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Oral health challenges in pregnant women: Recommendations for dental care

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Article  in  The Saudi Journal for Dental Research · December 2015

DOI: 10.1016/j.sjdr.2015.11.002

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 SJDR 55 No. of Pages 9
22 December 2015
The Saudi Journal for Dental Research (2015) xxx, xxx–xxx
1

King Saud University

The Saudi Journal for Dental Research

www.ksu.edu.sa
www.sciencedirect.com

2 REVIEW ARTICLE

4 Oral health challenges in pregnant women:

5 Recommendations for dental care professionals
6 Mustafa Naseem a, Zohaib Khurshid b, Hammad Ali Khan c, Fayez Niazi d,
7 Sana Shahab e, Muhammad Sohail Zafar f,*

a
8 Department of Community and Preventive Dentistry, Ziauddin College of Dentistry, Ziauddin University, Karachi, Pakistan
b
9 School of Materials and Metallurgy, University of Birmingham, UK
c
10 Department of Operative Dentistry, Ziauddin College of Dentistry, Ziauddin University, Karachi, Pakistan
d
11 Department of Oral Biology, Ziauddin College of Dentistry, Ziauddin University, Karachi, Pakistan
e
12 Department of Dental Materials Science, Sir Syed College of Medical Sciences for Girls, Pakistan
f
13 College of Dentistry, Taibah University, Madinah Al Munawwarah, Saudi Arabia

14 Received 14 April 2015; revised 3 November 2015; accepted 20 November 2015

15

17 KEYWORDS Abstract Pregnancy is a dynamic state leading to several physiological transient changes in the
18
19 Fetus; body systems including the oral cavity. In order to maintain good oral health, the dental treatment
20 Dental problems; should not be withheld. The dental management of pregnant patients involves special considera-
21 Teratology; tions. This review article discusses common dental problems a pregnant woman faces along with
22 Women’s health the relevant treatment implications, the risks of various medications to both mother and fetus
and common dental problems a pregnant women faces. In addition, the management of related den-
tal problems in the pregnant patients and appropriate scheduling of dental surgical procedures dur-
ing pregnancy has been discussed.
23 Ó 2015 Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

24 Contents

25 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
26 2. Common dental problems during pregnancy and management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
27 2.1. Dental caries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

* Corresponding author at: College of Dentistry,Taibah University, PO Box 2898, Madinah Al Munawwarah, Saudi Arabia. Tel.: +966
507544691.
E-mail address: drsohail_78@hotmail.com (M.S. Zafar).
Peer review under responsibility of King Saud University.

Production and hosting by Elsevier

http://dx.doi.org/10.1016/j.sjdr.2015.11.002
2352-0035 Ó 2015 Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Naseem M et al. Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for
Dental Research (2015), http://dx.doi.org/10.1016/j.sjdr.2015.11.002
 SJDR 55 No. of Pages 9
22 December 2015
2 M. Naseem et al.

28 2.1.1. Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
29 2.2. Periodontal disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
30 2.2.1. Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
31 2.3. Gingivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
32 2.3.1. Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
33 2.4. Tooth mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
34 2.4.1. Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
35 2.5. Tooth erosion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
36 3. Suitable timings and dental management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
37 4. Dental chair positioning and pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
38 5. Pharmacodynamics and pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
39 5.1. Analgesics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
40 5.2. Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
41 5.3. Local and general anesthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
42 6. Oral and dental health management guidelines during pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
43 6.1. First trimester. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
44 6.2. Second trimester . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
45 6.3. Selective radiographs can be taken third trimester . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
46 7. Dental radiations and pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
47 8. Teratology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
48 9. Conclusions and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
49 Conflict of interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
50 Funding statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
51 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
52 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
53

54

55 1. Introduction throughout the period of pregnancy with certain 85

precautions.4,10 86

56 Pregnancy is a state of physiological condition that brings An effective model for conceptualizing the management of 87

57 about various changes in the oral cavity along with other phys- the dental needs of pregnant women is needed. Such a model 88

58 iological changes taking place throughout the female body.1 should encompass interdisciplinary collaboration between the 89

59 Gingival hyperplasia, gingivitis, pyogenic granulomas and var- medical and dental care professionals in order to improve ser- 90

60 ious salivary alterations are some of the changes commonly vices and referral strategies.5 The following sections address 91

61 witnessed among pregnant women.2 The role of high levels various facets of management of pregnant patients based on 92

