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Pregnancy Update.Kurien S et al
New Horizon Dental College & Hospital, Department of Oral Medicine and Radiology, Chattisgarh, India; 2Assistant Professor, S D
Dental College and Hospital, Department of Oral and Maxillofacial Surgery, Maharashtra, India; 3Assistant Professor, Department of Oral and
Maxillofacial Surgery, Mansarovar Dental College, Bhopal (M.P.), India; 4Assistant Professor, Department of Conservative and Endodontics,
Mansarovar Dental College, Bhopal (M.P.), India; 5Professor, GITAM Dental College and Hospital, Department of Periodontics, Andhra
Pradesh, India;
6,7Assistant
Professor, S D Dental College and Hospital, Parbhani, Department of Periodontics, Maharashtra, India; 8Assistant
Professor, S D Dental College and Hospital, Parbhani, Department of Oral Pathology, Maharashtra, India.
ABSTRACT
The purpose of this article is to update general dentists and maxillofacial surgeons in the perioperative
management of the pregnant patient. Pregnancy results in physiologic changes in almost all organ systems in the
body mediated mainly by hormones; which influences the treatment schedule. Understanding these normal
changes is essential for providing quality care for pregnant women.
The general principles that apply in this situation are discussed, followed by the relevant physiologic changes and
their treatment implications, the risks of various medications to the mother and fetus, the management of
concomitant medical problems in the pregnant patient, appropriate timing of oral and maxillofacial surgery during
pregnancy, and management of emergencies during pregnancy. Information about the compatibility,
complications, and excretion of the common drugs during pregnancy is provided. Guidelines for the management
of a pregnant patient in the dental office are summarized.
Keywords: pregnant patient, physiology of pregnancy, treatment considerations.
How to cite this article: Kurien S, Kattimani V S, Sriram R, Sriram S K, Prabhakar Rao V K, Bhupathi A, Bodduru
R, Patil N N. Management of Pregnant Patient in Dentistry. J Int Oral Health 2013; 5(1):88-97.
Source of Support: Nil
th
Address for Correspondence: Dr Vivekanand S Kattimani, Assistant Professor, S D Dental College and Hospital,
Parbhani, Department of Oral and Maxillofacial Surgery, Maharashtra, India. Mobile: 09689742418, Email:
drvivekanandsk@gmail.com
Introduction
occur
hematologic,
genitourinary,
in
respiratory,
the
cardiovascular,
gastrointestinal,
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REVIEW ARTICLE
Pregnancy Update.Kurien S et al
in the management:
30%
to
50%
during
pregnancy,
mediators
like
progesterone,
bradycardia,
and
syncope
50%
of
pregnant
women
develop
an
abnormal
alveolar-arterial
Ventilation
patterns
and
patient
estrogen
women
2,.
concentrations
in
pregnant
number
anemia
and
respiratory
changes
occurring
during
of
of
erythrocytes
pregnancy
that
and
is
leukocytes,
maximal
by
occurrence.
Increased levels of circulating catecholamines and
cortisol contribute to the leukocytosis seen in
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REVIEW ARTICLE
Pregnancy Update.Kurien S et al
placental-induced
proteinuria,
coagulable
for
fivefold
state,
increasing
increase
in
the
the
risk
likelihood
of
of
edema),
HELLP
pregnant patients.
during
pregnancy
requires
intravenous
Pregnant
syndrome
not
Acute thromboembolism
identified.
hypertension,
been
and
triad
women
with
with
heparin,
aspirin,
or
intravenous
26
unfractionated
been
stopped
spontaneous bleeding.
heparin),
and
has
1,27
Gastrointestinal
System
changes
and
its
implications:
The main GI changes are nausea, vomiting, and
heartburn which are due to mechanical changes
resulting from an enlarging fetus, in combination
with hormonal changes. Two thirds of pregnant
patients complain of nausea and vomiting, with
immediately
regurgitation
special
consideration,
implications:
in
warrant
trimester.1,
occurs
experiences
Renal
(heartburn)
patient
if
and
genitourinary
changes
and
its
pregnant
pressure
gastroesophageal
the
and
of
hormonal
progesterone.
32
the
lower
effects
of
estrogen
patients
are
increased
glomerular
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REVIEW ARTICLE
Pregnancy Update.Kurien S et al
Oral
and
human
gonadotrophin)
and
secreted
changes
include
Elevated
circulating
increased
capillary
gingivitis,
estrogen,
gingival
which
permeability,
causes
predisposes
Increased uterine mass causes compression of IVC leads to venous stasis and
increased risk for deep venous thrombosis,
Decreased amplitude of T-waves on electrocardiogram,
Extra heart sounds / systolic S3 murmur.
Hematologic
Respiratory
Gastrointestinal
Genitourinary
Endocrine
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Pregnancy Update.Kurien S et al
Explanation
Category A
Category B
Category C
Animal studies show an adverse effect on the fetus but there are no
controlled studies in humans. The benefits from use of such drugs may be
acceptable.
Category D
Evidence of human risk, but in certain circumstances the use of such a drug
may be acceptable in pregnant women despite its potential risk.
Category X
Higher
hyperplasia.
cause
depends
amount
aspects
changes.
43
Pregnancy
does
not
volume
on
of
of
the
milk
chemical
consumed.
commonly
used
properties,
The
and
FDA
dose,
has
prescribed
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Pregnancy Update.Kurien S et al
Table 3: Common Drugs used in Dental Therapies with its Limitations and Remarks.
Drugs
Use in Pregnancy
Use in Lactation
Remarks
Antibiotics
Amoxicillin
Metronidazole
gentamycin.
Erythromycin
yes
yes
Penicillin
tetracycline.
Cephalosporins
Gentamycin
Clindamycin
Tetracycline
Chloramphenicol
yes
yes
no
no
with chloramphenicol
Analgesics
Acetaminophen
Morphine
Postpartum hemorrhage
yes
yes
Meperidine
Oxycodone
morphine.
Hydrocodone
Propoxyphene
With caution
With caution
no
Pentazocine
Aspirin
Ibuprofen
Naproxen
Antifungals
Clotrimazole
Nystatin
Fluconazole
Ketoconazole
yes
yes
With caution
With caution
Local Anesthetics
Lidocaine
Prilocaine
yes
With caution
yes
Mepivacaine &Bupivacaine
Etidocaine
Mepivacaine
Bupivacaine
Corticosteroids
Prednisolone
yes
yes
Sedative/Hypnotic
Nitrous oxide
yes
Nitrous oxide.
Barbiturate
Benzodiazepines
no
no
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Pregnancy Update.Kurien S et al
Effects on Fetus
Ethyl alcohol
Tobacco
Cocaine
Thalidomide
Micromelia
Methyl mercury
Anticonvulsants (all)
Carbamazepine
Spina bifida
Valproic acid
Lamotrigine
Phenobarbital
Urinary malformations
Topiramate
Angiotensin-converting enzyme
inhibitors
Retinoids
which
causes
less
gastric
of
anti-inflammatory
analgesics,
by
dentists.
Initial
assessment
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Pregnancy Update.Kurien S et al
(14th
to
28th
week):
procedures
are
more
safely
performed if necessary.
by15.
Radiographs, Pregnancy, And the Fetus:
trimester
appointments
avoided.
scheduled
with
33
treatment
be
performed if necessary.
should
to
periodontal
after
consultation
with
the
patients
REVIEW ARTICLE
Pregnancy Update.Kurien S et al
pregnancy.
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Pregnancy Update.Kurien S et al
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