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Pregnancy and Dental Work

Is having dental work while pregnant safe.

Pregnancy and dental work questions are common for expecting moms. Preventive dental cleanings and annual exams during pregnancy are not only safe but are recommended. The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums.

Preventive dental work while pregnant is essential to avoid oral infections such as gum disease, which has been linked to preterm birth.

Toothaches in pregnancy and other dental needs

Dental work while pregnant, such as cavity fillings and crowns, should be treated to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is ideal. Once you reach the third trimester , it may be very difficult to lie on your back for an extended period of time.

However, sometimes emergency dental work, such as a root canal or tooth extraction, is necessary. Elective treatments, such as teeth whitening and other cosmetic procedures, should be postponed until after the birth. It is best to avoid this dental work while pregnant and avoid exposing the developing baby to any risks, even if they are minimal.

What about the medications?

Currently, there are conflicting studies about possible adverse effects on the developing baby from medications used during dental work. Lidocaine is the most commonly used drug for dental work. Lidocaine (Category B) does cross the placenta after administration.

If dental work is needed, the amount of anesthesia administered should be as little as possible, but still enough to make you comfortable. If you are experiencing pain, request additional numbing. When you are comfortable, the amount of stress on you and the baby is reduced. Also, the more comfortable you are, the easier it is for the anesthesia to work. Dental work often requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled category B for safety in pregnancy, maybe prescribed after your procedure.

Are dental x-rays safe?

Routine x-rays , typically taken during annual exams, can usually be postponed until after the birth. X-rays are necessary to perform many dental procedures, especially emergencies. According to the American College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus. According to the ADA and ACOG, having dental X-rays during your pregnancy is considered safe with appropriate shielding.

Some women may elect to avoid dental work during the first trimester knowing this is the most vulnerable time of development. However, there is no evidence suggesting harm to the baby for those electing to visit the dentist during this time frame.

Also, if non-emergency dental work is needed during the third trimester, it is usually postponed until after the birth. This is to avoid the risk of premature labor and prolonged time lying on your back.

Suggestions for addressing your pregnancy and dental work needs:

The American Dental Association (ADA) recommends pregnant women eat a balanced diet , brush their teeth thoroughly with ADA-approved fluoride toothpaste twice a day, and floss daily.
Have preventive exams and cleanings during your pregnancy.
Let your dentist know you are pregnant.
Postpone non-emergency dental work until the second trimester or after delivery, if possible.
Elective procedures should be postponed until after the delivery.
Maintain healthy circulation by keeping your legs uncrossed while you sit in the dentist’s chair.
Take a pillow to help keep you and the baby more comfortable.
Bring headphones and some favorite music.

Want to Know More?

X-rays During Pregnancy
Cat Scans and Pregnancy

Compiled using information from the following sources:

1. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 41.

2. American College of Radiologists

https://www.acr.org/

3. American Dental Association

https://www.ada.org/

4. Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 7.

5. American College of Obstetricians and Gynecologists

https://www.acog.org/

6. American Thyroid Association

https://www.thyroid.org/

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When to Visit the Dentist During Pregnancy

WHEN TO VISIT THE DENTIST DURING PREGNANCY

Tell the Dentist As Soon As Possible

Postpone dental care during your first trimester, visit the dentist during your third trimester .

Following a consistent oral health care routine is especially important for pregnant women for several reasons.

Pregnancy changes the hormones in the body that put pregnant women at increased risk for periodontal disease, which is the most severe form of gum disease. As soon as you believe you’re pregnant, tell your dentist, because it may not be safe to have X-rays during pregnancy. You should also let your dentist know if you are trying to get pregnant; knowing this can help in planning x-rays or other treatments. Be sure to tell your dentist what medicines you’re taking and if your physician has given you any specific medical advice, as it may affect the treatment he or she recommends. When possible, visit your dentist before pregnancy so you can take are of any pre-existing dental problems before you conceive.

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The first trimester of your pregnancy (the first 13 weeks) is the time in which most of the baby's major organs develop. If you go to the dentist during your first trimester, tell your dentist that you're pregnant and have only a checkup and routine cleaning. If possible, postpone any major dental work until after the first trimester. However, if you have a dental emergency, don't wait! Infections in the mouth can be harmful to you and your baby. See your dentist immediately, and make sure that all dental professionals who examine you are aware you're pregnant.

If you have postponed seeing your dentist during your first or second trimester, the third trimester is the time to have a dental checkup to ensure that your mouth is healthy. By visiting your dentist at this time, he or she will be able to advise you on what you can do to prevent oral heath problems after your baby is born.

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Preventive, diagnostic and restorative dental treatment is safe throughout pregnancy.
Local anesthetics with epinephrine (e.g., bupivacaine, lidocaine, mepivacaine) may be used during pregnancy.
Special considerations should be given to pregnant dental personnel whose job duties can involve direct exposure to nitrous oxide and radiation.