62 of circulating estrogen is well established and associated with updated guidelines. These are intended as a resource for young 93

63 high prevalence of gingivitis and gingival hyperplasia.3 Proges- clinicians to gain knowledge and confidently cater to the needs 94

64 terone in the serum is also seen to be associated with melasma, of pregnant patients. 95

65 presenting a bilateral pigmentation or brown patches in the

66 mid face region.3,4 A general view of physiological changes 2. Common dental problems during pregnancy and management 96
67 on body systems during pregnancy is given in Fig. 1.
68 Various studies have found evidence linking together poor Like any other system, the oral cavity exhibits a number of 97
69 maternal oral health, pregnancy outcomes and dental health changes during pregnancy (Fig. 2) and thus requires special 98
70 of the offspring.5 These may range from preterm delivery attention by the dental care professionals. Below are men- 99
71 and low birth weight to higher risk of early caries among tioned few common dental problems that pregnant women 100
72 infants. Unfortunately, apart from self-maintenance of oral face. 101
73 hygiene, pregnant women face several other barriers in achiev-
74 ing optimal oral health.6,7 These barriers to seeking dental ser- 2.1. Dental caries 102
75 vices include lack of knowledge and value, negative oral health
76 experiences, negative attitudes toward oral health profession- Pregnant women are more prone to tooth decay due to upturn 103
77 als and negative attitudes of dental staff toward pregnant in the acidic environment of oral cavity, increased consump- 104
78 women.8 Similarly, incorrect assumptions, lack of knowledge tion of sugary diet and carelessness toward oral health.11 105
79 or experience often plays a role in the hesitance shown by den- Recurrent vomiting becomes common in pregnancy that 106
80 tists in providing dental care for pregnant women.2 Oral health enhances acidic environment leading to progress of carious 107
81 promotion, disease prevention, early detection and timely pathogens and an increased demineralization making teeth 108
82 intervention are crucial aspects for maternal and child oral prone to caries.9,10 Untreated carious lesions increase the inci- 109
83 health.9 It is widely established that many if not all routine dence of abscess and cellulitis.12 110
84 and preventive dental procedures can be safely performed

Please cite this article in press as: Naseem M et al. Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for
Dental Research (2015), http://dx.doi.org/10.1016/j.sjdr.2015.11.002
 SJDR 55 No. of Pages 9
22 December 2015
Oral Health and Pregnancy 3

Figure 1 Key physiological change observed in various body systems during pregnancy.

111 2.1.1. Management sional, root planning/deep scaling and prescribing 0.12% daily 138

112 It is advisable for pregnant women to limit sugary diet, brush chlorhexidine mouth rinses to limit the progress of disease. 139

113 regularly with fluoridated tooth paste and use over the counter Chlorhexidine is categorized as FDA class B and measured 140

114 fluoridated mouth rinses to counteract the effect of demineral- safe to practice in pregnant women.23 141

115 ization due to vomiting. The role of topical applications of flu-

116 oride is well accepted for the prevention of caries.13,14 Fluoride 2.3. Gingivitis 142
117 releasing restorative materials such as glass ionomers can inhi-
118 bit secondary caries.14–17 In addition, drugs such as metham-
Gingivitis or bleeding tender gums is the most common dental 143
119 phetamine that may further aggravate dental caries should
problem and contributes to around 60–70% of pregnant 144
120 be avoided.18,19
women. Such conditions are common due to decreased 145
immune response, hormonal fluctuations of estrogens and pro- 146
121 2.2. Periodontal disease gesterone and changes in normal oral flora.24,25 147

2.3.1. Management 148

122 About 30% of pregnant women suffer from periodontal dis-
123 eases.19,20 While the role of elevated levels of circulating estro- Commendations to improve the condition may comprise pro- 149

124 gen is well established in higher prevalence of gingivitis and fessional prophylaxis i.e. scaling, daily fluoridated tooth brush- 150

125 gingival hyperplasia during pregnancy,3 the association ing, flossing and saline mouth rinses should be encouraged that 151

126 between pregnancy and oral diseases like periodontitis require may help in easing the irritant. In addition, chlorhexidine 152

127 further research. The role of elevated levels of inflammatory mouth rinses may provide added benefit.26,27 153

128 markers (i.e. interleukin 6, interleukin 8 and PGE2) has been

129 found in the amniotic fluid of child bearing women having 2.4. Tooth mobility 154

