Dental Care during Pregnancy

Pregnancy is a physiological state where the female body undergoes multiple changes. The body needs to reset itself to accommodate for the growth and nutritional requirements of the mother as well as the fetus.

A lot of hormonal upsurge occurs to maintain the pregnant state and alter the other functionalities of the body. Due to these hormones, many changes are reflected systemically as well as in the oral cavity. It is very important to get a regular oral check up and maintain the oral health during pregnancy.

The gravid uterus exerts functional changes over many other systems of the body, which ultimately, either exert changes in the oral cavity or demand a change in the treatment protocol for the dentist.

Endocrine Changes

During pregnancy, the female sex hormones like Estrogen, Progesterone and Human Chorionic Gonadotropin (HCG) are on the rise. These hormones are responsible for the. multitude of changes that occur in the body.

Estrogen and Progesterone are insulin antagonists and therefore, lead to insulin resistance. Thus, insulin levels are increased in pregnant women.

Cardiovascular changes

The first trimester of pregnancy induces an increase in the cardiac output and heart rate. This leads to an increase in the stroke volume. All these physiological changes produce a functional murmur and tachycardia, which disappear post delivery.

By the second trimester of pregnancy, there is a decrease in the blood pressure and cardiac output in a supine position, due to the decreased venous return from the compression of the Inferior Vena cava by the gravid uterus.

This phase is characterised by the “Supine Hypotensive Syndrome” which results in

• Hypotension
• Bradycardia
• Syncope
• Nausea
• Diziness
• Fainting.

Such changes have a profound effect on the acceptance by the pregnant lady. Therefore, it is imperative to make the patient comfortable on the dental chair, while delivering dental care.

The patient should be seated on the dental chair with the right hip elevated by at least 10-12 cm OR she is placed in a 5%-15% tilt on her left side, to relieve pressure on the inferior vena cava.

Respiratory Changes

As the pregnancy evolves, he uterus continues to grow in size to accommodate the growing fetus. This pushes the diaphragm upwards and thereby, creates a pressure on the lungs.

This leads to a reduction in the functional residual capacity the lungs, which produces dyspnoea and moderate hypoxemia.

Frequent nose bleeds are common during pregnancy. This happens because the mucosa of the upper airways has a tendency to come friable and oedematous under the influence of the increased serum estrogen levels.

It is important to realise that these changes are normal during pregnancy, to render better dental care.

Pregnant patients ay have difficulty breathing, under a rubber dam. Therefore, longer appointments need to be discouraged and only elective dental care, without rubber dam should be provided.

Circulatory Changes

Two main changes occur in the blood during pregnancy.

1. There is an increase in the volume of RBCs, WBCs and platelets, which produces a hyper coagulable state. This makes the patient more prone to thromboembolism.
2. There is a marked increase in the blood volume, due to widespread vasodilatation. This creates a marked increase in the volume of plasma compared to RBC volume. This is a “Physiologic Aneamia of Pregnancy.”

Acute thromboembolism can be treated with IV anticoagulants for 5-10 days, followed by subcutaneous injections 8-12 hrs.

Elective surgical procedures should be delayed until post delivery. However, emergency treatment can be safely rendered during the second trimester of pregnancy.

Gastrointestinal Changes

Hormonal changes occurring in the body and mechanical changes exerted by the enlarging fetus, produces symptoms like nausea, vomiting and heart burn, which peaks at the end of the first trimester.

Pregnancy reflux is caused because of the slow gastric emptying rate, pressure of the enlarging uterus and decreased resting pressure of the lower gastrointestinal sphincter.

Morning dental appointments should be avoided for pregnant females.

Patients are advised to avoid citrus drinks and fatty food as they may cause stomach upset.

They should sip small volumes of salty beverages such as sports drinks, to prevent dehydration due to recurrent vomiting.

Orofacial Changes

The elevated levels of circulating oestrogen hormone causes increased capillary permeability which predisposes to gingival inflammatory changes, like gingivitis and gingival hyperplasia.

Any pre existing plaque and calculus levels in the mouth may be actually worsened during pregnancy. Hence, it is extremely important to maintain oral health and get regular dental check ups dine during this time.

Increase in the salivary oestrogen levels also causes proliferation and desquamation of oral mucosal cells, which provides a suitable environment for bacterial growth. This forms the niche for increased dental decay.

Radiographs should be minimised during pregnancy and if important, should be taken with adequate shields.

The first trimester is the period of organogenesis and therefore, dental treatment should be deferred until this time.

By the third trimester, the uterus is enlarged in size and poses an uncomfortable situation for the lady on the dental chair.

The second trimester is the safest period to perform elective dental procedures.

Apart from the regular precautions taken during dental procedures, it is important to understand the categories of drugs that can be safely administered during pregnancy. There are certain drugs that are capable of crossing the placental barrier and induce malformations in the developing fetus. These drugs are called Teratogens.

These teratogens are categorised as categories A, B, C, D and X, where A are the safest drugs and X are completely avoided during this phase.

It is important to realise that while treating a pregnant lady, treatment is being rendered to two individuals. Necessary precautions should be taken to avoid any harm to the other and the baby. Complete medical history should be obtained before the start of the treatment and any drug interactions and allergies should be kept in mind.