For Dentists & Students: Guidelines For Managing a Pregnant Women

So, lets face it… we all have encountered pregnant patients and some of us just don’t want to treat them scared of doing something wrong that might affect the mother or the baby. But come on, why do you really want to refer them if you can treat them?! To solve this problem, I will discussing the guidelines that is sponsored by Health Resources and Services Administration & Maternal and Child Health Bureau. It is also done in collaboration with the American College of Obstetricians and Gynecologists & American Dental Association.

Pregnancy is a unique period during a woman’s life and is characterized by complex physiological changes, which may adversely affect oral health. At the same time, oral health is key to overall health and well-being. Preventive, diagnostic, and restorative dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health.
Providing pregnant women with oral health care, educating them about preventing and treating dental caries is critical, both for women’s own oral health and for the future oral health of their children. Evidence suggests that most infants and young children acquire caries-causing bacteria from their mothers. Providing pregnant women with counseling to promote healthy oral health behaviors may reduce the transmission of such bacteria from mothers to infants and young children, thereby delaying or preventing the onset of caries.
For these reasons, it is essential for health professionals (e.g., dentists, dental hygienists, physicians, nurses, midwives, nurse practitioners, physician assistants) to provide pregnant women with appropriate and timely oral health care, which includes oral health education.

Guidance for Oral Health Professionals

I will be organizing the guidelines into steps as it is in the guideline it self.

1

1. Assess Pregnant Women’s Oral Health

– Take an oral health history. Following are examples of questions that oral health professionals may ask pregnant women. This information may be gathered through a conversation or a questionnaire.

• When and where was your last dental visit? Do you have swollen or bleeding gums, a toothache (pain), problems eating or chewing food, or other problems in your mouth?
• How many weeks pregnant are you? (When is your due date?)
• Do you have any questions or concerns about getting oral health care while you are pregnant?
• Since becoming pregnant, have you been vomiting? If so, how often?
• Have you received prenatal care? If not, do you need help making an appointment for prenatal care?

– In addition to reviewing the dental history, review medical and dietary histories, including use of tobacco, alcohol, and recreational drugs.
– Perform a comprehensive oral examination, which includes a risk assessment for dental caries and periodontal disease. 
– Take radiographs to evaluate and definitively diagnose oral diseases and conditions when clinically indicated

2. Advise Pregnant Women About Oral Health Care

– Reassure women that oral health care, including use of radiographs, pain medication, and local anesthesia, is safe throughout pregnancy.
– Encourage women to continue to seek oral health care, practice good oral hygiene, eat healthy foods, and attend prenatal classes during pregnancy.

– Use standard practice when placing restorative materials such as amalgam and composite.
– Use a rubber dam during endodontic procedures and restorative procedures.
– Position pregnant women appropriately during care:

• Keep the woman’s head at a higher level than her feet.
• Place woman in a semi-reclining position, as tolerated, and allow frequent position changes.
• Place a small pillow under the right hip, or have the woman turn slightly to the left as needed to avoid dizziness or nausea resulting from hypotension.

– Follow up with pregnant women to determine whether preventive and restorative treatment has been effective.
– Establish relationships with prenatal care health professionals in the community. Develop a formal referral process whereby the prenatal care health professional agrees to see the referred individual in a timely manner (e.g., that day, the following day) and to provide subsequent care.
– Consult with prenatal care health professionals, as necessary—for example, when considering the following:

• Co-morbid conditions that may affect management of oral problems (e.g., diabetes, hypertension, pulmonary or cardiac disease, bleeding disorders).
• The use of intravenous sedation or general anesthesia.
• The use of nitrous oxide as an adjunctive analgesic to local anesthetics.

3. Provide Oral Disease Management and Treatment to Pregnant Women

– Provide emergency or acute care at any time during the pregnancy, as indicated by the oral condition.
– Develop, discuss with women, and provide a comprehensive care plan that includes prevention, treatment, and maintenance throughout pregnancy. Discuss benefits and risks of treatment and alternatives to treatments.

4. Pharmacological Considerations for Pregnant Women

The pharmacological agents listed below are to be used for indicated medical conditions and with appropriate supervision.

  • Analgesics: MAY BE used during Pregnancy
  1. Acetaminophen
  2. Acetaminophen with Codeine, Hydrocodone, or Oxycodone
  3. Codeine
  4. Meperidine
  5. Morphine
  • Analgesics: MAY BE used in short duration during pregnancy; 48 to 72 hours. AVOID in 1st and 3rd trimesters.
  1. Aspirin
  2. Ibuprofen
  3. Naproxen
  • Antibiotics: MAY BE used during pregnancy.
  1. Amoxicillin
  2. Cephalosporins
  3. Clindamycin
  4. Metronidazole
  5. Penicillin
  • Antibiotics: AVOID during pregnancy.
  1. Ciprofloxacin
  2. Clarithromycin
  3. Levofloxacin
  4. Moxifloxacin
  • Antibiotics: NEVER use during pregnancy.
  1. Tetracycline
  • Anesthetics: Consult with a prenatal care health professional prior to using intravenous sedation or general anesthesia.
  1. Local anesthetics with epinephrine (e.g., Bupivacaine, Lidocaine, Mepivacaine): MAY BE used during pregnancy.
  2. Nitrous oxide (30%): MAY BE used during pregnancy when topical or local anesthetics are inadequate. Pregnant women require lower levels of nitrous oxide to achieve sedation; consult with prenatal care health professional.
  • Antimicrobials: Use ALCOHOL-FREE products during pregnancy. MAY BE used during pregnancy.
  1. Cetylpyridinium chloride mouth rinse
  2. Chlorhexidine mouth rinse
  3. Xylitol

I’m sure after this article, you will be wanting more pregnant women to come. Let me know your experience. I read each and every comment.

Haider Maitham, DDS / Bondistry

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