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Authors: Dr. Deepshikha Rathore, Dr. Shakti Singh Deora

INTRODUCTION

The “echo boom” of the 1980s has increased the incidence of pregnancy in our patient population. When a gravid patient has an urgent or emergent problem, knowledge of the unique aspects of pregnancy is necessary for optimal patient care. Maternal health is protected by an appreciation of the physiologic changes and demands of pregnancy. Fetal well-being is protected by avoidance of teratogens, fetal anoxia, and premature labor. Attention to these factors allows the clinician recognize, customize, and appropriately alter dental therapy to provide treatment with minimal maternal or fetal risk.

Preventive dental cleanings and annual exams during pregnancy are not only safe, but are recommended. The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums. Preventive dental work is essential to avoid oral infections such as gum disease, which has been linked to preterm birth.

COMMON ORAL MANIFESTATIONS

The inflammatory changes are usually restricted to the gingiva and probably do not cause permanent changes in periodontal tissues more often than those in the non-pregnant state. Although it is widely believed that pregnancy is harmful to the teeth, the effect of pregnancy on the initiation or progression of caries is not clear. Previous studies, however, indicate that the teeth do not soften, i.e. no significant withdrawal of calcium or other minerals occurs in the teeth.

MANGEMENT
a. Clinical Management
  • Thorough medical history including pregnancy complications, previous miscarriages, recent history of cramping , spotting, or pernicious vomiting
  • Nutritional counseling
  • Healthy oral environment
  • Optimal oral hygiene
b. Plaque control
  • scaling, polishing, and root planning may be performed through out pregnancy
  • Avoid use of high-alcohol-content antimicrobial mouth rinses
c. Dentoalveolar and elective procedures: -

The safest course of action is to postpone all unnecessary dental work until after the birth.

»» Controlling active disease

»» Eliminate problems that could cause complications in late pregnancy.

  1. To avoid in 1st trimester and last half of 3rd trimester (to avoid the risk of premature labor) except for plaque control. However, sometimes emergency dental work such as a root canal or tooth extraction is necessary.
  2. Elective treatments, such as teeth whitening and other cosmetic procedures, should be postponed until after the birth. It is best to avoid exposing the developing baby to any risks, even if they are minimal.
  3. 2nd trimester safest for routine dental care
  4. Avoid prolonged chair time to prevent supine hypotension syndrome
 
 

Turning the patient on her left side or a 6 inch soft wedge can be placed on the patient’s right side when reclined for clinical treatment.

d. Dental radiographs—
  • It is considered safe with the use of features such as high speed film, filtration, collimation and lead apron.
  • Still not to have any irradiation during pregnancy, esp. in 1st trimester.
  • Fetal organ development occurs during the first trimester; it is best to avoid all potential risks at this time if possible.
  • If non-emergency dental work is needed during the third trimester, it is usually postponed until after the birth.
e. Medications:-

Currently, there are conflicting studies about possible adverse effects on the developing baby from medications used during dental work. Lidocaine is the most commonly used drug for dental work. Lidocaine (Category B) does cross the placenta after administration.

If dental work is needed, the amount of anesthesia administered should be as little as possible, but still enough to make you comfortable. If you are experiencing pain, request additional numbing. When you are comfortable, the amount of stress on you and the baby is reduced. Also, the more comfortable you are, the easier it is for the anesthesia to work.

Dental work often requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled category for safety in pregnancy, may be prescribed after your procedure.


FDA classification: -- to determine the category of safe drugs during pregnancy
f. Oral and maxillofacial surgery for pregnant patients:-
  • Major oral surgical procedures should be postponed until after the delivery.
  • Pregnancy tumors when are painful, interfere with mastication, or continue to bleed or suppurate may require surgical intervention before delivery.
g. Infection: -

Dental work such as cavity fillings and crowns should be treated to reduce the chance of infection.

h. Pregnancy diabetes:-

Periodontal disease is a chronic infection of the gums and mouth. Gestational diabetes is an inability to process dietary sugars normally during pregnancy. Gestational diabetes puts women and their babies at increased risk of injury and illness. More severe periodontal disease poses additional threat to pregnant diabetics

i. Pre-eclampsia :-

is a medical condition where hypertension arises in pregnancy (pregnancyinduced hypertension) in association with significant amounts of protein in the urine

TREATMENT AND PREVENTION

The only known treatments for eclampsia or advancing pre-eclampsia are abortion or delivery, either by induction or Caesarean section. However, postpartum pre-eclampsia may occur up to 6 weeks following delivery even if symptoms were not present during the pregnancy

  1. Women with preeclampsia or eclampsia can be stabilized temporarily with magnesium sulfate intravenously to forestall seizures while steroid injections are administered to promote fetal lung maturation.
  2. Dietary and nutritional factors: Low levels of vitamin D may be a risk factor for preeclampsia and calcium supplementation in women with low-calcium diets found no change in preeclampsia rates but did find a decrease in the rate of severe preeclamptic complications. Low selenium status is associated with higher incidence of pre-eclampsia. Some other vitamin may also play a role.
  3. Aspirin supplementation: Aspirin supplementation is still being evaluated as to dosage, timing, and population and may provide a slight preventative benefit in some women
  4. Exercise
  5. Immunological tolerance: Research on the immunological basis for preeclampsia has suggested that continued exposure to a partner’s semen has a strong protective effect against pre-eclampsia, largely due to the absorption of several immune modulating factors present in seminal fluid
CONCLUSION

Despite the increased prevalence of dental problems among pregnant women, few women seek dental services in this population, which can be primarily attributed to women’s erroneous beliefs regarding the safety of dental examination. Therefore, there is an imperative need to offer oral health education and develop preventive programs for women of reproductive age.

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