Oral health in pregnancy

Normal pregnancy does not necessarily contraindicate dental treatment if the stage of gestation and the extent of dental procedures are taken into account. The first trimester is the period of organogenesis. In addition, approximately 75–80% of spontaneous abortions occur before the 16th week of gestation. T he fetus is thus very sensitive to environmental influences at this time. In the last half of the third trimester, premature delivery becomes a hazard. Prolonged chair time should be avoided because supine hypotensive syndrome may occur. Whether a pregnant woman is in a semireclining or a supine position, the great vessels, particularly the inferior vena cava, are compressed by the uterus. By interfering with venous return, this compression causes hypotension, decreased cardiac output, and eventual loss of consciousness. Supine hypotensive syndrome can usually be reversed byturning the patient on her left side, thereby relieving the pressure on the vena cava and allowing blood to return to the lower extremities and pelvic areas. Because of these hazards, however, no elective procedures, such as definitive periodontal surgery, should be performed during the first and third trimesters.

The second trimester is the safest period during which routine dental care can be provided. Even so, it is advisable to limit care to minimal treatment. Based on numerous studies that emphasize the role of local irritants in the initiation of periodontal disease during pregnancy, it is prudent to educate pregnant women about effective plaque control techniques early in pregnancy. All local irritants should be removed as soon as possible, before the effects of pregnancy are manifested in the gingival tissues.

If emergency treatment is indicated, it should be performed anytime during gestation to eliminate any associated physical or emotional stress. The pain and anxiety precipitated by a dental emergency may be more detrimental to a fetus than the treatment itself. One controversial area in the treatment of pregnant patients involves taking dental radiographs. Only serious dental emergencies require radiographic evaluation, especially in the first trimester, when a developing fetus is particularly susceptible to the effects of radiation. Routine radiographs should be avoided and taken only when necessary. If radiographs are taken, patients should wear a protective lead apron to reduce the amount of radiation to which the abdominal area is exposed.

Another area of concern involves drug therapy, because any drug given to a pregnant patient can affect her fetus by diffusion across the placental barrier. In most cases, it is safe practice to use a local anesthetic with a vasoconstrictor (1:100,000). Analgesics, including acetaminophen and aspirin (except during the third trimester, when bleeding problems can occur during or after delivery) are also safe.