Pregnancy Precautions in dental clinic

1. Pregnancy Precautions
In Dental Clinic
Pregnancy Myth:
A mother loses a tooth for every baby
Presented by,
Dr. Arya V Devi

2. Pregnancy Related Oral Health Problems
Pregnancy Gingivitis
Pregnancy granuloma
Increased Tooth Mobility
Dental Caries
Erosion
Candidiasis

3. 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

4. Timing of Dental Treatment During Pregnancy -
From Little and Fallace
First
trimester
Plaque control
Oral hygiene instruction
Scaling, polishing,
curettage
Avoid elective
treatment; urgent care
only
Second
trimester
Plaque control
Oral hygiene instruction
Scaling, polishing,
curettage
Routine dental care
Third
trimester
Plaque control
Oral hygiene instruction
Scaling, polishing,
curettage
After middle of third
trimester, elective care
should be avoided

5. Supine hypotensive syndrome
Compression of inferior vena cava &
aorta
Decrease venous return to heart
Decrease uteroplacental perfusion and
fetal distress

6. Symptoms
Sweating
Nausea
Weakness
Sense of lack of air
Drop in blood pressure
Bradycardia
Possible loss of consciousness

7. Prevention
Left lateral decubitus position
Elevation the right hip 10~12cm
Place a small pillow under right hip – left
l lateral displacement

8. Risks of Dental X-Rays
1 rad of utero radiation exposure has
been estimated to be approximately
0.1% malignant disease
Increased 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

9. Exposure can be limited by:
Lead apron shielding
Use long cone
Use proper collimation &
shielding
Modern fast film
Avoid retakes

10. (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

11. Category B (for best!)
Paracetamol, Ibuprofen,
Naproxen
Category C (use with
caution):
Paracetamol with
codeine or hydrocodone
Paracetamol 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
Trimester
Analgesics

12. 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

13. Penicillin V
Amoxicillin
Erythromycin (base
form)
Cephalexin,
cephalosporin
Clindamycin
Metronidazole
Ind
Doxycycline
Tetracycline
Erythromycin
(estolate form)
Vancomycin
Contr
a
Antibiotics

14. The Problem With Tetracycline
Accumulates in
bones and
chelates
calcium
Inhibits bone
growth
Discolors
teeth

15. 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

16. Misoprostol
Potent uterine stimulant
(has been used to induce
abortion)
May be teratogenic
Ulcer healing
drugs

17. Thank you
for your Attention……
