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Dentistry during pregnancy

Dental treatment during pregnancy and while nursing
Dental treatment during pregnancy and while nursing
Dentistry during Pregnancy and while Nursing
Although pregnancy is a normal, healthy state of being and not a disease, it poses a challenge for the dentist.

On one hand, the dentist must be careful not to cause damage to the developing fetus or the pregnant mother during the treatment, with radiation or by administering medication. On the other hand, ensuring that proper dental hygiene is maintained and that the teeth are in good condition is crucial to the health of the developing fetus. A direct correlation has been proven to exist between women with periodontitis and an increased chance of lower fetal birth weight and premature births. Therefore, the dentist treating a pregnant woman must carefully weigh whether the advantages of performing various treatments that the patient needs are greater than the potential danger they may pose.

Luckily, there are very few components of dental treatment performed at a professional dental clinic that have any influence on the health of the pregnant woman and her fetus.


Physical Changes that the Dentist Takes into Consideration when Performing Dental Treatments during Pregnancy:

1. There is a higher tendency to faint due to the change of position.

2. Lying down for a prolonged period of time during the dental treatment causes greater discomfort.

3. There are psychological changes related to fatigue or depression.

4. There is a slight decrease in blood clotting – there may be slightly more bleeding during dental treatments while pregnant.

5. There is an increase in the quantity of white blood cells, which can be confusing when performing blood tests to determine the presence of an infection.

6. There is a decrease in the response of the immune system during pregnancy and a large increase afterwards – this may cause more dramatic infections during pregnancy and a more acute inflammatory response afterward.

7. There is a tendency to contract gestational diabetes mellitus in 2-6% of women. This diabetes can sometimes continue after the pregnancy as well. Gestational diabetes increases the risk of infection and low fetal birth weight.


Dental Treatments during Pregnancy – Modifications Directly Connected to the Dental Treatment and the Oral Cavity:

1. An imbalanced diet and eating at irregular intervals because of increased appetite and the need for sugar may lead to a failure to maintain proper oral hygiene, resulting in severe caries.

2. Changes to the sense of taste can sometimes cause a “funny feeling in the mouth.”

3. An increased gag reflex obligates the dentist to perform the treatment more gently and carefully.

4. Vomiting can cause damage to the teeth due to the high acidity of the digestive juices in the stomach. This is usually a problem in the first trimester.

5. An increase in the breathing rate and the need for air during pregnancy will require the dentist to take longer breaks while performing dental treatments.

6. Supine Hypotensive syndrome is a condition that occurs in the final stages of pregnancy. The syndrome is characterized by a decrease in blood pressure, a slower heart rate, sweating, nausea, weakness and a feeling of gasping for breath. These symptoms, if they occur, happen while the woman is laying down (Picture 1) because of the pressure that the fetus is causing to one of the main blood vessels in the body, causing a decrease in blood flow to the heart. In these cases, the woman may faint. The solution to the problem is simple – while performing dental treatments during pregnancy, the woman can lie on her left side, preventing the pressure to the blood vessel and thus allowing for proper blood flow during the course of a long treatment.
As a rule, the most problematic period of the pregnancy in terms of dental treatments is the first trimester, while the best period for dental treatments is the second trimester. Despite this rule, there is sometimes a need to perform dental treatments even when the timing is not ideal, such as in cases of severe pain or an infection in the oral cavity that could affect the health of the fetus.


Preventative Plan:

Our main objective when treating a pregnant woman is to maintain maximum oral hygiene in order to lessen the number of bacteria in the oral cavity and as a result, lessen the inflammation sometimes characteristic in pregnant women due to hormonal changes. Studies performed over the past 25 years showed that women with lower levels of bacteria tended to give birth to children who had less caries (in the study, the researchers checked for the presence of bacteria from the streptococcus family, known to cause caries).

The preventative plan will include:

1. More frequent visits to the dental hygienist for the purpose of receiving instruction regarding proper brushing and keeping the bacterial plaque levels low.

2. A balanced diet, with the goal being to decrease consumption of sugars and highly sweetened soft drinks.

3. Sometimes the pregnant woman is given antibacterial mouthwashes even at the early stages of the pregnancy in order to reduce the number of bacteria in the mouth.