130 periodontal conditions, which is considered to be associated

131 with premature labor and low birth weight.8,21,22 Due to hormonal rush mineral changes in lamina dura and dis- 155
turbance in the periodontal ligament attachment, affect mobil- 156
132 2.2.1. Management ity of teeth leading to periodontal diseases.31,32 157

133 Recent evidence clearly demonstrates that scaling and root

134 planning is considered safe during pregnancy and improves 2.4.1. Management 158

135 both maternal and neonatal health.8 The management strate- This condition can be made reversible if given therapeutic 159
136 gies to overcome periodontal disease in pregnant females doses of vitamin C along with removal of local gingival 160
137 embraces vigilant diagnosis by the dental health care profes- irritants.28,29 161

Please cite this article in press as: Naseem M et al. Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for
Dental Research (2015), http://dx.doi.org/10.1016/j.sjdr.2015.11.002
 SJDR 55 No. of Pages 9
22 December 2015
4 M. Naseem et al.

Figure 2 Key oral changes and conditions during pregnancy.

162 2.5. Tooth erosion diseases, regular monitoring and management of present dis- 179
ease (Fig. 3). 180

163 Tooth erosion, another unwanted dental problem is considered

164 to be caused by pregnancy induced vomiting. It is understood 4. Dental chair positioning and pregnancy 181
165 that dental erosion can be effectively controlled with the use of
166 a solution containing sodium bicarbonate that neutralizes the
When performing chair side procedures it is of great impor- 182
167 acid and prevents damages.30 It is advised to consult patient’s
168 physician and gastroenterologist to control the related medical tance to make sure that the pregnant patients are seated in 183
the correct and safe position (Fig. 4). This helps to avoid 184
169 conditions.
any complication such as supine hypotensive syndrome in 185
the dental chair. For example, if a pregnant lady is seated in 186
170 3. Suitable timings and dental management the supine position, there are great chances of progression to 187
medium hypoxemia and an abnormal arterial oxygen gradient. 188
171 To preserve and promote oral health; scaling, polishing and Similarly there is a risk of compression of the vena cava and 189
172 root planning are recommended at any stage of pregnancy.21,22 aorta due to the gravid uterus which may lead to postural 190
173 However, it is strictly advised to perform general dentistry hypotension. Therefore it is important that the dealing dentist 191
174 procedures (i.e. routine restorations, endodontic therapy and makes her sit in the right position; i.e. either seated with her 192
175 elective extractions) after fetal organogenesis has taken place right hip elevated 10–12 cm so that the pressure on the vena 193
176 (i.e. in second and third trimester). Extensive and prolonged cava is reduced or by placing the patient in a 5–15% tilt on 194
177 dental procedures should be postponed till after delivery.3 her left side. In case the hypotension is not relieved, the patient 195
178 All treatment modalities should focus on the prevention of oral should be asked to acquire a full left lateral position. These 196

Please cite this article in press as: Naseem M et al. Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for
Dental Research (2015), http://dx.doi.org/10.1016/j.sjdr.2015.11.002
 SJDR 55 No. of Pages 9
22 December 2015
Oral Health and Pregnancy 5

Figure 3 Oral health care measures adopted during pregnancy.

197 modifications are however recommended during the third reported side effect of acetaminophen is hepatotoxicity. Due to 219
198 trimester.2,4,10 their availability in different formulations it is advised that a 220
pregnant woman should not exceed more than 4 grams per 221
199 5. Pharmacodynamics and pregnancy day.32 Other analgesics such as ibuprofen is sorted in category 222
B classification in first and second trimesters but changes to 223

200 Pregnancy is a phase having a high volume of drug distribu- category D in the third trimester as the drug is associated with 224

201 tion, decline in maximum plasma concentration, shorter lower amniotic fluid, premature heart valve closure and limits 225

202 plasma half-life, rise in lipid solubility and rate of clearance.6,31 the vaginal opening during labor.23 Dentist should recommend 226

203 Such dynamics contribute to an easy access of boundless drugs acetaminophen with codeine or oxycodone but prolonged use 227

204 through the placenta, therefore compromising the health of the is not suggested as it may result in neonatal depression. In gen- 228

205 fetus. In addition these drugs may result in low birth weight, eral, this apparently is not of worry as the dose regimes are 229

206 teratogenicity and further adverse effects leading to miscar- characteristically approved in connotation with dental 230

207 riage. Therefore during this phase, the use of drugs is not rec- treatment.32 231

208 ommended, especially during the first 13 weeks i.e. the first
209 trimester. Due to potential adverse effect of drugs and for a 5.2. Antibiotics 232

