Pregnancy causes profound and remarkable
changes in all organ system. The dental team should be aware of the altered
physiologic status of the pregnant patient to avoid inappropriate
interpretation of normal changes as pathologic. With pregnancy most important
change takes place in the cardiovascular and hematological system as a result of
the altered hormonal activity. Due to increase in mineralcorticoids, there is
the retention of sodium, which in turn leads to water retention, thus total
body water and plasma volume increases by 30-40% leading to hemodilution
(dilution of blood) there by producing a state of “physiologic anemia of
pregnancy”. During the second and third trimester, a decrease in the blood
pressure and cardiac output can occur when patient is in supine position due to
the compression of inferior venecave by gravid uterus, causing reduction of cardiac
output.
This condition is called supine hypotensive syndrome and is manifested
as light headedness, hypotension and syncope. If it occurs, emergency care for
situation consists of rolling the patient into her left side to lift the uterus
off the venecave and administering 100% oxygen. Pregnant patient may be
positioned semi-reclining. The ideal position of the pregnant women in dental
chair is left lateral decubitus position with right buttock and hip elevated 15
degrees
Pregnancy and dental work questions are
common for expecting moms. There is a general concept that pregnant moms should
completely avoid dental treatment rather depend on medications for removal of
dental symptoms. This concept is false.
Preventive dental cleanings and annual
exams during pregnancy are not only safe, but are recommended. The rise in
hormone levels during pregnancy causes the gums to swell, bleed, and trap food
causing increased irritation to your gums. Preventive dental work while
pregnant is essential to avoid oral infections such as gum disease, which
has been linked to preterm birth. During pregnancy, dental treatment may be modified
but need not be withheld, provided that the risk assessment is made properly
for both patient and the fetus.
First trimester – only emergency
procedure if utmost necessary should be done. Avoid X-rays as much as possible
because baby is in the organogenesis (organ forming stage)
Second trimester – the most safe and
comfortable period for the mother to accept dental treatment. Don’t skip your
dental check up appointment simply because you are pregnant. It is recommended
to atleast get cleaning done once if not done in past 6 month.
Third trimester
it is very difficult for
the pregnant lady to lie on her back for extended period of time. If at all she
has to take dental treatment the treatment span should be short , while getting
upfrom dental chair, if chair is reclined, it should be straightened slowly.
Coping
With Morning
Sickness
If morning
sickness is keeping you from brushing your teeth, change to a
bland tasting toothpaste during
pregnancy. Ask your dentist or hygienist to recommend brands.
Rinse your mouth out
with water or a mouth rinse
if you suffer from morning sickness and have bouts of frequent vomiting.
