Quality Resource Guide

Dental Care for Pregnant and Nursing Patients 2nd Edition

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complications (GDM, preeclampsia). The mother

should be educated during the interview process

regarding the importance of maintaining good health

and eliminating detrimental risk behaviors. This

is also an opportune time to review and reinforce

appropriate oral hygiene guidance with the patient

(see

Table 2

) and proactively educate her regarding

her role in ensuring her child’s oral health.

Consultation with the

patient’s

physician

is warranted if: 1) the patient has potentially

complicating comorbid conditions such as diabetes,

HTN, pulmonary or cardiovascular disease, and

bleeding disorders or; 2) the anticipated dental

therapy involves the use of general anesthesia,

intravenous sedation, or nitrous oxide.

Specific

considerations regarding dental-related issues are:

Vital Sign Monitoring:

Vital signs (BP & pulse)

should be checked at each appointment. A pregnant

patient who experiences an elevated BP (≥140/90)

after 20 weeks of gestation may have preeclampsia.

The patient should also be queried concerning any

rapid weight gain, upper right quadrant or epigastric

pain, migraine-type headaches, or visual problems

as these may represent early additional clues to

preeclampsia.

A patient reporting such symptoms

should be promptly referred to their physician for

evaluation.

Patient Positioning:

Supine hypotensive syndrome

is a condition associated with the later stages of

pregnancy and affects an estimated 15% to 20%

of pregnant patients.

When placed in a supine

position, the patient’s gravid uterus impinges on

the inferior vena cava to impair venous return to the

heart, resulting in abrupt hypotension, bradycardia,

diaphoresis, nausea, weakness and dyspnea.

Placing a small pillow under the patient’s right hip

and keeping the head above the feet when reclined

is often sufficient to prevent supine hypotensive

syndrome. If the patient reports feeling dizzy, faint,

or nauseous, she should be rolled onto her left side

to restore circulation.

Treatment Timing:

While the most recent

information confirms the safety of routine dental care

throughout pregnancy, many authorities continue to

recommend deferring elective care, except for oral

hygiene and plaque control instruction, during the

first trimester of pregnancy.

8,10

Urgent, or emergent

conditions, such as pain and/ or infection should be

promptly addressed to ensure patient comfort and

health regardless of the stage of pregnancy. Dental

care that is deemed necessary to control active

oral disease or eliminate potential or predictable

problems that may arise during the later stages

of pregnancy is best delivered during the second

trimester extending into the first half of the third

trimester. Extensive elective surgical procedures

should be deferred until after parturition.

Radiography:

As with all patients, the dental

practitioner must always weigh the benefits of

obtaining a radiograph as an adjunct to the diagnostic

process against the risk of patient exposure.

Obtaining radiographs during pregnancy should

be avoided unless necessary to diagnose or guide

management of an acute or urgent concern. Once

attainment of a radiograph is deemed necessary,

the dentist must employ the ALARA principle (As

Low as Reasonably Achievable) to minimize patient

exposure. (

Table 3

)

The pregnant dental patient may have anxiety

concerning any form of radiographic exposure.

For such cases it is important that the dentist

carefully explain and reassure to the patient that:

1) the radiograph is being ordered because it is

necessary to manage the acute/urgent problem at

hand; 2) the ALARA principles are being utilized

to minimize exposure, and; 3) the level of radiation

exposure from the typical dental radiograph is

far less than natural daily background radiation

exposure.

Drug Administration:

Drug administration during

pregnancy and lactation represents an area of

understandable concern.

5,9,15,16

During pregnancy

there is concern that prescribed drugs may cross

the placenta and potentially harm the fetus.

Additionally, respiratory depressant drugs may

predispose to maternal hypoxia and subsequent

fetal hypoxia. The clinician must always realize

the absence of adverse data regarding drug

administration

during

pregnancy

does

not

Table 3 - Radiation ALARA Principles

•

Use of the fastest image receptor compatible with the diagnostic task (F-speed film or

digital)

•

Collimate the beam to the size of the receptor whenever feasible

•

Use proper film exposure and processing techniques

•

Use protective aprons and thyroid collars, when appropriate

•

Limit the number of images obtained to the minimum necessary to obtain essential

diagnostic information.

Table 2 - Recommended Oral Hygiene Protocol during Pregnancy

•

Brush teeth with fluoridated toothpaste twice daily

•

Clean between teeth daily with floss or an interdental cleaner.

•

Rinse daily with an over-the-counter fluoridated, alcohol-free mouth rinse. After eating,

chew xylitol-containing gum or use other products, such as mints, with xylitol to help

reduce bacteria that can cause decay.

•

After vomiting, rinse the mouth with 1 teaspoon of baking soda dissolved in a cup of

water to stop acid from attacking teeth.

•

Eat healthy foods and minimize sugar consumption.