Dental Treatments During Pregnancy – Safe or Not?

Dental Visits during pregnancy are the most debated subject between Dental Associations and Obstetricians, Gynecologists and Pediatricians. Whether to visit a Dental Clinic and get Dental Treatments done or no?. Dental Associations and Gynecologists and Pediatricians all prefer Pregnant Women get a Dental Check up done during their pregnancy. There are certain specific Doubts or Questions which arise in the minds of Pregnant Women regarding Dental Visits during their pregnancy.

Which is the best time during Pregnancy to get Dental Treatments done?

In general Dental treatments can be performed during any stage of pregnancy with certain precautions. But the best time to perform elective dental treatment is the Second trimester – between14th to 20th Week.

Stages of Pregnancy and the Dental Treatments:

• 1st Trimester or first 3 months or 1-12 week: Better to “Avoid Elective Dental Treatments” as this is the time of Organs formation in the Fetus.
• 2nd Trimester or 3rd to 6th or 13-24 week:  “Preventive and Interceptive Dental Treatments can be done” and this the stage of Fetal growth and maturation.
• 3rd Trimester or 6th to 9th month or 25-40 weeks: Dental Emergencies only with Short Duration, avoid stress and longer duration treatments. All measure must be taken to avoid Parturition due to stress.

What is Swelling in the Gums or Pregnancy Granuloma during Pregnancy?

Due to the increase in production of Oestrogen Progestron and Cortisol which is a steroid results in the formation of a lump on the Gums called as Pregnancy Granuloma. This is mostly seen in the 1st Trimester.

Treatment of Pregnancy Granuloma is Excision if the size of the lesion is larger than >2cm or if you see that it is infected. The types of excision are Laser excision which is the preferred option as it minimizes bleeding and improves healing. If it is below >2cm in size Plaque control, scaling and curettage are the best options to avoid infection.

Dental Drugs Safe and Not Safe During Pregnancy

Why does it Bleed from Gums and Gums swelling?

Due to the changes in all the hormones, there is increased vascular permeability which is the reason for Gingival inflammation and also spontaneous gum bleeding usually seen in the 2nd and 3rd trimester of pregnancy. This can be prevented by maintaining good oral hygiene or by performing Scaling and Curettage in the 2nd trimester.

What is Postural Hypotension on Dental Chair and how to avoid it during Dental treatments?

In the 3rd trimester due to increase in the size of Uterus, it compresses the inferior vena cava which restricts venous return. This results in the patient experiencing postural Hypotension which seated in a Supine position (most common posture on a Dental Chair).

Postural Hypotension is also known as Supine Hypotension Syndrome Symptoms include Sweating, nausea, fatigue, dyspnea, syncope, hypotension and bradycardia. Pedal odema is also seen in some cases.

• Treatment of Postural Hypotension: Elevate the Right hip with a pillow and ask patient to face the left side and place a pillow under the hid (Left Lateral position) This shifts the weight of the Uterine from the Vena cava.

Increase in Teeth Sensitivity:

Due to Morning sickness or Hyperemesis gravidarum during the 1st trimester the gastric contents exposure to teeth leads to Dental Erosion which is the cause of increased Sensitivity. Due to Morning sickness it is best not to give early morning appointments to Pregnant women in their 1st Trimester.

Increase or Decrease in Saliva Production:

• Decrease in Saliva Production (Dry Mouth)- Seen during 1st and 3rd Trimesters of Pregnancy. This leads to Dry mouth which in turn results in increased cariogenic activity due to the reduced buffering capacity of Saliva. It can also lead to Fungal infections such as Oral Candidiasis which can be treated with topical antifungal gels.
• Increase in Saliva Production (Ptyalism) – During 2nd Trimester

Dental Radiography and Pregnancy? 

The most common question which Dentists and patients have in mind are is taking a Dental Radiograph or IOPA safe during pregnancy? Let us look at the stages in which Radiography should be avoided and when they can be taken.

Biological Response to Radiation is seen during the first two weeks of 1st Trimester (up to 6th week). During the first trimester –

• Radiation below 25 rads or 250 mGy is safe and does not cause spontaneous abortion
• Radiation above 50 rads or 500 mGy can lead to congenital fetal abnormalities
• After 16th week of conception – Radiation dose of 50 to 70 rads is considered the Safety Threshold

How much Radiation does IOPA, OPG and Bitewing Radiographs?

• 1 Periapical Radiograph (IOPA) causes – 0.01 millirads of radiation
• 1 Panoramic Radiograph (OPG) causes – 0.02 mGy or (0.002 rads) of radiation
• 4 Bitewings Radiographs – 0.07 mGy or 0.007 rads

From the amount of Exposure by Dental Radiographs we can determine that taking Diagnostic Dental Radiographs is SAFE in the 2nd and 3rd Trimester, but it is advised that Radiographs be avoided during the 1st Trimester. It is best to use a Lead Apron to protect the fetus and the use of RVG reduces the radiation even more to a large extent.

What is Mask of Pregnancy?

Usually in the 1st Trimester there are bilateral brown patches in the mid-face region which extend on either side seen in more than 70% of pregnant women, which is associated with the hormonal changes.

Dental Treatment Plans during respective Trimesters:

Dental Treatments during1st Trimester: 

Most time taking Dental treatments are contra-indicated during this period as it can lead to spontaneous Abortion.

Patient education about oral hygiene maintenance, plaque control and only Emergency Dental procedures should be performed (Access Openings, Abscess Drainage, Operculectomy) which can bring immediate relief to the patient.

Dental Treatments during 2nd Trimester:

• Emphasis on Oral Hygiene maintenance and plaque control should be done.
• Scaling, Curettage wherever necessary should be done.
• Elective Dental procedures can be performed.

Dental Treatments during 3rd Trimester:

Similar to Second Trimester but Elective procedures should be strictly avoided during second half of the third trimester.

During the three Trimesters there are risks to the Fetus from Prolonged Stress and Strain of Dental Treatments, so it is best to not Generalize every pregnant patient that walks into your clinic but to see each one with their complications and act accordingly.

References:

• Creasy RK; Resnik, R; Iams, JD (2004). Maternal-Fetal Medicine: Principles and Practice. Philadelphia: Saunders. pp. 118-119, 1173
• https://www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.htmlRetrieved17/11/18
• https://doi.org/10.1093/bja/aev374
• https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/dental-work-during-pregnancy/faq-20119318
• Sophia Kurien et Al. Management of Pregnant Patient in Dentistry. J Int Oral Health. 2013 Feb; 5(1): 88-97