210 safer approach, drugs have been categorized based on the risk
211 and hazards to the fetus.6,31 Food and Drug Administration Most antibiotics permitted by the dentist belongs to category B 233
212 (FDA), USA has categorized drugs based on their potential of FDA classification with exemption of gentamycin and doxy- 234
213 risk factors during pregnancy (Table 1). cycline both of which fits in to class D (Table 1). Gentamycin is 235
reported to cause fetal ototoxicity whereas doxycycline and its 236
214 5.1. Analgesics derivatives cause tetracycline staining of teeth and has a hostile 237
effect on developing bones. A ciprofloxacin (fluoroquinolones) 238

215 Analgesics are used for a short or limited span of time to treat, broad spectrum antibiotic is commonly prescribed in peri- 239

216 cure and minimize the hassle of pain. Acetaminophen is the odontal diseases associated with actinobacillus. Recent devel- 240

217 most common and safest analgesic used in pregnancy and is oping evidence suggests that this drug is involved in 241

218 categorized in group B by the FDA classification.32 The most arthropathy and has severe effects on evolving cartilages and 242

Please cite this article in press as: Naseem M et al. Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for
Dental Research (2015), http://dx.doi.org/10.1016/j.sjdr.2015.11.002
 SJDR 55 No. of Pages 9
22 December 2015
6 M. Naseem et al.

Table 1 FDA risk categories of drug used during pregnancy and their potential risk factors.
Category Risk factors Antibiotics Analgesics Sedative Local
hypnotics anesthetics
A Satisfactory well controlled studies on humans showing no
hazard to the fetus
B Studies on animals demonstrating no fetal risk whereas no Amoxicillin Acetaminophen Lidocaine
well controlled and adequate studies done on pregnant Cephalexin Ibuprofen Prilocaine
women Chlorhexidine Prednisolone
Clindamycin
Erythromycin
Metronidazole
Penicillin
C Studies on animals establishing fetal hazards no controlled Ciprofloxacin Codeine with Mepivacaine
studies on human beings acetaminophen
Hydrocodone
+ acetaminophen
Propoxyphene
D Evidence of risk to the fetus, can be used in exceptional Doxycycline Ibuprofen Barbiturates
cases or circumstances Tetracycline Benzodiazepines
(D)
X The hazards of using the drug in pregnant women far more
than the benefits
Nitrous oxide (avoided in the first trimester as it may result in
neonatal depression and spontaneous abortion)

Figure 4 Schematic presentation of correct dental chair positioning for pregnant patients.

243 is not recommended in pregnant women.33 Metronidazole clas- and prilocaine are categorized in class B whereas, mepivacaine, 249
244 sified in group B is prohibited to be used in first trimester as the bupivacaine and epinephrine fits in class C of the FDA classi- 250
245 drug has teratogenic effects.34 fication.23 Epinephrine with local anesthetics when adminis- 251
tered through an intravascular route theoretically may be 252
246 5.3. Local and general anesthetics associated with insufficiency of the utero-placental blood flow 253
but the reported cases in healthy pregnant women are 254

247 Localized use of anesthetics is considered safe when given 1:100,000.35 The concentration of epinephrine in a local anes- 255

248 properly and in precise dose. Anesthetics such as lidocaine thetic used in dentistry is considered safe provided a check is 256

Please cite this article in press as: Naseem M et al. Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for
Dental Research (2015), http://dx.doi.org/10.1016/j.sjdr.2015.11.002
 SJDR 55 No. of Pages 9
22 December 2015
Oral Health and Pregnancy 7

