Dental Health and Pregnancy
Many dental professionals may be apprehensive about providing dental care to pregnant patients due to fear of inadvertently harming the foetus. It is best to avail the required dental treatment before planning to conceive. The need to minimize systemic infection and disease is of the utmost importance during this period. Dental procedures that minimize the mother’s oral bacterial load are beneficial for her unborn child, writes Dr. Syed Parveez Ali
Pregnancy is a dynamic, physiological state evidenced by several temporary changes. Pregnant women may not fully understand the relevance of their bodies’ ongoing adaptations or how they relate either to their own or to their foetus’ health. A pregnant patient requires various levels of support throughout this time, such as medical monitoring or intervention, preventive care and emotional assistance.
The patient’s medical conditions may limit comprehensive care and certain dental procedures are delayed since this coincides with periods of foetus formation. This nine-month period in a woman’s life is a very critical period during which many women complain of various symptoms including vomiting, fatigue, change in taste perception, shortness of breath, and a craving for particular kinds of foods. During pregnancy there is an increase in oxygen demand. Constipation during this period can, in turn, lead to bleeding through the rectum. Morning sickness is another common problem.
Development of severe hypertension in the second or third trimester can be seen in about 5-10% of patients after about 20 weeks of pregnancy: a condition which requires immediate medical care. Later stages are associated with painful cramps. As foetal requirement increase, so does the need for nutrients. There is rise in levels of blood glucose, and lipids leading to pregnancy hypertension and diabetes.
Precautions in dental care during pregnancy
Many dental professionals may be apprehensive about providing dental care to pregnant patients due to fear of inadvertently harming the foetus. It is best to avail the required dental treatment before planning to conceive. The need to minimize systemic infection and disease is of the utmost importance during this period. Dental procedures that minimize the mother’s oral bacterial load are beneficial for her unborn child.
Dental hygiene procedures such as prophylaxis (procedure done for gum infection) can be done in any trimester of normal pregnancy. This reinforces good oral hygiene during pregnancy and prevents the type of gum infection called pregnancy tumor which can turn out to be a painful, non-aesthetic growth which leads to bleeding from the gums.
Pregnancy is associated with increased urge for food intake. Thus, multiple meals are taken: something which may predispose the pregnant woman to tooth decay. This is, of course, a condition which can develop into a source of pain. Exposing the patient to radiation is, however, to be avoided in all stages of pregnancy, but when there is a dire requirement radiographs may be taken as long as safety measures – like use of lower doses of radiation and use of lead aprons by patients – are strictly followed.
Appropriate iron supplements are to be given since anemia is commonly seen in patients during pregnancy and in cases where considerable amount of blood loss is expected. Invasive dental procedures like minor surgeries and extractions can be done safely using local anesthesia while the patient is in the second trimester of her pregnancy. Nevertheless, it is always advisable not to rush in for surgical dental procedures as soon as the patient enters into the second trimester. In fact, it is best to delay the procedures for the first two weeks of the second trimester. But, dental surgical procedures must not to be attempted during the first twelve weeks of pregnancy since this is the period of organ formation in the foetus. Moreover, once these procedures are initiated, appropriate antibiotics and pain killers are required which will interfere with the organ formation in fetus.
Dental surgical procedures are not to be attempted during the third trimester of pregnancy since it can induce the premature delivery of foetus due to the patient’s anxiety which, in turn, induces labour contractions. In conditions of extreme pain in either, or both, the extreme periods (i.e., the first and second trimesters) where a tooth may have to be removed, priority must be first given for conservative procedures like root canal treatment which will alleviate the pain and, at the same time, reduce oral bacterial load.
The dental procedures must be short and effective. Long procedures must be avoided since the angular position of the patient in the dental chair for long period can lead to positional hypotension, and as a result, as soon as the patient comes back to the normal position, she may feel giddiness. Pregnant patients must always make it a point to clearly inform the dentist of their pregnant condition during the first visit. However, it is not uncommon for patients to be unaware of their pregnant condition until the second trimester. A recent history of having missed at least two or three periods, may indicate pregnancy in women with otherwise healthy and regular periods.
Social habits of tobacco, alcohol or substance abuse are also a matter of great concern not only with regard to the patient’s health but also with regard to the health of her unborn child.
1) Dellinger TM, Livingstone LM: Pregnancy, physiological changes and consideration for dental patients, Dent clin N Am (2006) 677-697.
2) Gier R E, James Dr., Dental management of pregnant patient, Dent Clin N Am 1983:419-28.
3) Rose L F., Kaye D, Internal medicine for dentistry, 2nd ed., 1983.
4) Alexander R E, Eleven myths of dentoalveloar surgery. J Am Dent Association 1998;1271-9.
[The author is a Bangalore-based dentist doing his post graduation (MDS) in Oral health and Radiology. He receives his email at firstname.lastname@example.org]