Page 13 - GP spring 2023

Update on the Management of the Pregnant Patient
in the Dental Office

Authors: Marci Levine, DMD, MD and Analia Veitz-Keenan, DDS

Introduction that some physiological, hormonal, and di- ly deemed safe for pregnant women. It has
Oral care is essential for pregnant patients. etary changes associated with pregnancy, not been associated with any adverse infant
Several organizations, including the Amer- in turn, alter a woman’s risk for developing or maternal outcomes. 12
ican College of Obstetricians and Gynecol- some oral diseases. 6
ogists (ACOG) and the American Dental There is also no clear evidence that peri-
Association (ADA), agree that routine Oral health conditions more common- odontal treatment performed during preg-
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dental treatment throughout pregnancy is ly seen in pregnancy are often related to nancy is related to preterm birth. Pyogenic
necessary for pregnant women, is generally hormonal and dietary changes. They in- granulomas, or pregnancy tumors, occur in
safe, and can even prevent negative conse- clude gingivitis, periodontal disease, the the third trimester in approximately 0.2%

quences. The recommendation of avoid- development of pyogenic granulomas, and to 9.6% of patients and are often due to
1,2
ing elective dental work for all pregnant sometimes enamel erosion from vomiting an inflammatory reaction to dental plaque
patients in the first and third trimesters for or hyperemesis. During pregnancy, many exacerbated by hormonal fluctuations of
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fear of issues related to the teratogenicity changes occur in the oral cavity , and stud- pregnancy. 14
of the developing fetus (in the first trimes- ies have found an association between in-
ter) and inducing preterm labor from stress creased plasma levels of pregnancy hor- Some studies have found that changes in
on the pregnant mother (in the third tri- mones and worsening periodontal health salivary pH and microorganisms may occur
mester) is no longer advisable for modern status. 8 during pregnancy and thus increase the risk
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day practice. In most instances, delaying of developing caries. The effects of preg-
dental treatment because of pregnancy can Pregnancy gingivitis, defined as gingival nancy on the oral cavity seem to be limited
actually lead to significant health-related inflammation initiated by plaque exacerbat- primarily to the soft tissues. The popular
consequences for pregnant women. The ed by endogenous hormones, affects 36% belief that pregnancy weakens women’s
purpose of this update is to review recom- to nearly 100% of pregnant women. The teeth due to redirected calcium deposition
mendations for the current management of development of this inflammatory gingival is unsupported; calcium in teeth is stable
pregnant patients in the dental setting and pattern during pregnancy is controversial, and unable to supply calcium demands by
to present the position of several organiza- and studies have reported varying severi- the fetus. 16
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tions that work to promote and advocate for ties and timings of peak inflammation. Ac- Many women suffer from vomiting, partic-
the active care of these patients. cording to the literature, the degree of the
inflammation varies from mild to severe ularly in the first trimester, which may lead
Oral Health Considerations and may depend on the amount of plaque to acid erosion of enamel or perimyloly-
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Multiple organizations recognize and em- observed. 10 sis. Pregnancy may result in dental caries
phasize the importance of oral health as due to the increased acidity in the mouth,
part of the overall health of women and Pregnancy gingivitis has been identified to greater intake of sugary snacks and drinks
future children. For the past two decades, be a critical oral health issue facing wom- secondary to pregnancy cravings, and de-
in an effort to increase awareness, different en; therefore, it warrants special attention creased attention to prenatal oral health
professional associations and governmental in terms of prevention in dental practice. 9,10 maintenance. 18
agencies have issued practice recommen- Maternal periodontitis has also been asso- Intraoperative considerations
dations, policy briefs, and fact sheets to ciated with an increased risk of obstetric
raise public and professional understanding and neonatal morbidity, including prema- Dental radiography
of the oral health needs of pregnant women ture birth and low birth weight. An exten- Radiographs are essential for diagnosing
to improve oral health care provided during sive review of the current literature, which and treating dental issues and are consid-
pregnancy and early childhood. 3
included the analysis of multiple system- ered safe with proper shielding techniques,
Unfortunately, oral health is often under- atic reviews published in 2018, concluded even during pregnancy. 19-21. The American
Dental Association (ADA) recommends
valued, and only a small percentage of that despite the results indicating a positive that dentists ensure that patients’ radiation
pregnant women in this country consult a association between oral health and preg- exposure is as low as reasonably achiev-
dentist during pregnancy. Even when an nancy outcome, dentists must consider pos- able (also known as ALARA) and in com-
oral problem occurs, studies show that only sible sources of bias and other factors such pliance with being as low as diagnostical-
one-half of pregnant women seek attention as gestational age, the medical and gyne- ly acceptable (or ALADA). All patients
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for the problem. 4,5 Pregnant patients can co-obstetric background of the birth moth- should be adequately shielded when dental
be more susceptible to certain oral health er, and other environmental conditions. 11 radiographs are taken, regardless of preg-
conditions due to the physiological chang- Even though these studies did not show nancy status. Shielding should include the
es associated with being pregnant. These conclusive evidence for the link between use of both a thyroid collar and an abdom-
changes are vital to maintaining the stable periodontal disease and adverse pregnancy inal apron.
status of the mother and fetus. We know
outcomes, periodontal treatment is general-
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