Pregnancy Precautions In Dental Clinic

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



Routine dental care

Third trimester



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……

Health & Medicine

Pregnancy Precautions In Dental Clinic