Pregnant Patients

When caring for pregnant patients seeking dental care, elective treatment is best during the second trimester and emergency dental treatment can be performed whenever indicated. Nitrous oxide should be avoided if possible, but it can be used for short periods if needed at approximately 25 ppm during administration.²⁰ Local anesthetic with vasoconstrictor may be used during pregnancy, but should be limited. Monitoring blood pressure and vitals helps to detect pre-eclampsia, which is characterized by elevated BP. Radiographs should be taken only when the benefits outweigh the risks.¹

Pregnant patients must have excellent oral hygiene during pregnancy. They can be educated regarding the increased risk for pregnancy gingivitis during the second month of pregnancy, as well as the possibility of getting pyogenic granulomas, or pregnancy tumors. If the patient is experiencing morning sickness, dental appointments should be scheduled in the afternoon and every effort can be made to prevent the gag reflex during treatment by seating them in a semi-supine position. In addition, pregnant patients can rinse with sodium bicarbonate after vomiting and then brush their teeth once the pH level has increased.

During pregnancy, unnecessary drugs should be avoided, but if they are needed refer to the new FDA labeling which replaces the old five-letter system (A, B, C, D and X). The new labeling system addresses risks to expectant mothers, developing fetuses and infants who are breastfeeding.²¹ If analgesic is needed, acetaminophen is recommended as NSAIDs and Aspirin are contraindicated during pregnancy. Dental appointments should be kept short and the patient placed in a supine position as hypotension is possible in the 3rd trimester.

Table 17 provides follow-up questions that are helpful when caring for pregnant patients.