This document discusses considerations for dental care during pregnancy and breastfeeding. It notes that while pregnant patients are not medically compromised, dental care must avoid harming the developing fetus. The first trimester poses the highest risk, so elective care is best avoided then. Routine dental care is generally safest during the second trimester. Drug use and radiation exposure should be minimized, and safe alternatives utilized. Maintaining good oral hygiene benefits both mother and child without risk.

1. Pregnancy & Breast Feeding
December 4th
2005
Dr. Suresh. C. S. BDS; MDS; MDSc ( UK )
Oral Diagnosis I

2. Overview
 Pregnant patients are not considered medically
compromised patients.
 Pregnant patients poses a unique set of
management considerations for the dentist.
 Dental care must be rendered to the mother
without adversely affecting the developing
fetus.

3. Overview (Cont.)
 Providing routine dental care to pregnant patients
is generally safe. However, the potentially harmful
elements including:
 Ionizing radiation
 Drug administration

4. Physiology & Complications
 During pregnancy, several cardiovascular changes
occur:
 Blood volume increases 40%.
 Cardiac output increases 30-40%.
 RBC volume increases only about 15-20%.
 Blood pressure falls (100/70 mm Hg).
 Heart murmur (90% of cases).

5. Physiology & Complications
 During late pregnancy a supine hypotension
syndrome may occur:
 Abrupt fall in blood pressure
 Bradycardia
 Sweating
 Nausea
 Weakness
 Air hunger when the patient is in supine
position

6. Physiology & Complications
Normal pregnancy lasts about 40 weeks:
 During the first trimester, formation of organs
and systems occurs (fetus most susceptible to
malformation).
 After the first trimester, the majority of
formation is complete (growth & maturation).

7. Physiology & Complications
 Complications of pregnancy
 More common in expectant mothers who
harbor pathogens:
 Infections
 Glucose abnormalities
 Hypertension
 Might results in perinatal abnormalities and
congenital anomalies

8. Dental Management
 Dentist should determine the general health of the
patient:
 Proper medical history
 Current physician
 Gestational diabetes
 Miscarriage
 Hypertension
 Morning sickness

9. Dental Management
Preventive program
 Establish a healthy oral environment and an
optimum level of oral hygiene
 Minimize the exaggerated inflammatory response
 Studies have shown that maternal periodontal
disease increases the infant risk for low birth
weight
 Uses of prenatal fluoride and oral hygiene
measures benefits the mother & the newborn
without risk

10. Dental Management
Treatment Timing
 Elective dental care is best avoided during the
first trimester
 The second trimester is the safest period which
to provide routine dental care
 After the middle of third trimester, elective
dental care is best postponed
 Prolonged time should be avoided

11. Dental Management
Dental Radiographs
Irradiation should be avoided especially in
the first trimester of pregnancy
If radiographs becomes necessary, the
dentist must be aware of how to proceed
safely

12. Dental Management
Drug Administration
Ideally, no drug should be administered
during pregnancy, especially the first
trimester.
Counseling should be provided to make
sure that pregnant women clearly
understand the magnitude of risk associated
with drug

13. Dental Management
Drug Administration
The dentist should be familiar with FDA
categorization:
A: controlled studies in humans have failed to
demonstrate a risk to the fetus.
B: animal studies have not indicated fetal risk.
C: animal studies have shown a risk.
D: positive evidence of human fetal risk exists.
E: evidence of fetal abnormalities and fetal risk
exists.

14. Dental Management
Breast Feeding
Careful drug selection for the nursing
mother should be made.
Authorities suggest that she takes the drug
just after breast feeding and avoid nursing
for 4 hours or more if possible.

15. Oral Complications &
Manifestations
Pregnancy gingivitis
 Exaggerated inflammatory response to local
irritants.
 The most common location of pyogenic
granuloma is the labial aspect of the interdental
papillae
 A relationship between dental caries and
physiologic process of pregnancy has not been
demonstrated

16. Pyogenic Granuloma