DENTAL MANAGEMENT IN PREGNANCY

PRESENTED BY

Feras Al-Halabi

Abdulaziz Al-Abdulwahed

Mohammed Al-Dhubaiban

SUPERVISED BY:
DR. Naveed Khawaja 13 - Jan- 2007
 Why do we discuss pregnancy ?

What is the definition of pregnancy ?

Is there any changes during pregnancy ? and,

will it affect dental treatment ?

Is X-ray safe for a pregnant patient ?

Can we prescribe drugs during pregnancy ?

Amalgam and pregnancy, is there any concern ?

How to manage pregnant women in dental chair ?

Why do we discuss pregnancy ?

Dentist throughout their professional

careers will face the responsibility of
providing appropriate care for the pregnant
women.

Understanding the changes occurring in the

pregnant patient is essential to deliver
treatment with optimum safety to both
mother & child.
 Definition
Pregnancy is the period of time between
fertilization of the ovum (conception) & birth.

Duration:
280 days = 40 weeks = 9 months.

changes are :
physical, physiological & psychological.
 The Changes of Pregnancy
The cardiovascular changes

Respiratory changes

Hematological change

Renal changes

Gastrointestinal changes

Psychological Changes

Oral Changes
 The Cardiovascular Changes
The main cardiovascular
Dental Concern:
changes are :
1. Supine hypotensive
1. An increase in the total syndrome
blood volume & cardiac Etiology
output in late 2nd & 3rd Signs & symptoms
trimester
Management

2. A decrease in blood
pressure in 1st trimester
 Respiratory Changes
Main changes are: Dental concern:

1. Dyspnea placing the patient

in supine position
may precipitate
2. Hyperventilation
dyspnea

3. An increase in tidal
volume
 Hematological change
Hematological Dental concern:
changes are :

An increase in : The patient

considered in hyper-
1. Plasma volume coagulable state
increasing the risk of
2. Red blood cells
thromboembolism.
3. White blood cells

4. All coagulation factors

except factors XI and
XIII
 Renal Changes
Renal Changes are : Dental concern:

1. Increased glomerular
filtration rate (GFR). It is advisable to ask
the patient to void
2. The increase in the renal their bladder before
plasma flow.
dental procedure.
3. Increase frequency of
urination.
 Gastrointestinal Changes
Main Changes are : Dental concern:

1. Avoid morning apointments.

1. Nausea and vomiting
2. Advice the patient to avoid
citris and fatty food.
2. Heartburn Pyrosis
3. Prescribe fluoride mouth
wash.

4. Advice patient to avoid

brushing.
 Psychological Changes
Main changes : Dental concern:

Anxiety The dentist should

minimize
Emotional instability disturbances &
frequent changes in noises adjust room
mood, ranging from
temperature
happiness to
depression.
minimizing the
irritability to the
patient.
 Oral Changes
Pregnancy gingivitis

Pregnancy tumor

Tooth mobility

Dental caries

Facial pigmentation (melasma)

Pregnancy gingivitis
 Pregnancy gingivitis

Effect of periodontal disease on the fetus :

chronic periodontal disease during pregnancy

increases the likelihood of preterm delivery by 4
to 7 fold.

positive correlation between periodontal disease

and low birth weight
Pregnancy tumor
Tooth mobility
Dental caries
 Dental caries
Effect of the caries on the fetus :

A recent study has found a significant

association between high levels of
actinomyces naeslundii, an oral bacterium
associated with dental caries, and low birth
weight and preterm delivery
Facial pigmentation (melasma)
 Dental Radiographs for
Pregnant Women

Do we use radiographs In pregnant patients?

 Dental Radiographs for
Pregnant Women

Radiographs Exposure in Gy
Full month series, 1 X 10-5
(18 intraoral D film, lead apron)
Panoramic film 15 X 10-5
Daily radiation (cosmic) 4 X 10-4
Skull 4 X 10-3
Chest 8 X 10-3
 Dental Radiographs for
Pregnant Women
Although, the practitioner must use the necessary
precautions, such as the use of :

1. High-speed film

2. Filtration,

3. Collimation

4. Lead aprons.

greatly reduce exposure and the use of digital radiography

 & the use of digital radiography will
greatly reduce the exposure
What About Teratogenicity ?
Depends on fetal age and the dose of
radiation.

