PREGNANCY AND OMFS

DIKSHA YADAV (INTERN)

 INTRODUCTION

 Pregnancy is a major event in any women’s life.

 Pregnancy has been considered as an impediment to dental

treatment

 Preventive, routine and emergency dental procedures are suitable

during various phases of pregnancy with some modifications and

initial planning
 STAGES OF PREGNANCY

 1st trimester (0- 12 weeks)

 2nd trimester (13 – 28 weeks)

 3rd trimester (29 – 40 weeks)

 CHANGES DURING PREGNANCY

 3 TYPES OF CHANGES

1. ANATOMICAL CHANGES

2. PSYCOLOGICAL CHANGES

3. PHYSIOLOGICAL CHANGES
 ANATOMICAL CHANGES
 INCLUDES :

 Changes in weight

 Changes in volume

 Changes in size

 Changes in uterus
 PSYCHOLOGICAL CHANGES

 1ST trimester : anxiety, mood swings, fear of abortion

 2nd trimester : self conscious about weight and appearance

 3rd trimester : anxiety about labor and baby

 PHYSIOLOGICAL CHANGES
 1 ENDOCRINE CHANGES:

 Estrogen and progesterone increases

 Thyroxin, steroid and insulin level increases

 HPL increases size of breasts

 45% fail to produce sufficient insulin and develop gestational diabetes

 CARDIOVASCULAR CHANGES
 1st trimester:

cardiac output increases

Blood pressure is normal

 2nd trimester:

Blood pressure is decreased

heart rate increases by 10 beats/ min

 3rd trimester:

Blood pressure increases

 RESPIRATORY CHANGES

 Overall activity increases

 Diaphragm is displaced upward 3 to 4 cm residual volume decreases

 Oxygen consumption increases

 Respiratoty rate increases

 RENAL SYSTEM CHANGES

 Increase in GFR and urine

 1st trimester : frequency of urination increases (pressure exerted by bladder)

 UTI common

 Total blood volume increases

 Hemoglobin volume decreases

 Fibronolytic activity decreases

 GASTROINTESTIONAL CHANGES

 Morning sickness N/V common

 Increases gastric acid production

 Indigestion

 Decrease gastric mobility / constipation

 Increase in appetite and craving for unusual food

 GUIDELINES AND PRECAUTION
1. History (duration, number of times and abortion)

2. Elective dental procedure should be deffered to postpartum

3. Appointment to be kept short

4. Dental x-ray are best to be avoided

Source of radiation Absorbed exposure (cGy)

Skull radiograph 0.004

Full mouth dental series 0.00001

 The greatest risk of the fetus for teratogenicity and death is during 1st 10 days after

conception

 The most crucial period ---- fetal dev----- btw 4 and 18 wk after conception

 The safety of dental radiography can be by

a) Fast exposure technique

b) Digital imaging

c) Filtration

d) Lead aprons (most important)

e) Limited to affected tooth

5. Timing :

a) 1st trimester : oraganogenesis --- no dental procedure carried

out.
In case of serious tooth condition --- best course of action to
protect from infection---- without administration of any drugs

b) 2nd trimester : safest time to opt for tooth extraction.

c) 3rd trimester : uncomfortable , position slightly on left and preterm

delivery chances.
6. Position

: latter part of 1st trimester: semi reclining

: 2nd trimester : semi reclining position

: 3rd trimester : left lateral decubitus position (30 degree lateral tilt) to

prevent supine hypotensive syndrome

 SUPINE HYPOTENSIVE SYNDROME
 Occurs in 3rd trimester

 Compression of inferior vena cava and aorta

 Decrease venous return to heart

 Decrease uteroplacental perfusion and fetal distress

 Drug prescription should be done with care

7. Prescricing of drugs :

Donot use the drug unless it is absolute necessary

Risk and benefit ratio

Lower doses

Avoid of newer drugs and safe drugs

 FDA CLASSIFICATION
 Combines risk statements including congenital anomalies, fetal effects, perinatal risks and
therapeutic risk benefit ratio
A Controlled studies in women fail to demonstrate a risk to the fetus in 1st trimester and
the possibility of fetal harm appears remote (safe to use)
B Animal studies show no risk or if risk shown in animals controlled trials in women showed
no risk (safe to use)