Oral health care, including having dental radiographs taken and being given local anesthesia, is safe at any point during pregnancy. 1, 2 Further, the American Dental Association and the American College of Obstetricians and Gynecologists (ACOG) agree that emergency treatments, such as extractions, root canals or restorations can be safely performed during pregnancy and that delaying treatment may result in more complex problems. 1, 2 Although ACOG has a statement regarding postponing elective nonobstetric general surgery and some invasive procedures (e.g., cardiac catheterization or colonoscopy) until after delivery, 3 their statement on oral care during pregnancy and through the lifespan1 states that oral conditions requiring immediate treatment, such as periodontal or endodontic treatment, extractions, or restoration of untreated caries can be managed at any time during pregnancy.

When treating pregnant patients, it might be helpful to reach out to the obstetrician to develop a working relationship should consultation be needed later. Questions to ask might include: 4

When is the expected delivery date?
Is this a high-risk pregnancy? If so, are there any special concerns or contraindications?
Is there a recommended medication for pain control?

During pregnancy, several oral health conditions are more common:

Gingivitis may result from hormonal changes that exaggerate the response to bacteria in the gum tissue 4
Dental caries may occur due to changes in diet such as increased snacking due to cravings, increased acidity in the mouth due to vomiting, dry mouth or poor oral hygiene stemming from nausea and vomiting. 1, 4
Pyogenic granuloma (also known as granuloma gravidarum) is a round growth, usually connected to the gingivae by a thin cord of tissue, that may develop due to hormonal changes. 5,6
Erosion stemming from vomiting as a result of morning sickness may be detected. 5 Patients should be encouraged to avoid toothbrushing immediately after vomiting, which exposes the teeth to stomach acids. Instead, they should opt for rinsing with a diluted solution of 1 cup water and 1 teaspoon of baking soda to neutralize the acid. 5

Due to the increased risk of gingivitis and caries, the importance of good daily oral hygiene should be emphasized to these patients. Brushing twice a day with a soft-bristled brush for two minutes, using a fluoride-containing toothpaste, and cleaning between the teeth once a day should be encouraged. If it is determined that a topical fluoride treatment is needed to minimize the effects of erosion, fluoride varnish may be preferred over gel treatments due to nausea. 7

Periodontitis and Adverse Pregnancy Outcomes

Much has been written in recent years about the relationship between maternal periodontitis and pregnancy outcomes. While findings of individual studies have been mixed, an overview of 23 systematic reviews conducted through 2016 concluded that associations exist between periodontitis and pre-term birth, low birthweight babies, low birthweight babies born prematurely and the development of pre-eclampsia. 8

More research is needed to determine the relationship between periodontitis and pregnancy outcomes, however, should periodontitis develop during pregnancy, scaling and root planing is recognized as safe to perform. 1, 4 The ACOG statement on oral care during pregnancy and through the lifespan1 states that “despite the lack of evidence for a causal relationship between periodontal disease and adverse pregnancy outcomes, the treatment of maternal periodontal disease during pregnancy is not associated with any adverse maternal or birth outcomes,” and “prenatal periodontal therapy is associated with the improvement of maternal oral health.”

Medication Safety Labeling

Historically, manufacturers have relied on an alphabetical system to communicate the safety of medications for use with pregnant patients. In 2015, the U.S. Food & Drug Administration began phasing out that system for prescription drugs, replacing it with a narrative section in the package insert that discusses the benefits and risks of using a particular medication with this population. 9, 10 The new system will be phased-in, with a full compliance date of 2020.

The alphabetical system (Table) will continue to be used for over-the-counter (OTC) medications. 11

An image of Table. Pregnancy Risk Categories12 for OTC Medications.

Medication Selection

Questions about use of local anesthetics or antibiotics in pregnant individuals are common. Options considered safe for use in these situations include:

Local anesthesia (with or without epinephrine) 1, 13-15
Amoxicillin
Cephalosporins
Clindamycin
Metronidazole

Use of other medications calls for consultation with the patient’s obstetrician to weigh risks and benefits. An example of a situation that may benefit from consultation is pain relief. Several analgesics had been placed in pregnancy Category B, which indicated that they were typically safe to use; however, in 2015, the U.S. Food & Drug Administration clarified that position , stating that the published research is “too limited to make any recommendations” on pain reliever use in this population. 17 This suggests that decisions made about medications for pain relief should be arrived at after consultation with the obstetrician. That said, emergencies call for immediate implementation of standard emergency protocols.

Questions often arise about medication use by patients who are lactating. Most medication product inserts have information related to use during lactation. The National Library of Medicine also provides a searchable database ( LactMed ) on this topic.

Nitrous Oxide

Nitrous oxide is classified as a pregnancy risk group Category C medication, meaning that there is a risk of fetal harm if administered during pregnancy. It is recommended that pregnant individuals, both patients and staff, avoid exposure to nitrous oxide. 18 The National Institute of Occupational Safety and Health (NIOSH), a federal agency affiliated with the Centers for Disease Control and Prevention, recommends use of a scavenging system and exposure limits of N 2 O concentrations in dental operations to approximately 25 ppm during analgesia administration. 19

Dental offices that use nitrous oxide-oxygen can review best management practices on the Nitrous Oxide Oral Health Topic page.