257 kept on the proper aspiration technique and the amount

Table 2 Drug and maternal teratogens and possible undesired
258 injected.35 On the other hand when doing elective surgical pro-
effects.
259 cedures under general anesthesia, it is important to keep in
260 consideration the following aspects in relation to the growing Known side-effects
261 fetus; Drugs teratogens
Alcohol Cranio-facial abnormalities, fetal
262  The fetal oxygenation should be retained by maintaining alcoholic syndrome
263 maternal PaCO2 and PaO2. Tobacco Brain damage, cleft lip and palate
264  The use of teratogenic agents should be avoided. Cocaine Placental abruption, cognitive delay
265  Premature labor should be prevented. Thalidomide Malformation of extremities of new born
Methyl mercury Brain damage, microcephaly
266
ACE inhibitors Cranio-facial abnormalities
267 Nitrous oxide is the anesthetic of choice and most com- Valproic acid Mental retardation, neural tube effects
268 monly used in surgical procedures. Nitrous oxide is not listed Tetracycline Maternal toxicity and discoloration of
269 in the FDA classification as its use during pregnancy is still tooth
270 controversial.36 The drug is reported to be involved in preterm Phenytoin Hypoplastic nails, typical facies
271 birth, abortions and birth defects. Though the correct timings Warfarin Facial dysmorphism, chondrodysplasia
272 of long and extensive surgical procedures should be delayed till Benzodiazepines/ Cleft lip and palate deformities
273 after delivery but if a surgical procedure is to be performed in barbiturates
274 urgency in pregnant women, low levels of nitrous oxide should Maternal teratogens
275 be administered, prophylactic dose of folic acid, methionine Toxoplasmosis Spinal abnormalities, brain dysfunction
276 and vitamin B12 should be prescribed during first trimester. Chlamydia Conjunctivitis, pneumonia
277 It is best to avoid N2O during first trimester as the hazards Hepatitis B Liver damage
278 clearly outweigh the benefits.36–38 Parvovirus Anemia
Chicken pox Eyes damage

279 6. Oral and dental health management guidelines during

280 pregnancy
tives procedures are safe to perform. Recommendations 310
during this pace include: maintenance of oral hygiene and 311
281 Oral health care management of pregnant patients is consid-
plaque control. 312
282 ered to be a very important aspect. It is recommended to assess
 It’s safe to perform scaling, polishing and curettage if 313
283 patient’s current dental health status and then to educate her
necessary. 314
284 about the expected changes during pregnancy and measures
 Active oral diseases should be controlled. 315
285 that can be helpful to avoid pain and distress. The dental
 It’s safe to perform elective procedures i.e. root canal, 316
286 examination and treatment causes no harm to the fetus (during
extraction, restorations. 317
287 second and third trimester) in contrast to that if left untreated,
318
288 e.g. dental decay may cause infant caries at a later stage.39 Sim-
289 ilarly other procedures such as diagnosis, periodontal treat-
290 ment, restorations and extractions are of no harm and are 6.3. Selective radiographs can be taken third trimester 319

291 recommended to be performed during the middle trimester

292 as organogenesis is complete by then. It is appropriate to perform short dental procedures during the 320
third trimester as there is not significant risk to the fetus. How- 321

293 6.1. First trimester ever, there is an increased risk of discomfort to the mother that 322
can be reduced to a greater extent by proper positioning 323
(Fig. 4). The recommended time to perform procedures is dur- 324
294 The first trimester is not considered to be an appropriate time
ing the middle of the third trimester. The following measures 325
295 for performing procedures. Organogenesis takes place during
are recommended during third trimester: 326
296 this period and is prone to risk of teratogens. Also the risk
297 of spontaneous abortions increases. Following guidelines
 Maintenance of oral hygiene and plaque control. 327
298 should be followed during this time:
 It’s safe to perform scaling, polishing and curettage if 328
necessary. 329
299  The individual should be well educated about the oral
 Active oral diseases should be controlled. 330
300 changes taking place.
 It’s safe to perform elective procedures. 331
301  Instructions to maintain oral hygiene.
 The radiograph use should be minimized. 332
302  The treatment should be limited to periodontal prophylaxis
 Procedures not to be performed after mid time of the third 333
303 and emergency treatment.
trimester. 334
304  Avoid routine radiographs.
335
305

306 6.2. Second trimester 7. Dental radiations and pregnancy 336

308
307  In this trimester the organogenesis phase is complete and Current evidence suggests that ‘dental radiography’ is mea- 337

309 procedures such as emergent dento-alveolar and other elec- sured as harmless in child bearing women. The safety directly 338
rests upon the type and amount of radiations to which the 339

Please cite this article in press as: Naseem M et al. Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for
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 SJDR 55 No. of Pages 9
22 December 2015
8 M. Naseem et al.

340 patients is exposed. Special precautionary measures should be Funding statement 393
341 guaranteed for pregnant women (e.g. thyroid collar, lead
342 apron, and speed films) because the risk to the growing fetus None. 394
343 is directly connected to rise in exposure.40 Fetus radiation
344 exposure over 10 rads is considered to be hazardous and
Acknowledgments 395
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346 malities of the eyes. It’s uncommon for a single X-ray or col-
None. 396
347 lection of investigative X-rays to exceed 5 rads.40 For
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