While carrying out dental treatment in pregnancy, the dentists usually follow a certain set of dental guidelines for pregnant women in order to make sure that there is a proper balance established between the health care of the woman in question and the safety of the fetus inside.
The importance of maintaining good oral hygiene becomes more relevant than ever, in the pregnant woman, thanks to the hormonal changes that take place during pregnancy.
Before looking at these dental guidelines for pregnant women, let’s see what is it that makes pregnant women different than the normal ones, physiologically.
Physiological Changes That Take Place in Pregnant Women
There are multiple hormonal changes that take place in a woman when she gets pregnant. There are abrupt increases in Estrogen and Progesterone hormone levels.
It has been believed that a woman produces more estrogen during one pregnancy than throughout her entire life when she is not pregnant.
There may be an increase of 20% to 40% in the cardiac output. Tachycardia (increase in the heart rate, usually more than 100 beats per minute) and heart murmurs are also common findings in pregnant females.
There may be an increase of 30% in the blood volume.
There is an increase in the respiratory rate.
Dental Guidelines for Pregnant Women
These are the guidelines commonly followed by the dentists around the world when treating a pregnant woman for dental problems.
First, let’s see what are the precautions to be taken in each trimester.
- In the first trimester, the fetus is especially susceptible to teratogenic influence and abortion. So it is better to avoid major dental procedures and surgical procedures during the first trimester unless there is an emergency.
- The second trimester is the best suited for dental treatments. Performing dental treatments in the second trimester ensure that the fetus gets the most benefit and the pregnant woman gets the optimal advantage.
- In the third trimester, the dental treatments should be avoided if possible, except for emergency treatment. The risks of hypertension and syncope are the greatest in the third trimester, due to the fetal position. Syncope is a temporary loss of consciousness due to insufficient blood flow to the brain. It is also commonly called ‘fainting’ or ‘passing out’.
- There may also be an increased risk of anemia and eclampsia in the third trimester.
Specific Guidelines To Be Followed When Giving Dental Treatment in Pregnancy
- Preventive dental prophylaxis (scaling and cleaning) should be undertaken at the beginning of the second trimester and the third trimester.
- Elective dental care should be postponed if possible. Elective dental procedures are the procedures that are chosen by the dentist or the patient, which are advantageous but are not urgent.
- Nondeferrable treatments should be carried out during the second trimester. For example, Caries removal and restoration.
- Extra care should be taken in females with past history of abortions when treating them for dental problems.
- It is best to avoid radiographs/x-rays whenever possible. If it is a must, radiographs should be taken with the lead shielding covering the patient and the fetus.
- You should consult with your physician and get medical clearance for the use of certain drugs like local anesthesia, antibiotics, and analgesics prior to the visit to the dentist’s office. Lidocaine, Penicillin, Erythromycin, and Acetaminophen are the commonly approved drugs by the physicians.
- When using local anesthesia the dentist may use the plain lidocaine solution, the one without adrenaline. Why? Because adrenaline is a vasoconstrictor and it may increase the blood pressure in the pregnant woman who may already be suffering from hypertension. So all kind of vasoconstrictors should possibly be avoided.
- The use of Diazepam, Nitrous oxide, and Tetracycline should be strictly avoided.
- The dental procedures requiring a longer chair time should be avoided in pregnant women.
- The sitting up position is the best for pregnant women undergoing dental treatment. Care should always be taken to keep the head level higher than the heart, to avoid unnecessary pressure on the heart, especially Vena Cava and Aorta.
- The patient can also be turned to the left side or the left lateral position during the dental treatment.
- As mentioned earlier radiographs/x-rays should be avoided. If it is unavoidable, one IOPA or OPG is permitted provided proper protection using a lead shielding is used.
- If the patient loses consciousness during dental treatment, she should be made to sleep on her left side/left-lateral position with her head and the legs kept at an elevated level. Oxygen may be administered in some cases and glucose can also be used to provide instant energy.
- Oropharyngeal suction may come in handy in patients with symptoms of morning sickness.
General Complications Of Pregnancy You Need To Know Before Visiting Your Dentist
Miscarriages or Spontaneous Abortions
There is almost a 15% chance of spontaneous abortion, that may take place during the first trimester. More than 80% of spontaneous abortions happen before 12 weeks of pregnancy. So try to avoid excessive stress during this period. It is time to take rest and relax. Try to avoid dental treatments during this phase.
This is a condition where the person becomes unconscious temporarily due to insufficient blood flow to the brain. This usually happens in people with low blood pressure, when because of the low pressure the heart can’t pump enough blood to the brain.
When a fertilized egg gets implanted outside the uterus, the condition is called ectopic pregnancy. If this occurs in the Fallopian tube the condition is called ‘tubal pregnancy’.
Ectopic pregnancy is usually characterized by abdominal pain and profuse bleeding.
When the baby is delivered before the mother reaches the 37th week of pregnancy, the birth is termed as ‘premature birth’ and the baby is called ‘ premature baby’.
Preeclampsia and Eclampsia
If the pregnant female has high blood pressure and if there are either large amounts of protein in the urine or other associated organ dysfunction, the condition is termed as ‘Preeclampsia’.
Eclampsia is the onset of the seizure, in preeclamptic patients. Preeclampsia is not a very common condition and may affect 5% of the pregnant women.
Oligohydramnios and Polyhydramnios
Oligohydramnios is a condition characterized by the deficiency of amniotic fluid. Polyhydramnios is a condition characterized by an excess of amniotic fluid in the amniotic sac.