Radiographs are considered safe for the pregnant patient, at any stage during pregnancy, when abdominal and thyroid shielding is used. 1

Dental professionals who take radiographs should inform their employer in writing that they are pregnant as soon as they are aware of the pregnancy. The employee should be provided with a personal dosimetry badge and the manufacturer’s instructions should be followed to ensure that the occupational radiation exposure does not exceed 0.5 millisieverts (mSv) per month. 19 Provision of dosimetry badges and limiting exposure to 0.5 mSv/month are recommendations for good practice; to determine whether there are related regulations in your state, contact your radiation protection program .

During pregnancy, individuals may be at increased risk for oral conditions such as gingivitis and dental caries, and should be counseled by both their obstetrician and dentist on the importance of good oral hygiene throughout the pregnancy. Regular and emergency dental care, including the use of local anesthetics and radiographs, is safe at any stage during pregnancy.

Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients (Trans.2005:330)

Resolved, that the following ADA Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients be adopted.

Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients 1. Dentists are encouraged to inquire about pregnant or postpartum patients’ history of alcohol and other drug use, including nicotine. 2. As healthcare professionals, dentists are encouraged to advise these patients to avoid the use of these substances and to urge them to disclose any such use to their primary care providers. 3. Dentists who become aware of postpartum patients’ resumption of tobacco or illegal drug use, or excessive alcohol intake, are encouraged to recommend that the patient stop these behaviors. The dentist is encouraged to be prepared to inform the woman of treatment resources, if indicated.

American Dental Association Adopted 2005; Reviewed 2017

Dental Examinations for Pregnant Persons and Persons of Child-Bearing Age (Trans.2014:508)

Resolved, that the ADA urge all pregnant persons and persons of child-bearing age to have a regular dental examination.

American Dental Association Adopted 2014

Dental Treatment During Pregnancy (Trans.2014:508)

Resolved, that the ADA acknowledges that preventive, diagnostic and restorative dental treatment to promote health and eliminate disease is safe throughout pregnancy and is effective in improving and maintaining the oral health of the mother and child.

American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. Oral Health Care During Pregnancy and Through the Lifespan (Number 569). 2013; Reaffirmed 2017. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/08/oral-health-care-during-pregnancy-and-through-the-lifespan . Accessed June 14, 2023.
American Dental Association. ADA Current Policies, 1954-2022. 2023. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/about/governance/current_policies.pdf . Accessed June 14, 2023.
American College of Obstetricians and Gynecologists Committee on Obstetric Practice and the American Society of Anesthesiologists. Nonobstetric Surgery During Pregnancy (Number 775). 2017; Reaffirmed 2021. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/nonobstetric-surgery-during-pregnancy .
Niessen LC. Women's Health. In: Patton LL, Glick M, editors. The ADA Practical Guide to Patients with Medical Conditions. Second ed. Hoboken NJ: John Wiley & Sons; 2016. p. 423-34.
Steinberg BJ, Hilton IV, Iida H, Samelson R. Oral health and dental care during pregnancy. Dent Clin North Am 2013;57(2):195-210.
Silva de Araujo Figueiredo C, Goncalves Carvalho Rosalem C, Costa Cantanhede AL, Abreu Fonseca Thomaz EB, Fontoura Nogueira da Cruz MC. Systemic alterations and their oral manifestations in pregnant women. J Obstet Gynaecol Res 2017;43(1):16-22.
Giglio JA, Lanni SM, Laskin DM, Giglio NW. Oral health care for the pregnant patient. J Can Dent Assoc 2009;75(1):43-8.
Daalderop LA, Wieland BV, Tomsin K, et al. Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews. JDR Clin Trans Res 2018;3(1):10-27.
U.S. Food and Drug Administration. Pregnancy & Lactation: Improved Benefit-Risk Information. 2015. https://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/SmallBusinessAssistance/UCM431132.pdf . Accessed June 14, 2023.
U.S. Food and Drug Administration. Pregnancy and Lactation Labeling (Drugs) Final Rule. https://www.fda.gov/drugs/labeling-information-drug-products/pregnancy-and-lactation-labeling-drugs-final-rule . Accessed June 14, 2023.
U.S. Food and Drug Administration. Questions and Answers on the Pregnancy and Lactation Labeling Rule. https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093311.htm . Accessed June 14, 2023.
Mendia J, Cuddy MA, Moore PA. Drug therapy for the pregnant dental patient. Compend Contin Educ Dent 2012;33(8):568-70, 72, 74-6 passim; quiz 79, 96.
Oral Healthcare During Pregnancy Expert Workgroup. Oral Health Care During Pregnancy: A National Consensus Statement. Washington, DC: National Maternal and Child Oral Health Resource Center; 2012.
Bassiur JP, Boyd BC, Burrell KH, et al. ADA/PDR Guide to Dental Therapeutics. Fifth ed. Montvale NJ: Physicians' Desk Reference, Inc.; 2009.
Manautou MA, Mayberry ME. Local anesthetics and pregnancy: A review of the evidence and why dentists should feel safe to treat pregnant people. J Evid Based Dent Pract 2023;23(2):101833.
California Dental Association Foundation; American College of Obstetricians and Gynecologists, District IX.
U.S. Food & Drug Administration. FDA Drug Safety Communication: FDA has Reviewed Possible Risks of Pain Medicine During Pregnancy. 2015. https://www.fda.gov/Drugs/DrugSafety/ucm429117.htm . Accessed June 14, 2023.
National Institute for Occupational Safety and Health. International Chemical Safety Cards: Nitrous Oxide. https://www.cdc.gov/niosh/docs/hazardcontrol/hc3.html . Accessed June 14, 2023.
The National Institute for Occupational Safety and Health (NIOSH). Control of Nitrous Oxide in Dental Operatories (DHHS/NIOSH Publication No. 96-107). U.S. Department of Health & Human Services. https://www.cdc.gov/niosh/docs/hazardcontrol/hc3.html . Accessed June 14, 2023.
National Council for Radiation Protection & Measurements. NCRP Report No. 145 - Radiation Protection in Dentistry. Bethesda: National Council on Radiation Protection and Measurement; 2003.

