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Pregnancy And Dentistry
It’s one of the most exciting, most elating things on earth. In a way, yes it’s a miracle. We’re talking about having a baby. But pregnancy may bring some questions along.
A pregnant lady may be in doubt about going to a dentist, since no mother-to-be want her child to be exposed to chemicals and other stuff. So, best way to break these kind of doubts, is to know what is right and what is wrong for a pregnant.
Please check out these headlines:
- The most common drugs used by dentists have been shown to be safe for use in pregnancy with a few exceptions.
- The second trimester through the first half of the third trimester is the safest time to provide dental treatment.
- During a patient’s first trimester, start a preventive care program consisting of plaque control and oral hygiene instruction.
- Morning sickness is common and may cause permanent damage to the tooth enamel. The patient should rinse her mouth with water after vomiting rather than causing further damage with toothbrush abrasion.
- In the third trimester, scaling and prophylaxis may be repeated to minimize hormonal gingival changes.
Treating A Pregnant Patient
Several common things that take place during pregnancy can pose difficulty for a dental patient. Let’s call them alterations in normal physiology, and pregnancy-related pathology. As a woman goes through the 40 weeks of a full-term pregnancy, her body adapts to the baby and works harder. Vital signs may show a slight increase as all systems work for two. In some cases, a dangerous elevation of blood pressure must be addressed quickly, and for some women, total bed rest is prescribed. This elevation in blood pressure during pregnancy is called preeclampsia or eclampsia in more severe cases. While many women see their obstetricians or gynaecologist regularly, taking their blood pressure in a dental office provides another opportunity to intercept this potentially life-threatening condition before serious damage takes place to a woman or her baby.
Sometimes the increased blood volume and cardiac output during pregnancy leads to a heart murmur. This particular murmur does not need antibiotic premedication for dental treatment, but if a woman had a heart murmur before her pregnancy, the standard rules still apply. Other cardiovascular issues may arise: anemia, edema of the ankles, and shortness of breath are common but usually don’t need any special alterations of dental treatment.
As a baby grows, it pushes its mother’s stomach and diaphragm upward and her intestines decrease in motility. She may have an increased gag reflex that could cause problems for any procedure, especially impressions. Some women may have problems with gastroesophageal reflux and constipation. Wheezing may be a sign of acid reflux into the trachea and bronchi. Positional discomfort is evident in sleeping on one’s side or in a semi-reclining position.
Throughout pregnancy, hormones fluctuate. In some women, a change in pigmentation becomes evident as a mask across the malar areas of the face. Other changes include the loosening of the ligaments, especially in the pelvis and the knees, but also in the periodontal ligament. The development of pregnancy gingivitis and gingival granulomas is also believed to be caused by these changes in hormones.
Slight osteoporosis may develop in the jaw, although it’s likely that we do not have the equipment to measure these subtle changes. No calcium is lost from the teeth for the baby’s development, but it is possible that mom may lose some of her bone density to help supply the baby’s skeletal requirements.
Morning sickness is common and may cause permanent damage to the tooth enamel. The patient should rinse her mouth with water after vomiting rather than causing further damage with toothbrush abrasion.
As previously mentioned, pregnancy may lead to development or worsening of several oral problems such as gingivitis, pyogenic granuloma formation, erosion, and tooth mobility. Proper diagnosis of these conditions will lead to the right treatment, therefore increasing the mother and baby’s overall health.
Modifications of dental treatment
During a patient’s first trimester, initiate a preventive care program consisting of plaque control and oral hygiene instruction. Simple scaling and prophylaxis may be accomplished, but no elective treatment should be started. Only emergency dental needs should be considered during this trimester. The baby’s organs develop during this time and are most sensitive to radiation and chemicals. Proper radiograph technique using a lead abdominal shield and the lowest dose possible (fast film or digital) produce a fetal exposure that is extremely low, probably on the order of one ten thousandth the amount implicated in the alteration of genetic material, malformation, or spontaneous abortion.
At no time and for no patient should radiographs be used cavalierly, but for many patients, the postponement of radiographs caters more to their emotional health. When indicated to treat an emergency, the fewest number of images necessary to obtain the correct diagnosis should be obtained.