Fetus age : 0-18 weeks

Dose of radiation : 0.01Gy , The chance of

teratogenicity is about 0.1%

Although the chance of teratogenicity is

minimal, the radiographic examination
should be limited to the effected tooth
Dental drug prescription &
pregnancy
 Dental drug prescription &
pregnancy
Category A includes drugs that have been studied in
humans and have evidence supporting their safe use.

Category B drugs show no evidence of risk in humans.

Category C includes drugs for which teratogenic risk

cannot be ruled out.

Category D includes drugs that have demonstrated

risks in humans.

Category X includes agents that have been shown to

be harmful to the mother or fetus.
 Dental drug prescription &
pregnancy
common drugs used :

Lidocaine xylocaine B
Aspirin C D in the 3 trimester
rd

Acetaminophen Panadol B

Ibuprophen B
delayed labor D in the 3rd trimester
Amoxcillin B
Clindamycin B
Metronidazole B
 Dental Amalgam & Pregnancy
Amalgam restorations
release vaporized mercury
during function.
Mercury is known to cause
congenital malformations

The amount of mercury

absorbed from amalgam
restorations (2.0-5.0g per
day) is minimal, not clinically
significant to the dental
patients, and well below the
toxic level )
 Dental Amalgam & Pregnancy
The U.S.Public Health
Service and Health
Canada advice dentists
that amalgam restorations
should not be removed
from or placed into a
pregnant patient. This
statement reflect the need
for more research and not
related to the potential
effect of amalgam on the
fetus.
Dental Management of Pregnant
Patient
Goals :

1. To develop efficient & effective

treatment & compatible with the
patients physical & emotional ability to
undergo and respond well to dental
care.

2. Maintain the safety & well-being of the

developing fetus or newborn.
 Dental Management of
Pregnant Patient

Patient assessment

Preventive strategies

Therapeutic strategies
 Therapeutic strategies
Classification of dental treatments :
1. Emergency treatment
2. Non emergency but necessary treatment
3. Elective treatment

Timing of dental treatments :

First trimester (conception to 14th week)
Second trimester (14th to 28th week)
Third trimester (29th week until childbirth)
 Timing of dental treatments
1st trimester (conception to 14th week)

Educate the patient about maternal oral changes

during pregnancy.

Emphasize strict oral hygiene instructions and

thereby plaque control.

Limit dental treatment to periodontal prophylaxis

and emergency treatments only.

Avoid routine radiographs. Use selectively and when

needed

morning appointments should be avoided.

 Timing of dental treatments
2nd trimester (14th to 28th week)

Oral hygiene, instruction, and plaque control.

Scaling, polishing, and curettage may be

performed if necessary.

Control of active oral diseases, if any.

Elective dental care is safe. But it is best to

deferred until after parturition.

Avoid routine radiographs. Use selectively and

when needed
 Timing of dental treatments
3rd trimester (29th week until childbirth)

Oral hygiene, instruction, and plaque control.

Scaling, polishing, and curettage may be

performed if necessary.

Avoid elective dental care during the second half

of the third trimester.

Avoid routine radiographs. Use selectively and

when needed.
 Points to be considered
1. Consultation with the patients physician should be undertaken.

2. Keep appointment times short.

3. Intermission in the middle of a sitting could be a great help, since

the pregnant patient feels discomfort remaining in one position too
long.

4. It is advisable to ask the patient to void the bladder just prior to

starting the dental procedure.

5. Emergency treatment should be performed regardless to the

pregnancy stage.

6. The dentist should adapt conversation and instructions to her

receptiveness. Also, it is recommended to minimize disturbance,
interruptions and noises

7. Finally remember It is important to remember that treatment is

being rendered to 2 patients: mother and fetus .
 Conclusion
In the 1st trimester rapid cell division and active
organogenesis occur; also the patient may suffer from
nausea and vomiting so it is advisable to limit dental
treatment to emergency and periodontal prophylaxis.

The 2nd trimester is considered the safest period for

providing dental care because organogenesis is
completed and the fetus has not grown to a potentially
uncomfortable size.

Lastly, in the 3rd trimester the pregnant patient

experience increasing fatigue and finds it increasingly
difficult to assume and maintain a comfortable
position. So, limited dental treatment is advisable.