Dental Care in Pregnancy
Dental care is extremely important during pregnancy. Pregnant women have elevated levels of estrogen and progesterone. These hormones cause the gums to be more sensitive to the bacteria that is found in plaque and can lead to a condition known as “pregnancy gingivitis”. Some of the symptoms of gingivitis include red, swollen, and bleeding gums. To avoid the buildup of plaque, it is important to brush teeth at least twice a day and floss before going to bed.
Research suggests that gingivitis in pregnancy has been linked with an increased risk of pre-term and low birth weight babies. It is estimated that women with periodontal disease are seven times more likely to experience premature delivery.
It is recommended that women continue with their regular dental cleaning and check-ups to avoid oral infections that can affect the fetus, such as gingivitis and periodontal disease. Major dental treatments that are not considered urgent should be postponed until after the child is born. Procedures that are deemed urgent by your dentist should be performed during the second trimester to minimize any potential risks to the fetus. The second trimester is safer than the first since most of the baby’s organs are formed by this time.
Dental anesthetics such as novocaine or lidocaine are considered safe in the doses used in most dental procedures. Acceptable antibiotics include penicillin, amoxicillin, and clindamycin. Tetracycline should be avoided. Pain medications such as Tylenol are approved, but aspirin or ibuprofen should not be used.
X-rays: In general, X-rays are best avoided in pregnancy. However, circumstances do occur where a dental X-ray is necessary. If a patient needs a dental X-ray, she will need an abdominal shield placed.
Patient Positioning: Patients greater than 18-20 weeks pregnant will tolerate dental exams better if they can be tilted to one side or the other. Lying flat on the back may lead to hypotension with resultant nausea and vomiting.
Analgesia/Anesthesia: Local anesthetics are preferable to IV conscious sedation; oral narcotics can be used as needed for pain control (i.e. hydrocodone, codeine, propoxyphene); patients need to be counseled not to combine acetaminophen with these products as they already contain acetaminophen; avoid non-steroidal anti-inflammatory agents like aspirin, ibuprofen, naprosyn and ketorolac.
Antibiotics: Should antibiotics be needed, the cephalosporin and penicillin family can generally be used. If the patient is allergic to penicillin or a cephalosporin, clindamycin can be considered.