The second trimester through the first half of the third trimester is the safest time to provide dental treatment. Periodontal maintenance and preventive care and simple restorative procedures that will eliminate potential problems and control active disease may be performed. Complex and elective dental care is best deferred until after the baby is born.
In the third trimester, scaling and prophylaxis may be repeated to minimize hormonal gingival changes. Supine position may cause the fetus to occlude the blood supply from returning to the heart, leading to a loss of consciousness. Elevation of the right hip of the mother in the dental chair will allow the inferior vena cava to stay patent and avoid this pooling of the blood in the legs. If she does start to feel faint, the patient should position herself on her side. Emergency dental treatment should be provided, as the mother’s severe pain, infection, or both can cause problems for the baby.
The most common drugs used by dentists have been shown to be safe for use in pregnancy with a few exceptions. Lidocaine with epinephrine is safe, but as with any patient, proper aspiration to avoid intravascular injection is necessary for effective anesthesia and to avoid the cardiovascular side effects of epinephrine. Too rapid a heartbeat and systemic vasoconstriction can lead to fetal hypoxia.
Penicillin, clindamycin, and cephalosporins are safe antibiotics and should be prescribed when indicated. Tetracyclines of any type should be avoided during pregnancy and breastfeeding to avoid any discoloration of the teeth.
Analgesia presents a more difficult decision, but acetaminophen is OK for most patients. Aspirin and other nonsteroidal, anti-inflammatory drugs (e.g., ibuprofen) should not be prescribed. For severe pain, oxycodone is considered safe. Codeine, hydrocodone, or propoxyphene are probably safe for a short time. Nitrous oxide is controversial but probably safe as long as there is oxygen administered as well.
The recent data on carbamide bleaching solutions continues to be cautious and it is not recommended during pregnancy. For more information about medications and their use in pregnancy, check any drug reference for the A, B, C, D, X classification. For drugs that have a C or lower rating, consultation with a physician is recommended.
When is a consultation necessary?
- I ask pregnant patients several questions before I do any dental treatment.
- Are you seeing a physician for prenatal care?
- What is your due date?
- Have you had any previous complications of prior pregnancies?
- Is this considered a high-risk pregnancy?
A consultation with a physician is necessary if there are any irregularities or if a patient’s blood pressure is elevated above 140 over 90. I typically inform a patient’s obstetrician if I’m going to prescribe narcotics, and most OBs are grateful. My concern for the patient’s well-being as well as the baby’s allows the mom-to-be to feel relaxed and have confidence in the treatment. It is best to avoid any dental emergency, but efficient. compassionate care reduces stress. Healthy teeth and gums lead to better nutrition and reduce inflammatory chemicals in the body. There should be no teeth lost just because a woman has a baby.
Xiong X, Buekens P, et al. Periodontal disease and adverse pregnancy outcomes: a systematic review. Obstetrical and Gynecological Survey 2006; 61(5):307-309.
Offenbacher S, Boggess KA, et al. Progressive periodontal disease and risk of very preterm delivery. Obstetrics and Gynecology 2006; 107(1):29-36.
Periodontal Disease and the preterm, low-birth-weight baby
Since the first report of a connection between periodontal inflammation and complications in pregnancy was reported in the 1990s, there has been much speculation why. It remains to be seen how exactly, but the identification of inflammatory markers seems to be a strong candidate. Other research is needed with a much larger number of patients, and there are many variables with these women.
One recent review of 25 studies suggested an association between periodontal disease and adverse pregnancy outcomes, including miscarriage and preeclampsia.1 The Oral Conditions and Pregnancy (OCAP) study2 quantified the incidence of preterm birth at 11.2 percent among periodontally healthy women, compared to 28.6 percent in women with moderate to severe periodontal disease.
It is difficult to evaluate the sociological part of poor oral health, that is, how much are poor oral hygiene and poor dental care signs that other factors in systemic health are neglected? Is a person who doesn’t floss also avoiding proper nutrition, exercise, and health care? Periodontists are working closely with obstetricians to continue the search for etiologies.
(Based on the article by Wendy S. Hupp, DMD)