Professional Resources

X-rays: Dental Radiography and Pregnancy

ADA Library Services

Search JADA

Patient Resources

JADA “For the Patient” page:

Pregnancy and oral health (March 2021)

ADA MouthHealthy:

U.S. Centers for Disease Control and Prevention: Radiation and Pregnancy: A Fact Sheet for the Public
Oral Healthcare During Pregnancy: A National Consensus Statement
Recommendations on Oral Health Care for the Pregnant Adolescent
Guideline on Oral Health Care for the Pregnant Adolescent
LactMed (U.S. National Library of Medicine Toxicology Data Network drugs and lactation database)
American Academy of Pediatrics: Oral Health Toolkit for Providers

Last Updated: June 22, 2023

Prepared by:

Research Services and Scientific Information, ADA Library & Archives.

Content on the Oral Health Topics section of ADA.org is for informational purposes only. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.

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Pregnancy week by week

Prenatal care: First trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

Your menstrual cycle, gynecological history and any past pregnancies
Your personal and family medical history
Exposure to anything that could be toxic
Medications you take, including prescription and over-the-counter medications, vitamins or supplements
Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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Dental Care Is Safe and Important During Pregnancy

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Dental care is safe and important during pregnancy.

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Pregnancy and dental health: What you need to know

Expecting a baby? There’s a lot to think about. But don’t forget about your teeth. Being pregnant has major effects on the body, and your mouth is no exception. Here’s what you should know.

When should I see my dentist?

Make an appointment with your dentist as soon as you are pregnant. Let your dentist know how far along you are and if you have any medical conditions or a high-risk pregnancy. Your dentist can help assess your oral health and map out a plan for the rest of your pregnancy.

If you’re planning to become pregnant, it’s a good idea to visit a dentist beforehand to take care of any dental issues that may be affected by your pregnancy.

How does pregnancy affect my oral health?

Being pregnant puts you at higher risk for tooth decay, gum disease (also known as “pregnancy gingivitis”) and oral growths called “pregnancy tumors.” These conditions are treatable, so make an appointment with your dentist.

How can I avoid these conditions?

Brushing and flossing vigilantly can help fight gum disease and tooth decay, but there’s nothing you can do at home to get rid of pregnancy tumors. They usually disappear after birth, or you can ask your dentist to remove them.

How does my oral health affect my baby’s health?

If you have moderate to severe gum disease, you may be at higher risk for delivering a pre-term, low-birth weight baby.

Can I get a dental cleaning while pregnant?

Yes, dental cleanings pose no harm during pregnancy. In fact, they’re a great way to keep your teeth and gums healthy, which is especially important during pregnancy. Some dental plans may cover an additional cleaning for pregnant women. Check if your plan includes this feature.

Dentistry Decoded: Cleaning

What happens during a dental cleaning?

Are dental x-rays safe during pregnancy?

Dental x-rays are now considered safe during all stages of pregnancy by the American Dental Association . X-rays can be vital in catching major problems that cannot be seen otherwise, like tooth decay, bone loss and infected root canals. Dental x-rays are not believed to cause birth defects, although a 2004 study did find an increase in low-weight birth among women who had dental x-rays while pregnant. If you have any concerns, talk to your dentist, who can help evaluate your case and decide whether x-rays can be postponed.

Is anesthesia safe during pregnancy?

Anesthesia during the first trimester may be linked to early miscarriage. If you need any dental work that requires anesthesia, such as a filling or root canal treatment, talk to your dentist about postponing the procedure until the second trimester of your pregnancy.

Last updated January 10, 2022

The right way to floss.

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An oral health guide for your growing child

Every stage in a child's life comes with different dental needs and responsibilities. Do your part to make sure your child’s oral health care is on track from the start.

The oral health information on this website is intended for educational purposes only. Always consult a licensed dentist or other qualified health care professional for any questions concerning your oral health.

Do’s and don’ts during the first trimester of pregnancy

A high-risk pregnancy physician offers tips for a healthy start for you and baby.

