Quality Resource Guide

Dental Care for Pregnant and Nursing Patients 3rd Edition

www.metdental.com

Potential Pregnancy-

Associated Oral Findings

Perimylolysis:

Up to 2% of pregnant patients

experience acid-induced enamel erosion from

hyperemesis.

Measures to manage perimylolysis

include following a recommended oral hygiene

protocol (

Table 2

) and rinsing with baking soda

after vomiting to help neutralize the acidic

environment and avoiding brushing for one hour

after rinsing. To avoid potential dehydration

associated with hyperemesis, the patient may

be advised to sip salty liquids such as sports

beverages.

Pregnancy Gingivitis:

Pregnancy gingivitis is

observed in up to 75% of pregnant patients.

It tends to peak during the third trimester and

begins to regress during the last month of

pregnancy and after parturition. It is postulated

the increased levels of sex hormones associated

with pregnancy suppress the immune response,

compromise local defense mechanisms, and

reduce the natural protection of the gingival

environment. Inattention to oral hygiene likely

increases the risk. The American Academy of

Pediatric Dentistry recommends that a dental

prophylaxis be provided during the first trimester

and again during the third trimester if the patient’s

oral hygiene is inadequate or periodontal

conditions warrant professional care.

Pregnancy Tumor:

Up to 5% of pregnant patients

develop a pyogenic granuloma (pregnancy tumor,

epulis gravidarum).

These rapidly growing

lesions typically arise from inflammatory gingivitis

during the second or third trimester. They usually

regress after parturition, but excision either during

pregnancy or after parturition may be necessary.

Caries:

There is no convincing evidence that

pregnancy per se increases the patient’s risk of

caries.

However, the altered food cravings and

dietary changes often observed during pregnancy

combined with inattention to oral hygiene does

increase caries risk. Women with high caries risk

harbor high levels of the

Streptococcus mutans

and vertical transmission of the cariogenic

Streptococcus mutans

from mother to child with

subsequent caries risk is well documented.

The hygiene protocols recommended in

Table 2

benefit not only the mother, but also the newborn.

Professionally applied topical fluoride treatments

(gels, pastes, varnishes) are considered safe

and may be used when indicated. The use of

prenatal fluoride supplements is not beneficial to

the developing fetus and is not recommended.

Dry mouth:

The patient may experience

temporary oral dryness during her pregnancy.

The patient should be advised to sip water

and use sugar-free gums or candy to stimulate

salivary flow.

Tooth

mobility:

The

increased

gingival

inflammation and mineral changes affecting the

lamina dura during pregnancy are believed to

underlie the generalized tooth mobility that may

be observed.

The mobility typically regresses

after parturition, but may persist in situations of

unmasked periodontal disease.

Summary

Pregnancy represents a unique phase in a

woman’s life and presents unique challenges

for the dental practitioner to consider when

rendering dental care. The pregnant patient

should be educated on the importance of

establishing and maintaining good oral health

for the well-being of both herself and her

developing child. Withholding necessary dental

care during pregnancy is neither recommended

nor justified. This Guide briefly reviewed the

physiologic changes observed in pregnancy

and

suggested

management

strategies

allow for the delivery of safe and effective

dental care.