Prenatal dental care

Prenatal dental care is the care of the oral cavity during the time when the fetus develops inside a woman. The woman’s body is subject to several changes during pregnancy. Some of these changes occur in the oral cavity; which may cause tooth decay and periodontal tissue loss, that is why dental care is recommended to maintain oral health, hygiene and well being.

Psychological changes during pregnancy

The increased levels of progesterone and estrogen induce changes in the gum tissue and oral cavity; the gum tissues become more prone to irritants. The flow of blood and permeability of vessels increase in the periodontium, in addition to changes occurring in the collagen production. Decreased calcium and phosphate reduces the saliva pH values, altering the composition of saliva, and the medium of the oral cavity.

Dental interventions during pregnancy

There have been suggestions that pregnant women should seek dental visits after child birth to avoid any adverse effects on the mother and fetus during the period of pregnancy, but there is no evidence to support this avoidance. Dental procedures are most preferred during the second trimester of pregnancy, however emergency treatment should be performed regardless of the gestational period. Practitioners should keep the dental visit short, and minimally invasive. It is also safe to use dental local anesthetics during pregnancy; however, the type of vasoconstrictor, amount of anesthesia should be well regulated by the dentist. The safety of local anesthesia with a vasoconstrictor is questioned in patients having systemic conditions such as heart disease, untreated diabetes, hypertension, or hyperthyroidism.

Blood pressure and cardiac output decrease in pregnant women, to overcome potential hypotensive syndrome resulting from the supine position on the dental chair, it is recommended that the patient should have the right hip elevated 10 to 12 cm by placing a cushion; meaning the patient's hip position should be higher than the foot level in the second and third trimesters to relieve the pressure on the inferior vena cava, and if necessary, the patient should be tilted 5% to 15% on her left side. If patient experiences fatigue, weakness and hypotension, a full left lateral position may be needed.

Periodontal maintenance procedures such as scaling and root-planning can positively improve the quality of life in pregnant women; by decreasing the microbial activity by removing plaque and calculus, and other irritants. Pyogenic granulomas or “pregnancy tumors,” are commonly seen on the labial surface of the papilla in pregnant women. Lesions can be treated by local debridement or deep incision depending on their size, and by following adequate oral hygiene measures.

Radiographic exposure

Undergoing radiographic xray images with the use of a lead apron and a collar do not impose problems to the mother or fetus.

Medications & teratogenic potentials

The FDA categorized drugs according to their safety with respect to their effects on pregnant populations into 5 categories, from category A to category X.

A - The drug has not shown an increased risk of fetal abnormalities when tested on pregnant women.

B - The drug was used in animal studies but revealed no evidence of harm to the fetus, but there are no adequate studies to prove this conclusion in pregnant women, or studies have shown an actual adverse effect on animals, but studies in pregnant women have failed to demonstrate a risk to the fetus.

C - studies have shown an adverse effect but no studies to determine these effects in pregnant women.

D - The drug causes a risk to the fetus, but the benefits of therapy may outweigh the potential risk.

X - the product is contraindicated because fetal abnormalities were seen.

Research & evidence

There have been suggestions that severe periodontitis and tooth caries may increase the risk of having preterm birth and low birth weight, however, systemic reviews found insufficient evidence to determine if periodontitis or tooth decay can develop adverse birth outcomes.