When is it safe to treat a pregnant patient?

Pregnancy is divided into trimesters – the first trimester is between 1-12 weeks, the second 13-20 weeks, and the third 20-40 weeks. It is safe to treat a pregnant patient during all three trimesters. Of the three trimesters, however, the second is the best period to treat dental issues. During the first trimester, symptoms such as syncope, postural hypotension, nausea, tiredness, and polyuria are very common, and can all affect dental treatment. With this in mind, there are various other complications that should be taken into consideration when treating a pregnant patient.

What are some complications that pregnant patients might face during treatment?

Supine hypotension syndrome occurs when the inferior vena cava (a major vein located in the trunk of your body) is pressed due to the weight of the fetus as a mother lays down on her back. Because the inferior vena cava takes blood back to your heart, this means less blood will reach the mother’s heart. This can cause a loss of consciousness and even fainting. If you recognize the symptoms of supine hypotension syndrome, rolling the patient to the left side can alleviate the weight that the fetus is placing on the vena cava.

How do hormones affect the oral health of our pregnant patients?

Pregnant patients have an increase of two hormones – estrogen and progesterone. Elevated female sex hormones relate to enhanced susceptibility to gingival inflammation and the growth of gram-negative anaerobic bacteria. Estrogen causes cellular changes – it inhibits the movement of immune cells (neutrophils) and enzyme activity, as well as enhancing cellular reproduction in the blood vessels. This means that estrogen has an important part in influencing inflammation in the oral cavity. Progresterone acts as bacterial food, and is a tasty diet for bad bacteria such as P. intermedia, P. gingivalis, and T. forsynthia. With these factors in mind, it is common for pregnant patients to exhibit what is known as pregnancy induced gingivitis.

‘Elevated female sex hormones relate to enhanced susceptibility to gingival inflammation and the growth of gram-negative anaerobic bacteria.’

I’ve heard pre-eclampsia during pregnancy is associated with periodontal disease, is this true?

Pre-eclampsia is a disease seen in pregnant patients that is characterized by high blood pressure as well as proteinuria (proteins found in urine). In patients that had periodontal disease, it was found that there is a 2.69x greater risk of developing pre-eclampsia than those who do not have periodontal disease.

What drugs should be avoided when treating pregnant patients? What drugs are O.K. to use with pregnant patients?

Whenever evaluating the safeness of drugs to use with pregnancy, it’s important to review the U.S. FDA pregnancy risk factor categories. Although there are more specific definitions, we will oversimplify this by stating that drugs in class C and above (C, D, X) should be avoided when treating pregnant patients.

Although septocaine (articaine) has one of the lowest half-lifes of local anesthetics, it is scheduled as a class C drug, and therefore is controversial for use on pregnant patients. Because of this, lidocaine should be utilized as a class B anesthetic.

The use of ibuprofen for pain management should be avoided, as well, especially in the third trimester. This is due to the possibility of premature closure of the ductus arteriosus in the third trimester, putting the baby at risk. Instead, acetaminophen is the safest analgesic that should be given for post-operative pain. Use of aspirin should be avoided at all times, as well.

For dental anxiety, nitrous oxide is often administered to patients in order to relieve patients of fear during procedures. Although nitrous oxide is a class C drug, single, acute exposure of nitrous oxide has not been associated with fetal abnormalities and is safe to use on pregnant patients. However, chronic exposure of nitrous oxide such as that by the nitrous operator (assistants, hygienists) should be avoided during pregnancy.

Donaldson, M., Goodchild, J. Pregnancy, breast-feeding and drugs used in dentistry. JADA, Vol. 143(8). August 2012. Pgs. 858-871.

Gursoy, M., Zeidan-Chulia, F., Kononen, E., Moreira, J. C. F., Liukkonen, J., Sorsa, T., and Gursoy, U. K.
Pregnancy-Induced Gingivitis and OMICS in Dentistry: In Silico Modeling and in Vivo Prospective Validation of Estradiol-Modulated Inflammatory Biomarkers. OMICS A Journal of Integrative Biology, Vol. 18, Number 9. 2014. Pgs. 582-590.

Huang, X., Wang, J., Liu, J., Hua, L., Zhang, D., Hu, T., Ge, Z. Maternal Periodontal Disease and Risk of Preeclampsia: A Meta-analysis. J Huazhong Univ Sci Technol [Med Sci]. 34(5):2014. Pgs. 729-735.