Consideration for treating Pregnant Oral Surgical patients

Knife & Pen

Pregnancy is an emotionally charged experience for the mother and thus establishing a good surgeon-patient    relationship goes a long way in reducing stress and anxiety for the patient.

Considerations for treating Pregnant Oral Surgical patients

    1. A pregnant patient poses special management consideration for the treating Oral Surgeon because care must be delivered without adversely affecting the developing fetus.
    2. Organogenesis occurs during the first trimester therefore chances of fetal malformations are diminished after that. However fetal dentition remains susceptible to toxins, radiation or drugs (tetracyclines)
    3. Pregnant patients have an exaggerated inflammatory response of gingival tissues due to increased estrogen and progesterone levels. This mandates preventive regimen of oral plaque control throughout the entire pregnancy
    4. Second trimester is generally the safest period (13-27 weeks) for routine dental care/ minor oral surgical procedures. Major surgical procedures should be postponed until after delivery.
    5. Diagnostic radiologic procedures should be avoided during pregnancy unless the information obtained is absolutely necessary for well being of the patient. Always put lead apron and thyroid shield before taking any xrays.
    6. Drugs administered to pregnant patient may cross placental barrier so avoid any drugs during first trimester. Always choose safer alternatives in analgesics, antibiotics and local anesthetics (three most common group of drugs)
    7. Acetaminophen (Paracetamol) is safest analgesic; NSAIDS & Opiods to be avoided. Amoxillin & Cephalosporins can be used; Tetracyclines (Doxycycline) to be strictly avoided. Lidocaine is the safest Local anesthetic; avoid Articaine & bupivacaine (fetal Hypoxia can occur)
    8. Supine Hypotensive syndrome can occur in pregnant patients when they lie supine on the dental chair or OT table. It can be avoided by putting a support (folded towel/ sheet) under the right hip & buttocks to elevate it approximately 15 degrees (takes the pressure off the Inferior Vena Cava).
    9. Hypersensitive Gag reflex is another special issue that occurs in pregnant patient. This can cause repeated regurgitation resulting in halitosis & enamel erosion. Advise the patient to rinse with baking soda water to neutralise the acid.
    10. Rinsing with hydrogen peroxide mouthwash must not be done by patients with Amalgam restorations. Peroxide can release Mercury from these restorations and cause damage to developing fetus