You’re pregnant! Take some time to jump for joy and feel grateful for this blessing before diving into the world of parental responsibilities.

Your work as a new parent starts now. While you can’t protect against every complication, you can follow these helpful tips to have a healthy, happy first trimester.

Free downloads: Pregnancy guidebooks by trimester

Do think of food as fuel.

Contrary to the old saying, you’re not actually eating for two. You will need more calories and nutrition later in your pregnancy, but there’s no need to double your intake now.

Instead of quantity, focus on the quality of your food . Fuel your body with healthy food. If possible, choose organic food and eat from local food sources if you can. This limits your exposure to pesticides.

Do focus on folate.

You should be taking 400 micrograms (mcg) of folic acid a day in the first trimester of pregnancy. If you were not already taking folic acid supplements in advance of getting pregnant, start immediately.

This helps prevent two common and serious birth defects : spina bifida and anencephaly. It’s even recommended by some organizations that all women ages 15 to 45 take 400 micrograms of folic acid daily – not just those who are pregnant.

Once your pregnancy is confirmed, your physician will probably recommend you take a prenatal vitamin. These vitamins are designed to meet the recommendations for folic acid intake.

Speaking of prenatal vitamins …

Do take your prenatal vitamins.

These vitamins supply the folate you need, and they also help cover your needs for calcium, iron and zinc. They also provide the appropriate amounts of DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). These two types of omega-3 fats help your baby’s brain develop.

Not a fan of the big pills? Talk to your OB provider about an alternative vitamin regimen.

Read more: The ABCs of vitamins in pregnancy

Do eat the rainbow.

While you’re meal planning or feeling snacky, try to eat colorful foods. Reach for dark green spinach, orange carrots, red apples, yellow bananas, blueberries, etc.

Brightly colored foods offer the most nutrients and antioxidants. And having a varied diet will expose your baby to a range of tastes and flavors. Your baby eats what you eat through the amniotic fluid, so if you eat a wide variety of foods, your baby will also.

Your body is going through tremendous changes and is developing an entirely new life-providing system for your baby. As it grows the placenta, you will likely find yourself beyond exhausted some days. Plus, you’re going through monumental hormonal and emotional changes .

Take naps when you can. If you work, try scheduling a little bit of rest time into your lunch hour.

You may need to sleep more than you’re used to at night. Set bedtimes and stick to them to gift your body a solid eight to nine hours of sleep each night.

Do exercise.

Regular exercise helps you combat the fatigue and mood and hormonal changes that happen in the first trimester. It also helps prevent weight gain and battle insomnia.

If you don’t have regular exercise already built into your routine, no sweat! There are several ways you can adopt a more active lifestyle, even during pregnancy. But before you begin any new exercise routine, contact your OB provider. Your provider can suggest options specific to your needs, considering your current state of health and what is best for your baby.

Do get a flu shot.

Pregnant people can safely get a flu shot – and they’re highly encouraged to do so. According to the CDC, the flu is more likely to cause severe illness in pregnant people than in those who are not pregnant.

Because of changes to your immune system, heart and lungs, you’re more prone to serious illness from the flu. Also, some evidence shows that getting the flu while pregnant can raise your risk of complications, including premature labor. The flu vaccine reduces that risk.

Even better, the flu vaccine can also protect your baby from contracting the flu after birth. When you get vaccinated during pregnancy, you’re passing on antibodies to your child. The vaccine will help protect your baby against the flu for the first few months after birth.

Do get a COVID-19 vaccine.

Like the flu, COVID-19 is dangerous to pregnant people and their babies. Pregnant people who get COVID-19 are more likely to need hospitalization and intensive care. They’re also more at risk for preterm delivery, stillbirth and pre-eclampsia.

Research has shown that the COVID-19 vaccine is safe for those who are pregnant, planning on becoming pregnant or want to get pregnant in the future.

Talk to a provider you trust if you’re nervous about getting vaccinated while pregnant. Your provider can answer your questions and address any concerns you may have.

Learn more about COVID-19 vaccines and pregnancy.

Do visit the dentist.

The American Congress of Obstetricians and Gynecologists (ACOG) says that teeth cleaning and dental X-rays are safe for pregnant people. In fact, OB/GYNs are now advised to do oral health assessments during an initial prenatal visit and to encourage dental visits during pregnancy.

The ACOG reports that 40% of pregnant Americans have some degree of periodontal disease and that the physical changes from pregnancy can affect the gums and teeth. A dental visit can identify any potential dental needs early.

Do stay hydrated.

Hydration helps prevent preterm labor. It also helps prevent headaches, kidney stones and dizziness. If you’re already battling constipation and hemorrhoids, staying hydrated can help fight these conditions.

If your urine is light yellow to clear, you’re getting enough hydration. If it’s dark yellow, you need to increase your water intake.

Do make sure your medications are safe.

The bottle of aspirin you’ve been using to relieve headaches may not be safe for you to take while pregnant. Before you take anything, check this list of medications that are generally safe to use while pregnant .

If you struggle with allergies , try to negate the need for medication by avoiding your allergy triggers.

Always talk to your provider before starting any medications, herbs or supplements.

