Pregnancy Precautions In Dental Clinic
Pregnancy Myth:A mother loses a tooth for every
baby
Presented by,Dr. Arya V Devi
Pregnancy Related Oral Health Problems
Pregnancy Gingivitis
Pregnancy granuloma
Increased Tooth Mobility
Dental Caries
Erosion
Candidiasis
Treatment Timing
•Avoid elective treatment that can be delayed•Offer anticipatory guidance
First Trimester
•The optimal time for dental treatment•Organogenesis complete, fetus not large
Second Trimester
•very uncomfortable (short visits)•Position slightly on left side
Third Trimester
Timing of Dental Treatment During
Pregnancy - From Little and Fallace
First trimester
Plaque controlOral hygiene instruction
Scaling, polishing, curettage
Avoid elective treatment; urgent care
only
Second trimester
Plaque controlOral hygiene instruction
Scaling, polishing, curettage
Routine dental care
Third trimester
Plaque controlOral hygiene instruction
Scaling, polishing, curettage
After middle of third trimester, elective care
should be avoided
Supine hypotensive syndrome
Compression of inferior vena cava & aorta
Decrease venous return to heart
Decrease uteroplacental perfusion and fetal distress
Symptoms Sweating Nausea Weakness Sense of lack of airDrop in blood pressureBradycardiaPossible loss of consciousness
Prevention
Left lateral decubitus position
Elevation the right hip 10~12cm
Place a small pillow under right hip – left l lateral displacement
Risks of Dental X-Rays
1 rad of utero radiation exposure has been estimated to be approximately
0.1% malignant diseaseIncreased frequency of malignancy disease in
childhood e.g. leukemia
Birth of a deformed child
A dental periapical film 0.00001 rad (0.1 mrad)
Death of embryo
Exposure can be limited by:
Lead apron shielding
Use long cone
Use proper collimation & shielding
Modern fast film
Avoid retakes
(F.D.A) classification system
Category Drug
A Controlled studies showed no risk to the patient
B Either animal studies have shown no risk
C Potential benefit must be greater than the risk to the fetus
D Evidence of fetal risk proven
X Proven fetal risk clearly outweighs any potential benefit
Category B (for best!)Paracetamol, Ibuprofen,Naproxen
Category C (use with caution):Paracetamol with codeine or hydrocodoneParacetamol with oxycodone
1st and 2nd
Trimester
Causes delivery problems:Aspirin (C/ 3D)Ibuprofen (B/3D)Naproxen (B/3D)
Causes neonatal respiratory depression and opioid withdrawal:Codeine (C/3D)Hydrocodone (C/3D)Oxycodone(C/3D) Avoid
During the
Third Trimeste
r
Analgesics
Sedatives/Anxiolytics (e.g. Diazepam ) are rated D and can cause oral clefts with prolonged exposure.
Nitrous oxide should not be used in 1st trimester (If used in 2nd and 3rd, do not go below 50% O2)CHRONIC exposure may result in fetal loss and infertility
Sedatives
Penicillin VAmoxicillinErythromycin (base form)
Cephalexin, cephalosporinClindamycinMetronidazole
Ind
DoxycyclineTetracycline
Erythromycin (estolate form)Vancomycin
Contra
Antibiotics
The Problem With Tetracycline
Accumulates in bones and
chelates calcium
Inhibits bone growth
Discolors teeth
Lidocaine + vasoconstrictor: most common local 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
Local Anesthetics
Misoprostol
Potent uterine stimulant (has been used to induce abortion)
May be teratogenic
Ulcer healing drugs
Thank you for your
Attention……