Pregnancy is an extraordinary and dynamic physiological state with several transient changes. The surge of hormones induced during pregnancy causes several changes in the mother’s body and the oral cavity is no exception.

Failure to treat dental conditions or keep good oral hygiene may compromise the health of the mother and the fetus. Increased circulating estrogen causes increased capillary permeability within the gingival tissues. This predisposes pregnant women to several gingival conditions. However, with good oral hygiene, most conditions may subside postpartum.

The following changes are commonly seen in pregnancy:

  • Gingivitis
  • Gingival hyperplasia/enlargement
  • Pyogenic granuloma
  • Reduced salivary flow
  • Tooth erosion when women have severe morning sickness
  • Increased facial pigmentation, also known as ‘melasma’ or the “mask of pregnancy”

The dental management of pregnant patients requires special attention

Good oral hygiene can help prevent or reduce the severity of the hormone mediated inflammatory oral changes. According the American Dental Association, the following guidelines should be adhered to when treating a pregnant woman in the dental practice.

  1. Educate expectant mothers about oral changes
  2. Emphasize strict oral hygiene instructions and plaque control
  3. Limit dental treatment to oral hygiene prophylaxis and emergency treatments only
  4. Radiographs are considered safe at any stage during the pregnancy with abdominal and thyroid shields
  5. Local anesthetics with epinephrine (e.g., bupivacaine, lidocaine, mepivacaine) are considered safe during pregnancy
  6. The following antibiotics are considered safe for pregnant patients:  Penicillin, Amoxicillin, Cephalosporins, and Clindamycin

It is important for dentists to have a basic understanding of the underlying physiological changes of pregnancy. This understanding allows providers to create an effective treatment plan and deliver the necessary medical and dental care. Teledentistry is a great way to communicate with your pregnant patient, especially if they are not aware of when it is safe or not to visit the dentist or may have difficulty traveling to see a practitioner.

 

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Simitha Singh Rambiritch

Simitha Singh Rambiritch is a Dentist from South Africa with a Masters in Science in Oral Medicine and Periodontology from the University of the Witwatersrand (Wits). She was a clinician in the South African public and private sector and an oral medicine and periodontology lecturer for dental and oral hygiene students at the Wits School of Oral Health Sciences for almost 8 years. She also authored several publications in the South African Dental Journal. Simitha was the 2013 recipient of the Margot Lachmann Fellowship, for excellence in cancer research, with a focus on early diagnostic biomarkers in premalignant and autoimmune conditions and their conversion rate to oral cancer. She was invited to present her findings at the 9th International Congress on Autoimmunity in Nice, France.

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