Do ask for help.

Are you already more tired than usual during your first trimester of pregnancy? Ask your partner to help out more, maybe picking up a few extra tasks around the house to ease your burden.

You have a support system – take advantage of it. Ask a friend or family member for help. Do what you need to do to ensure you are getting enough rest, for your health and for your growing baby. Having extra help or having fewer tasks to accomplish will give you more time to rest.

Don’t smoke.

If you’re a smoker , now is the best time to quit. Quitting will give your health a boost and protect the health of your baby. Talk with your provider today about ways to quit.

According to the CDC, smoking while pregnant comes with risks. People who smoke during pregnancy are more at risk of miscarriage. Babies born to those who smoked during pregnancy are at increased risk for birth defects, premature birth, low birth weight and infant death.

These babies also are at greater risk for learning disabilities. Smoking during and after pregnancy is also a risk factor for sudden infant death syndrome (SIDS) . And babies born to people who smoked during pregnancy are more likely to become smokers earlier themselves due to a physiologic nicotine addiction.

What about electronic cigarettes? The CDC says that while the aerosol of e-cigarettes typically has fewer harmful substances than cigarette smoke, e-cigarettes that contain nicotine aren’t safe during pregnancy. The nicotine alone is a health danger for pregnant people and developing babies. It can also damage a developing baby’s brain and lungs.

Don’t drink alcohol.

There is no amount of alcohol that is safe during pregnancy. And there is no time during pregnancy when alcohol does not carry risks.

Drinking alcohol while pregnant can cause problems for a developing baby at any stage. This includes the days and weeks before a person knows they’re pregnant. Drinking alcohol anytime in the first trimester can cause central nervous system problems and abnormal facial features and growth. Drinking alcohol later in a pregnancy can lead to miscarriage, stillbirth and fetal alcohol spectrum disorders (FASDs). These disorders are a range of behavioral and intellectual disabilities.

Children with FASDs may have:

Abnormal facial features
Poor coordination and memory
Difficulty with attention
Learning disabilities and difficulties in school
Speech and language delays
Poor reasoning and judgment skills
Sleep and sucking problems as infants
Vision and hearing problems
Problems with the heart, kidney or bones

If someone drinks during pregnancy, it is never too late to stop. The sooner they stop, the better the health benefits are for themselves and their baby.

If you need help, talk to your provider right away. There are resources available.

Don’t eat raw meat.

Pregnant people who eat raw or undercooked meat and eggs are at risk of contracting listeriosis and toxoplasmosis. These can lead to serious and life-threatening illnesses and can cause severe birth defects and miscarriage.

Cook your meat and eggs thoroughly before eating.

Don’t visit the sauna.

Avoid the sauna and hot tub. There is a risk of overheating, dehydration and fainting every time you use a sauna, whirlpool, hot tub or steam room. If you’re looking to relax, soak in a hot bath instead.

Don’t drink too much caffeine .

This is an especially tricky one in this first trimester of pregnancy because you are so very tired. But caffeine can cross the placenta and affect your growing baby’s heart rate.

Research suggests that some caffeine is OK in the first trimester – up to about 200 milligrams a day or about two cups of coffee. But some studies suggest that drinking too much caffeine might be associated with a greater risk of miscarriage.

Don’t clean the litter box.

There’s no reason to fear or avoid your pet cat during pregnancy, but leave the litter box to your partner or a friend. There are millions of parasites in feline waste, and one – toxoplasma gondii – is especially dangerous to pregnant people.

Exposure to this parasite can increase your risk of miscarriage or stillbirth. Babies born with this parasite could develop serious health problems, including seizures and mental disabilities. It also can lead to vision problems.

Don’t overeat.

Studies show that half of people gain too much weight during pregnancy . When that happens, the baby is at greater risk of obesity later in life. You will need additional calories in the second and third trimesters, but doctors disagree about whether you need any extra calories in this first trimester.

Eat until you’re satisfied and then stop.

Take care of yourself

This list of do’s and don’ts in the first trimester of pregnancy may seem a bit intimidating. But don’t let it scare you.

Most of these guidelines can be easily summed up: Take care of yourself. Be sure to eat healthy foods, drink lots of water and get enough sleep.

Before you know it, your little one will finally be here. When you hold and snuggle with your newborn, remember to thank yourself for following this list of do’s and don’ts months ago in your first trimester. A healthy, happy baby makes it all worthwhile.

10 things to expect in your second trimester
Exercise during pregnancy: Is it safe?
You can have a happy and healthy plus-size pregnancy

Posted In Health Information , Pregnancy , Women's

Our content is for informational purposes only and should not be relied upon as medical advice. The content is not designed to replace a physician's medical assessment and medical judgment. As always, please consult first with your physician about health matters. Click here for Terms and Conditions.

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Pregnancy and your dental health

When you’re expecting a baby, there’s SO much to do. But busy as you are, don’t let good dental habits drop off your list! Taking good care of your teeth and gums is even more important right now, since pregnancy causes changes that can elevate your risks for cavities and gum disease.

