, Articaine and bupivacaine are in category C.
• Neither general anesthesia nor intravenous sedation should be used at all during pregnancy.
• Administration of nitrous oxide should be avoided specially during first trimester.

MEDICATIONS DURING PREGNANCY

Certain frequently used drugs are distributed from the maternal plasma through the placenta to the fetus, or to breast milk, exposing the neonate to potentially dangerous concentrations. These drugs are found to be excreted in human breast milk.

• Category A includes drugs that have been tested in humans and there is evidence to say that they are 100% safe to use.
• Category B includes drugs that are relatively safe to use. (e.g., paracetamol and amoxicillin).
• Category C includes the majority of drugs, such as aspirin, which should be used with caution.
• Category D includes drugs such as tetracycline, which should be avoided during pregnancy

Many analgesics, including acetaminophen and aspirin are safe. The exception is the third trimester when a potential bleeding is of concern.

Although some antibiotics can be harmful to developing babies, antibiotics such as penicillin, amoxicillin and clindamycin are labeled category B for safety during pregnancy by the FDA. Category A antibiotics are the safest, while categories C, D, and X are increasingly harmful to fetuses.

Sedatives/ barbiturates are absolutely contra-indicated.

DENTAL X-RAYS DURING PREGNANCY

It’s safe to take an X-ray of a pregnant women during at any stage during the pregnancy but it should be judiciously taken, especially in the sensitive first trimester when organs are being formed.

But it is essential  to cover the patient by a leaded apron that minimizes exposure to the abdomen.

The clinician will also cover the throat of the patient with a leaded collar to protect the thyroid from radiation.

CLEANING AND SCALING PROCEDURES

Going to the dentist for a routine cleaning and checkup is both safe and essential for a pregnant patient as she has more chances of developing gingivitis during her pregnancy tenure.

This will further allow to stop progressing periodontal disease, which can affect the patient as well as their baby’s health.

DENTAL FILLINGS

Dental amalgam fillings release mercury vapour in the mouth, especially during chewing which may cross the placenta through blood circulation.

Filling materials that are preferred instead of amalgam include glass-ionomer cement, composite resins or porcelain.

ORAL CARE TIPS FOR HEALTHY PREGNANCY

• • Do visit for regular check-ups at respective dental clinic

 

• • Use a soft toothbrush and floss gently to prevent injury to delicate gum tissues

 

• • Use an antiplaque toothpaste twice a day and floss daily and rinse with an alcohol-free mouthwash

 

• • Rinse your mouth to keep acids from affecting your teeth and gums

 

• Follow a healthy diet including plenty of calcium, phosphorus, protein, and vitamins A, C and D.