Page 14 - GP spring 2023

Chair position erations should be implemented, such as cluding misinformation or financial consid-
Pregnancy causes many changes in the monitoring to prevent hypoxia, hypoten- erations. 28,29
physiology of the female patient. During sion, and aspiration. Pregnant women may
pregnancy, the position of the dental chair require lower levels of nitrous oxide to Multidimensional approaches are needed to
may have to be adjusted to maximize pa- achieve sedation and should be monitored increase dental care access and protect and
tients’ comfort levels. During the third tri- with pulse oximetry. 25 promote women’s oral health during preg-
mester, pregnant women are at risk of ex- nancy. Despite current recommendations
periencing supine hypotensive syndrome. Medications and Operative and Postop- that it is safe to treat patients throughout
When a patient is lying in a supine position, erative Considerations pregnancy, many dentists are not knowl-
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the enlarged uterus can compress against In 2015, the Food and Drug Administration edgeable about this topic. It is our goal
the vena cava, which carries blood to the (FDA) changed the alphabetical classifi- to advance dentists’ understanding of the
heart. This pressure exerted by the fetus cation of the safety of medications for use management of pregnant patients and
may lead to a sudden drop in blood pres- in pregnant patients. It replaced it with a thereby promote oral health for all patients,
sure. To avoid dizziness and fainting, the narrative section in the package insert that including those who are pregnant.
dentist should position a pregnant patient in discusses the risks and benefits of using a
a more semi-reclined position. A maneuver particular drug in this population. Conclusions
that could help is to tell the patient to move In 2014, the ADA enacted policy that
to the left side or place a cushion under her Dentists should be familiar with the preg- women of child-bearing age receive dental
lower back on the right side to help repo- nancy risk categories for commonly pre- examinations and, also in the same year,
sition the gravid uterus more towards the scribed and recommended pharmaceuti- that “Preventive, diagnostic and restor-
aorta, which does not collapse as easily. 22 cals, including analgesics and antibiotics. ative dental treatment to promote health
and eliminate the disease is safe through-
Pregnant women often experience gastro- Different organizations seem to agree that out pregnancy and is effective in improv-
esophageal reflux (or heartburn) secondary acetaminophen is the first choice for anal- ing and maintaining the oral health of the
to pregnancy-induced hormonal changes gesia, as dental pain is often managed with mother and her child.”
that relax the tone of the lower esophageal non-narcotics. For the use of other anal-
sphincter, and thus lying supine (or flat) gesics, the treating obstetrician should be All organizations agree that dental treat-
in the dental chair may make acid reflux consulted. 26 ment during pregnancy is safe and should
worse. be recommended to improve the oral and
Certain antibiotics may be used during general health of the pregnant woman.
It is important to remember that pregnant pregnancy, including penicillin, amoxi-
women are also prone to significant flu- cillin, cephalosporins, clindamycin, and Regular dental care is crucial to achiev-
id shifts and should be encouraged to sit metronidazole. Other antibiotics, such as ing and maintaining good oral and general
up slowly before leaving the dental chair, ciprofloxacin, clarithromycin, levofloxa- health. Despite the lack of evidence that
especially after lying down for longer ap- cin, and moxifloxacin should be avoided. prenatal oral health care improves pregnan-
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pointments. Tetracycline should never be used. Tetra- cy outcomes, ample evidence shows that
cyclines are not recommended in pregnan- oral health care is paramount. 26-29,30
Use of Local Anesthesia cy because of the risk of hepatotoxicity in
Local anesthesia (lidocaine with or with- the mother, and the potential for permanent A comprehensive evaluation, dental pro-
out epinephrine) is safe for administration discoloration of teeth in the fetus. 27 phylaxis, and periodontal maintenance
during pregnancy. Many recommendations (with scaling and root planing) can signifi-
support the use of lidocaine with epineph- Antimicrobials are frequently recommend- cantly improve clinical outcomes for preg-
rine. Lidocaine (2%) is a category B drug ed for use during pregnancy, such as rinses nant women and have been recognized by
(no evidence of risk in humans) as opposed with cetylpyridinium chloride (Crest Pro the American College of Obstetricians and
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to mepivacaine (3%) which is a category C Health , Cepacol , TheraBreath ), chlor- Gynecologists (ACOG) as safe and effec-
drug (risk in humans cannot be ruled out). hexidine, or products with xylitol. 26 tive for patients who are pregnant.
Lidocaine with epinephrine is preferred as Dental conditions that require immediate As such, pregnant women should be eval-
it prolongs the length of anesthesia as the treatment, such as extractions, root canals, uated and cared for regularly (every six
drug is absorbed more slowly.
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and restoration (amalgam or composite) of months) and certainly more often if and
Use of Nitrous Oxide untreated caries, may be managed at any when issues arise. Routine dental prophy-
According to the National Institute for Oc- time during pregnancy. Delaying treatment laxis, as well as nutritional counseling, can
cupational Safety and Health’s Internation- may be detrimental to the oral health of the be extremely helpful in maintaining good
al Chemical Safety Cards, nitrous oxide mother. oral health throughout pregnancy and af-
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is classified as pregnancy risk category C Dentists’ Perceptions of Providing Care terward. The ACOG also recommends that
and should be avoided for patients who are to Pregnant Patients patients should be advised to maintain good
known to be pregnant. oral hygiene and receive fluoride varnishes
According to the literature, many patients in certain situations. For patients with vom-
Nitrous oxide should be limited to only avoid the dentist during pregnancy, and iting secondary to morning sickness or with
those cases where topical and local an- dentists are reluctant to offer treatment to gastric reflux during late pregnancy, the use
esthetics are inadequate. Special consid- pregnant women for several reasons, in- of antacids or rinsing with a baking soda

www.nysagd.org l Spring 2023 l GP 14