Your baby’s teeth are developing during pregnancy, too — so this is a great time to learn how you can support their future dental health.

Is it safe to visit the dentist while I’m pregnant?

Yes. In fact, experts at the American Dental Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics all encourage you to see your dentist while you’re expecting.

It’s a good idea to take care of dental cleanings and any needed procedures (such as cavity fillings) before your baby arrives. Seeing your dentist now also ensures you get the care you need to deal with pregnancy-related symptoms you might be experiencing.

When should I tell my dentist I’m pregnant?

Right away – even if you aren’t 100% sure yet. Let your dental team know how far along you are and share your expected due date. This can help them plan appropriate care and look carefully for signs of pregnancy-related issues in your mouth.

During your visit, let your dentist know about any medications you are taking. If your pregnancy has been classified as high-risk, your dentist or doctor might recommend that certain dental treatments be postponed.

How will pregnancy affect my mouth?

Many people have no dental discomfort during pregnancy. However, the demands on your body while you’re carrying a baby can change your risks for certain conditions that affect your teeth and gums.

Some people develop a condition known as pregnancy gingivitis , which causes swollen, tender gums that may bleed a little when you brush or floss. Higher hormonal levels during pregnancy affect the way your gums react to plaque , the sticky film that builds up on teeth, especially between dental cleanings.

Since gingivitis can lead to more serious forms of gum disease, your dentist will recommend ways to treat any symptoms you are having. You may need more frequent cleanings during pregnancy, or an anti-microbial mouth rinse.

Cavity risks can rise during pregnancy, too. If you are eating more carbohydrates than usual, this offers extra fuel for the bacteria that cause tooth decay. Morning sickness can increase the level of acids in your mouth, causing damage to the shiny, protective coating on your teeth (enamel). Your dentist may recommend rinsing your mouth with a teaspoon of baking soda mixed with water to cleanse away excess acids.

How can I protect my teeth and gums while I’m pregnant?

Now more than ever, it’s important to brush twice daily for at least two minutes each time. (Morning and night is generally best.) You should also floss once a day to cleanse away particles of food between teeth and drink plenty of plain water in between meals.

You might find it a little more difficult to maintain your regular dental routine while you’re expecting, especially if you feel tired or busy. You may have a more sensitive gag reflex or tender gums that make brushing a little more uncomfortable.

If you need extra motivation, keep in mind that your baby’s health depends on you. Poor health habits during pregnancy have been linked with premature delivery, preeclampsia , gestational diabetes and other concerns. Eating a balanced diet, staying hydrated and taking extra-good care of your teeth and mouth are good for you and your child.

What are pregnancy tumors?

Pregnancy tumors are overgrowths of tissue that can develop on the gums, usually during the second trimester. These growths are not cancer, just a form of swelling that typically shows up between teeth. They may be related to an excess buildup of plaque in between teeth.

Pregnancy tumors often bleed easily and have a red, raw-looking, raspberry-like appearance. They usually disappear after your baby is born, but if you are concerned, talk with your dentist about ways to address them.

Should I talk to my dentist about the medications I’m taking?

Your dentist should have the full list of prescriptions and over-the-counter drugs you are taking, including vitamins and dietary supplements. Since this may have changed during pregnancy, be sure to update your dentist when you visit.

Keeping your dentist informed also helps in choosing medications you might need before or after dental treatment, such as antibiotics or pain relievers. Both your doctor and dentist want to choose medications that are safe for you and your baby.

What if I need local anesthetics during pregnancy?

If you’re pregnant and need a filling, a root canal or a tooth pulled, one thing you don’t have to worry about is the safety of the numbing medications your dentist may use. They are safe for both you and your baby.

One study followed a group of pregnant parents who were given anesthetics (such as lidocaine) during dental procedures and a group that received none. Researchers found no difference in the rate of miscarriages, birth defects, premature births or birth weight between the two groups.

Is it safe to have dental X-rays while I’m expecting?

Yes, according to the American College of Obstetricians and Gynecologists, dental X-rays are safe during pregnancy. Dental X-rays emit very low doses of radiation, and your dental team will take steps to minimize your exposure by properly positioning you for imaging and focusing the beam on the area of interest.

Dental X-rays also do not need to be delayed if you are trying to become pregnant or are breastfeeding. According to the American Association of Physicists in Medicine , you are not considered at risk of passing along radiation damage to future offspring by participating in medical imaging. 

What do I need to know about my baby’s dental health?

Your baby’s teeth will begin to form between the third and sixth month of your pregnancy. This is one reason doctors and dentists recommend a healthy diet rich in vitamins A, C, D and calcium. Eating plenty of vegetables, fruits and dairy products will nourish your baby’s developing teeth.

When your newborn arrives, all 20 primary (baby) teeth will already be in place underneath their gums. To set up a healthy routine, wipe down their gums with a damp cloth or a small piece of gauze after feeding. Here are more tips for creating mouth-healthy habits that will benefit your child for life.

HUGH SILK, MD, ALAN B. DOUGLASS, MD, JOANNA M. DOUGLASS, BDS, DDS, AND LAURA SILK, MD

Am Fam Physician. 2008;77(8):1139-1144

Author disclosure: Nothing to disclose.