C Studies in animals with adverse effects and no human studies or no animal or human
studies but benefit of use may out weight potential harms(used only if benefits out
weight the risks)
D There is evidence of human fetal risk but benefits may out weight risks(avoided with
some exceptional circumstances)

X Studies in animal and human demonstrate fetal abnormalities or there is evidence of

fetal risk or both and risk out weight any benefits(strictly avoided during pregnancy)
 LOCAL ANESTHESIA

DRUG FDA CATEGORY USE DURING RISK USE DURING

PREGNANCY BREAST FEEDING

LIDOCAINE B YES - YES

-
PRILOCAINE B YES YES

USE WITH FETAL

MEPIVACAINE C CAUTION BRADYCARDIA YES
 GENERAL ANESTHESIA
 PEROPERATIVE ASSESSMENT:

• Premedication to reduce anxiety, catechol

• Aspiration prophylaxis

 PARTURIENT < 24 WEEKS GESTATION

• Use non particulate antacid as aspiration prophylaxis

• Monitor and maintain oxygenation

• Avoid N2o in high concentration

• Document fetal heart tone before and after procedure

 PARTURIENT > 24 WEEKS GESTATION

• Discuss tocolytic agents with obstetrician

• Aspiration prophylaxis

• Left uterine displacement maintain throughout the procedure

• Monitor and maintain oxygenation

• Use fetal monitoring intraoperatively when possibleto optimize the intrauterine

environment

• Monitor for uterine contraction postoperatively

 SEDATIVE/ HYPONOTICS
BARBITURATES D AVOID NEONATAL AVOID
RESPIRATORY
DEPRESSION

BENZODIAZEPIN D/X AVOID ORAL CLEFTS AVOID

 ANALGESICS
PARACETAMOL B YES - BE CAREFUL TO
USE

POST PARTUM
ASPIRIN C/D AVOID IN 3RD HEMMORHAGE AVOID
TRIMESTER
DUCTUS
ARTERIOSUSS

ACETAMINOPHEN B YES - YES

DELAYED LABOUR
IBUPROFEN B AVOID IN 2ND YES
HALF OF CONTRICTION OF
PREGNANCY DUCTUS
ARTERIOSUS
 ANTIBIOTICS
PENICILLIN B YES -- YES

ERYTHROMYCIN B YES -- YES

CEPHALOSPORIN B YES -- YES

TOOTH
TETRACYCLINE D AVOID DISCOLORATION AVOID
AND BONE
DEFORMITIES

METRONIDAZOLE B YES MUTAGENIC YES

 CORTOCOSTEROIDS

PREDNISONE B YES DELAYED LABOUR YES

 MULTIVITAMINS
 Vitamins and minerals preparation which contain VIT A in the retinol form
are adviced to avoid in the 1st 12 weeks of pregnancy.

 Supplements containing retinol may increase the teratogenic risk

especially in the 1st trimester

 VIT A -------------- fat soluble – excessive stored in liver----toxic effect to liver

and congenital birth defect

 VIT E--------------- increases risk of abdominal pain and premature rupture of

amniotic sack

 Supplements considered safe---- folate, iron, vit D, magnesium.

 CONTRAINDICATED DRUGS
 Chloramphenicol ( blood disorder)

 Ciprofloxacin (muscle and skeletal growth disturbed)

 Sulfonamides (jaundice)

 Trimethoprim (neural tube defect)

 Codeine (withdrawal symptoms)

 Ibuprofen (miscarriage, delayed labor, premature closure of ductus arteriosus)

 Warfarin (birth defects)

 Clonazepam pass into breast milk)

 Lorazepam (birth defects and withdrawal symptoms)

 SUMMARY
 Any procedure best to be avoided.

 Emergency procedure can be done but with precaution

 Drugs administration should be done with care

 Not medically compromised but special care required

 REFERENCES
 Office on womens health (2010), stages of preganancy

 Education in anesthesia critical care and pain, 1 April 2006, Nina kylie

 British journal of anesthesia 2012, published by oxford university press

 Journal of international oral health, Management of pregnant

patient(abstract)2013

 Medical pharmacology, K.D. Tripathi

 U.S. food and drug administration, pregnancy and lactation: improved benefit – risk
information 2015.