Guidelines for Oral Health Care in Pregnancy


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Guidelines for Oral Health Care in Pregnancy



Dental care is safe and essential during pregnancy



Pregnancy is not a reason to defer routine dental care or treatment



Diagnostic measures, including needed dental x-rays, can be undertaken safely



Scaling and root planing to control periodontal disease can be undertaken safely; avoid using metronidazole

in the first trimester



Treatment for acute infection or sources of sepsis should be provided at any stage of pregnancy. A number of

antibiotics are safe for use



Treatment, including root-canal therapy and tooth extraction, can be undertaken safely



Needed diagnosis, preventive care, and treatment can be provided throughout pregnancy; if in doubt,

coordinate with the woman’s prenatal medical provider



Emergency care should be provided at any time during pregnancy



Delay in necessary treatment could cause unforeseen harm to the mother and possibly to the fetus



For many women, treatment of oral disease during pregnancy is particularly important because health and dental

health insurance may be available only during pregnancy or up to two months post-partum

Medical Conditions and Dental Treatment Considerations

Hypertensive Disorders and Pregnancy Hypertensive disorders, including chronic or preexisting hypertension and the development of hypertension during pregnancy, occur in 12–22% of pregnant women. Oral health professionals should be aware of hypertensive disorders because of increased risk of bleeding during procedures. Consult with the woman’s prenatal care provider before initiating dental procedures in women with uncontrolled severe hypertension (blood pressure values greater than or equal to 160/110mm Hg).

Diabetes and Pregnancy Gestational diabetes occurs in 2–5% of pregnant women in the U.S. It is usually diagnosed after 24 weeks of gestation. Any inflammation process, including acute and chronic periodontal infection, can make diabetes control more difficult. Poorly controlled diabetes is associated with adverse pregnancy outcomes such as preeclampsia, congenital anomalies, and large-for gestational age newborns. Meticulous control to avoid or minimize dental infection is important for pregnant women with diabetes. Controlling all sources of acute or chronic inflammation helps control diabetes.

Heparin and Pregnancy A small number of pregnant women with the diagnosis of thrombophilia (a blood disorder) may be receiving daily injections of heparin to improve pregnancy outcome. Heparin increases the risk for bleeding complications during dental procedures. Dental providers should consult with the woman’s prenatal medical provider prior to dental treatment.

Risk of Aspiration and Positioning During Pregnancy Pregnant women have delayed gastric emptying and are considered to always have a ―full stomach.‖ Thus, they are at increased risk for aspiration. Maintaining a semi-seated position or positioning with a pillow helps avoid nausea or aspiration and can make the woman feel more comfortable.

Guidelines for Treatment in Pregnancy

Indications

Radiographs

Analgesics (with FDA category*)

Local Anesthetic (with FDA category*)

anytime

during

Diagnostic x-

Acetaminophen

Lidocaine with

pregnancy rays are safe

(B)

epinephrine (2%)

during

Meperidine (B)

(B), considered

pregnancy

Morphine (B)

safe during

Codeine (C)

pregnancy

Use neck

(thyroid collar)

Acetaminophen + Mepivacaine (3%)

and abdomen

Codeine (C)

(C), use if benefit

shield

outweighs

Acetaminophen + possible risk to

(Hydrocodone (C) fetus

e.g. Vicodin

Acetaminophen + Oxycodone (C) e.g. Percocet

Amalgam placement or
removal
No evidence that the type of mercury released from existing fillings harms the fetus
Use rubber dam and high-speed evacuation to reduce mercury vapor inhalation

Nitrious Oxide
30% nitrous oxide can be used when topical or local anesthetics are inadequate
Pregnant women require lower levels of nitrous oxide to achieve sedation

Anesthesia

Antibiotics & AntiInvectives (with FDA
category*)
Penicillin (B) Amoxicillin (B) Cephalosporins (B) Clindamycin (B) Erythromycin not in estolate form (B)
Quinolones (C) Clarithromycin (C)
As prophylaxis for dental surgery: use same criteria for all people at risk for bacteremia

1st Trimester (1-13 weeks)
2nd Trimester (14-27 weeks)
3rd Trimester (28-40 weeks)

Spontaneous pregnancy loss occurs in 10-15% of all clinically-recognized pregnancies in the first trimester. Most losses are due to chromosome abnormalities. Yet, women may prefer to wait until the second trimester (14th week) for dental
care.

AVOID: Metronidazole
(B)

NEVER USE Ibuprofen or Indomethacin

AVOID: Sulfonamides (C)

NEVER & CAUTIONS

NEVER USE Aspirin unless prescribed by the prenatal care provider
Caution: Consult with prenatal care provider before recommending Ibuprofen (B) or Naprosyn (B) during the 1st and 2nd trimesters

Caution: CONSULT with prenatal care provider if using anesthesia other than a local block e.g. IV sedation or GA

NEVER USE Tetracycline (D) Erythromycin in estolate form

*Cat B: No evidence of risk in humans; either animal studies show risk (human findings do not) or, if no adequate human studies done, animal findings negative. *Cat C: Human studies are lacking and animal studies are either positive for fetal risk or lacking as well; potential benefits may justify the potential risk. *Cat D: Positive evidence of risk. investigational or post marketing data show risk to fetus. Nevertheless, potential benefits may outweigh the risk.
Consult with the patient’s prenatal care provider with questions and concerns about the use of any medication.
These recommendations have been reviewed with dentists and prenatal care providers—obstetricians, family doctors, nurse practitioners—throughout Oregon. We believe they represent the standard of care in Oregon. if you have questions about individual patients, contact that patient’s care provider directly.
Produced with support from the Northwest Center to Reduce Oral Health Disparities (NIH/NIDCR U54 DE019346), School of Dentistry, University of Washington. SUGGESTED CITATION: Northwest Center to Reduce Oral Health Disparities, 2009. Guidelines for Oral Health Care in Pregnancy. Seattle, WA: School of Dentistry, University of Washington.
Source material for this document includes Oral Health Care During Pregnancy and Early Childhood: Practice Guidelines. New York, NY: New York State Department of Health, 2006.
ACOG GUIDELINES FOR DENTAL CARE IN PREGNANCY: Caries, poor dentition, and periodontal disease may be associated with an increased risk for preterm delivery. it is very important that pregnant women continue usual dental care in pregnancy. This dental care includes routine brushing and flossing, scheduled cleanings, and any medically needed dental work. Many dentists will require a note from the obstetrician stating that dental care requiring local anesthesia, antibiotics, or narcotic analgesia is not contraindicated in pregnancy. The dentist should be aware that pregnant women’s gums do bleed more easily. Found in Guidelines for Perinatal Care, Sixth Edition, pp 123-124; http://www.acog.org/publications/guidelinesForPerinatalCare/gpc-83.pdf Copyright October 2007 by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists

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Guidelines for Oral Health Care in Pregnancy