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Q U I N T E S S E N C E I N T E R N AT I O N A L
Key words: dental treatment, drug use, pregnancy, pregnancy gingivitis, prenatal fluoride,
risk factors
PHYSIOLOGIC CHANGES
ASSOCIATED WITH
PREGNANCY
Pregnancy causes profound and remarkable
changes in all organ systems.1 The dental
team should be aware of the altered physiologic status of the pregnant patient to avoid
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Q U I N T E S S E N C E I N T E R N AT I O N A L
Cengiz
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Q U I N T E S S E N C E I N T E R N AT I O N A L
Cengiz
Ta b l e 1
Category
Definition
A
B
Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there
is no evidence of risk in later trimesters), and the possibility of fetal harm appears remote.
Either animal reproduction studies have not demonstrated a fetal risk but there are no controlled
studies in pregnant women or animal reproduction studies have shown an adverse effect (other
than a decrease in fertility) that was not confirmed in controlled studies in women in the first
trimester (and there is no evidence of risk in later trimesters).
Either studies in animals have revealed adverse effects on the fetus (teratogenic, embryocidal, or
other) and there are no controlled studies in women or studies in women and animals are not
available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.
There is positive evidence of human fetal risk, but the benefits of use in pregnant women may
be acceptable despite the risk (for example, if the drug is needed in a life-threatening situation or
for a serious disease for which safer drugs cannot be used or are ineffective).
Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence
of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant
women clearly outweighs any possible benefit. The drug is contraindicated in women who are
or may become pregnant.
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Prenatal fluoride
Although the efficacy of dietary fluoride supplementation to children for preventing dental caries has been well established,36,37 prenatal fluoride supplementation has been
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Q U I N T E S S E N C E I N T E R N AT I O N A L
Cengiz
Ta b l e 2
Drug
FDA category
Use while
breast-feeding
Use in pregnancy
C
B
B
C
B
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
C
C
B
C
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Do not use in 3rd trimester
Do not use in 3rd trimester
Do not use in 3rd trimester
Do not use in 3rd trimester
Do not use in 3rd trimester
Do not use in 3rd trimester
Do not use in 3rd trimester
Do not use in 3rd trimester
Low dose, short duration acceptable
Low dose, short duration acceptable
Low dose, short duration acceptable
Low dose, short duration acceptable
Yes
Use cautiously
Use cautiously
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Use cautiously
Use cautiously
Yes
Yes
Yes
Yes
Yes
Yes (do not use estolate)
Yes
Use cautiously
Yes
No
No
Use cautiously
Yes
Use cautiously
Use cautiously
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Use cautiously
Yes
No
No
Yes
B
C/D*
C/D*
B/D*
B/D*
B/D*
B/D*
B/D*
B/D*
C
B
B
C
B
B
B
B
B
B
B
C
B
D
D
B
B
C
C
B
The first category refers to the first and second trimesters; the second category refers to the third trimester.
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Cengiz
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Q U I N T E S S E N C E I N T E R N AT I O N A L
Cengiz
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Q U I N T E S S E N C E I N T E R N AT I O N A L
Cengiz
Ta b l e 3
Purpose
To educate parents about dental development of the child
To educate parents about dental disease and prevention
To provide a suitable environment for the child
To strengthen and prepare the child and his or her dentition for life
Methods
Education on development, prevention, and disease
Demonstration of oral hygiene procedures
Counseling to instill preventive attitudes and motivation
Evaluation of parent's learning, acceptance, and needs
Content
Parent's oral health
Education of parents about dental disease processes and oral hygiene, to reduce bacterial load and effect of
transmission and prematurity[Au: prematurity of what?]
Motivation of parents for plaque removal and oral hygiene, to improve their own health (cardiovascular relationships) and to help their expected child
Discuss changes in maternal oral health: changes in gingival health, risk of caries from carbohydrates, myths of
pregnancy, and needed dental treatment, and when best to accomplish that treatment
Child's oral health
Child development, including aspects of oral, emotional, and general development affecting oral health and oral
health delivery
Effects of lifestyle on the child: habits, substance abuse, sugar intake, maternal disease, nutrition (including
nutrient roles in tooth development), prenatal fluoride, breast-feeding
Postnatal period: teething, tooth eruption patterns, nonnutritive sucking, timing of the first dental visit, bottle use
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CONCLUSION
After consulting the patients physician and
assessing the potential risks of undergoing
dental treatment during pregnancy, necessary treatment and drugs should not be withheld from the patient who requires them.
Proper assessment, intervention, and patient
education about dental problems during
pregnancy can help to enhance pregnancy
outcomes. Clinicians and oral hygienists can
assume vital roles in maintaining oral health
during pregnancy by prenatal oral health
counseling.
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Q U I N T E S S E N C E I N T E R N AT I O N A L
Cengiz
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Cengiz
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