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Management of Pregnant Patients in Dental Practice: Pramod - Mats@yahoo - Co.in
Management of Pregnant Patients in Dental Practice: Pramod - Mats@yahoo - Co.in
IN DENTAL PRACTICE
ABSTRACT:
Pregnancy is a unique period in a woman's lifetime. Good oral health during pregnancy is important to the overall
health of both the expectant mother and her baby. Therefore, it is important to maintain good oral health during
pregnancy because it has the potential to reduce the transmission of pathogenic bacteria from mothers to their
children. Dental care is safe for the pregnant patient and can prevent long term health problems for both mother and
child. During pregnancy dental treatment may be modified but need not be withheld, provided that the risk
assessment is made properly for both the patient and the fetus. Oral changes in the mouth are due to the altera .. tion
in the levels of estrogen and progesterone. This variation in the female sex hormones causes an increase in oral
vasculature permeability and decrease in the host immunity, thus making the pregnant woman more prone to oral
infections. Although pregnancy is not a contraindication to dental treatments, the clinician should consult with the
patient's physician to clarify individual treatment issues. When prescribing medication during pregnancy, the main
concern is the risk of teratogenesis, because drugs cross the placenta by simple diffusion. Drugs are administered
during pregnancy only when they are essential for the pregnant woman's well-being, and the drug of choice should
always be the one that is the least toxic. Prescribing of systemic drugs of any kind ideally should be performed after
consultation with the general medical practitioner or obstetrician.
INTRODUCTION: Pregnancy is a unique Dental care is safe for the pregnant patient and can
period in a woman's lifetime. Good oral health during prevent long term health problems for both mother and
pregnancy is important to the overall health of both child. Overestimation of the risk of teratogenicity in
the expectant mother and her baby. Oral health the fetus resulting from medical and dental procedures
assessment should be part of comprehensive prenatal or drugs may cause a clinician to avoid necessary
care for all women and every general medical treatment of the expectant mother.
practitioner and obstetrician should consider referral During pregnancy dental treatment may be modified
of a newly pregnant woman to a dentist as routine'. but need not be withheld, provided that the risk
Therefore, it is important to maintain good oral health assessment is made properly for both the patient and
during pregnancy because it has the potential to the fetus".
reduce the transmission of pathogenic bacteria from
mothers to their children.
44
CODS Journal Vol-S Issue-2, September 2013
;.._~~~~
risk of edema
RESPIRATORY SYSTEM
0 Decreased Pa02 in supine position
nasogastric tube
0 Progesterone-induced hyperventilation
MANAGEMENT OF PREGNANT
~~~~--~~--~--~--~----~=--~~
PATIENTS IN DENTAL PRA(';TICE 46
CODS Journal Vol-S lssue-Z, September 2013
t
Root sC3Iir:t:g~pllani!lg
AvoidX-mv>
Avoid X·ray~
Elective dental treatment
Only EMERG€NCf
treatment
Avo.id treatment in second
halt of ~nird tri mester
Penodontal prophvlaxi'S:
COOS Journal Vo!-5 lssue-Z, September 2013
AnytimeDuring Dagnoo::a"W'lS Aceta I oplle {B) Lidocail1ie with I No (ll'idence 3(% nitrous oxrcle Penici IJin (6)
Pr~nancy alesafeduli 9 Me~rtdmeIB) epil'l,ephrinQ' (2%) i thatthelype can be used when Amoxicij!ln {B)
pregnancy M'Orph' e (B) (B),consideredsafe , 01mercury tcckalo focal Cepnalosporins (81
Codeirne (0 duringpre{illan.cy I released frOrnil anesthetics are Clindam)'cin (8)
I exi Slin9 6l1ing s ina de'quare Er)"hromycin not in
A.cet;; i opnen-
IthY(1Jd co]!a I . Mepi1/,lCdline(3M harms the fews ..s!olate form 1(6)
Codeine (0
<llidiaOOOOlefl (C), use ifbenl?fit Pregna nt women
shierd ACifliJ i ophen", OI!il"Ic~;ghsp~sib!e ' Use nlbber dam require lower leviOl.s Qllinolones (C)
H:yotlrocodo e ((J Fi,s'k toietus and high·spe~d 01nitrous o~ide to (iarith romycill !C)
~.g.Vi 00] acllteveseda~on
A.cetJmi ophen ... As p,ophylaxi~ for
Oxycoc!one (C) e.g. dental surgery: use
Pe.lcoc,e· same cri!e.rJa·for all
people at risK fo.r
bacteremia
1st Tlimester Spontaneouspr~na ('floss oecursjn 1 Ci" l5~~ 01 ~II dinicillJy·rrecognized p~egnilnd!?s in the • rst triffi€s!el. Mo.>! bssss are AVOID:
(1. ll'i'ITKSl due to duo ow e a bn ormafiti es, ¥"t, women may prefer to wait until the ssecnd trime5'tel n 4':""W~€ [ f r dental care. Metronidazole (S)
-
2nd Tfimestel
(11'2'1 WEEKS)
I
I
i
3rd Ttimester NEVE!! USE NSAlDs AV01D:
(lS·~OI'IH~'SII e.g.lbup!'ciEln IOJ SulfoJ1lamid~s'l()
Indome°hadrn
•Cat B:No evidence of risk in hurma s;,either ,anlmalstudies snowilisk (humalil findings. do not)' Of, if noadE<luate human 5tudi~. dome, anJma'l nrndings negative.