4. Research has proven the affectivity of the use of fluoride during the second and third trimesters, showing that 97% of children born to women who used fluoride (such as those in drinking water, toothpaste and mouthwash) reached the age of 10 with no cavities. The same study also showed that the use of fluoride was linked to higher birth weight and a decrease in preterm birth.


The Timing of Dental Treatments during Pregnancy:

Unfortunately, not all women become pregnant when the state of their teeth is in fair condition. Often, there is a need to do a “first aid” treatment. It is important to note that treatment of a severe infection or pain should never be neglected because of pregnancy!

Table 1 Shows the Best Timetable for Performing Dental Treatments during Pregnancy in each Trimester




Dental Treatments during Pregnancy – X-Ray Radiation during Pregnancy

People are often worried about the pregnant mother and developing fetus being exposed to radiation. This fear is legitimate, but regarding X-rays used in dental treatments, things are a bit different.

The degree of radiation used in dental treatments is miniscule (especially when a digital X-ray is used – see an interesting article on the subject on the site – Digital X-ray) in comparison with all other types of radiography (Table 2). Research shows that radiation ranging between 5-10 cGy (centigray) during the course of the entire pregnancy does not cause any damage to the fetus. The radiation emitted in a set of 20 regular dental X-rays (non-digital) is approximately 0.00001 cGy. As long as the dentist abides by the rules of safe radiography – meaning, the use of a regulation lead vest and not exposing to radiation when not necessary for the treatment, there is no problem at all with performing dental X-rays during pregnancy.


Table 2 Compares the Types of X-rays and the Radiation to the Fetus




Dental Treatments during Pregnancy – Medications:

The primary danger expressed by those worried about the use of medications during pregnancy is the passing of the drug to the fetus via the placenta and the risk of this causing danger to the fetus. We should note that in order for the drug to be dangerous to the fetus, it must cross the placental barrier as well as be at a dosage that endangers the fetus in any way. An additional danger that must be taken into account is medications that could suppress the mother’s respiration rate, a situation that could cause a lack of oxygen supply to the fetus, putting it in danger.

In regards to the use of medications as well, the dentist must weigh out the benefits as compared to the potential risk. Ideally, it would be preferable not to give a pregnant woman any medications, especially during the first trimester. Therefore, most of the drugs administered today to pregnant women are those which, if not used, the potential danger to the mother (and fetus) is great.

In order to define the risk level of medications, the American Food and Drug Administration (FDA) categorized the medications according to the risk level they pose to the developing fetus:

Class A – Medications which, in research conducted on humans, exhibited that they do not pose a danger, and the potential of them causing damage is very small.

Class B – Medications which, in testing conducted on animals, exhibited that they do not cause damage to the fetus, but testing on humans was not conducted. Another way of defining Class B drugs is medications which, when used on animals, were shown to cause damage to the animals, but damage was not shown in research done on humans. Most of the medications fall under this category because the scientific world is hesitant about performing experiments on humans using drugs that may cause damage to the fetus.

Class C –Medications which have caused damage in animals but research on humans was not performed, or medications which have not been tested at all on humans or animals.

• Class D –Medications regarding which there is testimony of damage caused to fetuses only in certain conditions. These medications are sometimes still given to pregnant women.

Class X –Medications which caused definite damage in humans and the benefit of using them does not outweigh the potential risk to the fetus. These drugs are not used during pregnancy.

Table 3 shows a Summary of Common Medications used in Dentistry and their Risk Level Classification



*This table should not be used as a recommendation to use or not use the medications! Consult your dentist before beginning any treatment involving the use of medications during pregnancy.


Sources:

1. James W. Little, Donald A. Falace – Dental Management of the Medically Compromised Patient, Seventh Ed., Chapter 18 “Pregnancy and Breastfeeding.”

2. “Wise, Correct Usage of Radiography in Dentistry” – The Scientific Council of the Dentistry Union, Israel.

3. Lopez, N.J., Da Silva, I., Ipinza, J., Gutierrez, J. - Periodontal therapy reduces the rate of preterm low birth weight in woman with pregnancy associated gingivitis. J.Periodontal 2005.


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