• Cat (; Human stooies are lac' ·ng and animal studies are either positive for fetal risk or tJ(king as "",ell;potential benefits may jus'tify I'he potential risk,
• Cat D:iPasiti\'ele'~ic!ence of risk I vestigational or post ma~xetin9 data show risk to fetus. Nevertheless. potential benefits may QIJt'I,·eigh the rilst
48
C:OD5Journal Vol-5 lssue-Z, September 2013
~ Impaired venous return to the heart that results from compression of inferior vena cava by
gravid uterus.
~ So when working on a gravid patient, the position of the patient is utmost important.
~ The ideal position of the gravid patient in the dental chair is the left lateral decubitus position
'18l A preventive 6-inch soft wedge( rolled towel) should be placed on the patients right side
When prescribing medication during pregnancy, the main concern is the risk of teratogenesis, because
drugs cross the placenta by simple diffusion. Drugs are administered during pregnancy only when they are
essential for the pregnant woman's well-being, and the drug of choice should always be the one that is the
least toxic. In practice, dentists mainly prescribe antibiotics to control infections and painkillers to relieve
the pain. Any drug that is prescribed during pregnancy should have the fewest possible side effects and it
should aim to improve the health of the mother or the fetus .In human pregnancy, the time from 2 to 4
weeks from the last menstrual period represents the pre differentiation period of the fetus2. During this
period, the human fetus is relatively resistant to teratogens. The period of maximum teratogenic risk is
organogenesis, which occurs from the end of the predifferentiation period until the end of the lOth week
after the last menstrual period. To determine the risks associated with the use of drugs in pregnancy, the
United States Food and Drug Administration (FDA) has classified drugs based on the level of risk they
pose to the fetus . Accordingly, drugs in category A and category B are considered safe for use, whereas
drugs in category C may be used only if the benefits outweigh the risks. Drugs in category D are avoided
with some exceptional circumstances, while drugs in category X are strictly avoided in pregnant women",
(ODS Journal Vol-5 Issue-2, September 2013
------------~~~
-- - .,
A
-'----
Controlled studies
--~~--~--------.-~
in women fail to demonstrate a risk to the fetus
remote
trimester
women and animals are not available. Drug should only be given
pregnant.
L~ aresmencs: Iqe-c'.nh)e
Artic::3ine C 'res. Ye'!O
Bup ....cccrre B y""
lJdoc:ll."1e B y~
~',e~ne C Ye-=o
Prilocaine B y.,. Ye!O
Loe:tl ane~~.rC1,: TC;:Mcl
Scnzocoine
D.tc\co.ne
l,;doca;ne
Ietracccoe Ye~
A.t-~gesics
AcebmiOOOOen 9 y~ Yes
kpmn C/o- Do not use In!l.-d tnraester U!:ec..:u..1tClU!..'y
!).flunoooJ qO· 00 not eee 3rd b';r.'1e::ter
In U:;.e c:ruhovs.'y
Etcco'ac BID- Dc not use in 3..-ri trimester 'res
Muttl:opmfen 9/0· 00 not we in :3tdttim~t Yes
[bo;:.ro5en 8/0" Do not use a"I 3;-ctnme:;!eJ'" Ye!O
Kemrol3C 8/0- Do not cee 1f'13rd tnm~f
Kd:opro~n SfD- Do not U!>-C" In ard trimeser
Na;:lIoce-n 810- Do not use in 3m trime&el Ye!l'
Co<!<>",. C Low dose. $l-.ert d~o:'! ~o:;e~le Yes
O><ycodono B Low eese. short duration accep:ta:»e Y••
:.I.e;:eridlne B Low dose. 5hcrt duration accectcoe Us.ec."lUbou!.ly
P~pho:no C low ecee, sncet d1Jr.1tfon ;;1:CCCpbfl~ u-..., =.I1iov,,¥
Antitrucroblab
I=bnicllln B y"" Ye::
Amo<~lmn B Yes Yes
Arnc::OOcilin ... cbvuJoruc-acld B Yeo Ye'!:
Ocx:lCllbn B Ye:o Ve!:
Cephabs;:oOre B Yes
Ery".hrom,oore B Yes lee no! we e-!:'tO!~)
HEPARIN AND
management and drug use. Quintessence
receiving daily injections of heparin to improve pregnancy outcome.
PREGNANCY
international 2007;38:133-142.
Additionally, some women may be on low molecular weight heparin
j 51