Oral health care in pregnancy is often avoided and misunderstood by physicians, dentists, and patients. Evidence-based practice guidelines are still being developed. Research suggests that some prenatal oral conditions may have adverse consequences for the child. Periodontitis is associated with preterm birth and low birth weight, and high levels of cariogenic bacteria in mothers can lead to increased dental caries in the infant. Other oral lesions, such as gingivitis and pregnancy tumors, are benign and require only reassurance and monitoring. Every pregnant woman should be screened for oral risks, counseled on proper oral hygiene, and referred for dental treatment when necessary. Dental procedures such as diagnostic radiography, periodontal treatment, restorations, and extractions are safe and are best performed during the second trimester. Xylitol and chlorhexidine may be used as adjuvant therapy for high-risk mothers in the early postpartum period to reduce transmission of cariogenic bacteria to their infants. Appropriate dental care and prevention during pregnancy may reduce poor prenatal outcomes and decrease infant caries.

Comprehensive prenatal health care should include an assessment of oral health, but this is often overlooked. 1 Only 22 to 34 percent of women in the United States consult a dentist during pregnancy. Even when an oral problem occurs, only one half of pregnant women attend to it. 2 This problem is compounded by a lack of national clinical guidelines for the management of common oral conditions in pregnancy. The American Dental Association and the American College of Obstetricians and Gynecologists provide only advisory brochures on oral health for pregnant patients. New York recently became the first state to create an evidence-based prenatal oral health consensus document. 3 In the absence of practice guidelines, fear of medicolegal action based on negligent or substandard treatment of oral conditions during pregnancy abounds, but it is largely unfounded. 4

In addition to a lack of practice standards, barriers to dental care during pregnancy include inadequate dental insurance, persistent myths about the effects of pregnancy on dental health, and concerns for fetal safety during dental treatment. 5 Patients, physicians, and dentists are cautious, often avoiding treatment of oral health issues during pregnancy.

Nevertheless, pregnancy is a time when women may be more motivated to make healthy changes. 3 Physicians can address maternal oral issues, potentially reducing the risk of preterm birth and childhood caries through oral disease prevention, diagnosis, early management, and dental referral.

Common Oral Problems in Pregnancy

Oral lesions.

During pregnancy, the oral cavity is exposed more often to gastric acid that can erode dental enamel. Morning sickness is a common cause early in pregnancy; later, a lax esophageal sphincter and upward pressure from the gravid uterus can cause or exacerbate acid reflux. Patients with hyperemesis gravidarum can have enamel erosions. 6 Management strategies aim to reduce oral acid exposure through dietary and lifestyle changes, plus the use of antiemetics, antacids, or both. Rinsing the mouth with a teaspoon of baking soda in a cup of water after vomiting can neutralize acid. 3 Pregnant women should be advised to avoid brushing their teeth immediately after vomiting and to use a toothbrush with soft bristles when they do brush to reduce the risk of enamel damage. Fluoride mouthwash can protect eroded or sensitive teeth. 7

One fourth of women of reproductive age have dental caries, a disease in which dietary carbohydrate is fermented by oral bacteria into acid that demineralizes enamel 8 ( Figure 1 ) . Pregnant women are at higher risk of tooth decay for several reasons, including increased acidity in the oral cavity, sugary dietary cravings, and limited attention to oral health. 9 Early caries appears as white, demineralized areas that later break down into brownish cavitations. Fillings or crowns are a sign of previous caries. Untreated dental caries can lead to oral abscess and facial cellulitis. Children of mothers who have high caries levels are more likely to get caries. 10 Pregnant patients should decrease their risk of caries by brushing twice daily with a fluoride toothpaste and limiting sugary foods. Patients with untreated caries and associated complications should be referred to a dentist for definitive treatment.

PREGNANCY ORAL TUMOR

Pregnancy oral tumor ( Figure 2 ) occurs in up to 5 percent of pregnancies and is indistinguishable from pyogenic granuloma. This vascular lesion is caused by increased progesterone in combination with local irritants and bacteria. Lesions are typically erythematous, smooth, and lobulated; they are located primarily on the gingiva. The tongue, palate, or buccal mucosa may also be involved. Pregnancy tumors are most common after the first trimester, grow rapidly, and typically recede after delivery. Management is usually observational unless the tumors bleed, interfere with mastication, or do not resolve after delivery. Lesions surgically removed during pregnancy are likely to recur. 11

LOOSE (MOBILE) TEETH

Teeth can loosen during pregnancy, even in the absence of gum disease, because of increased levels of progesterone and estrogen affecting the periodontium (i.e., the ligaments and bone that support the teeth). 12 For uncomplicated loose teeth not associated with periodontal disease (see below), physicians should reassure patients that the condition is temporary, and alone it will not cause tooth loss.

Gingivitis ( Figure 3 ) is the most common oral disease in pregnancy, with a prevalence of 60 to 75 percent. 6 Approximately one half of women with preexisting gingivitis have significant exacerbation during pregnancy. 9 Gingivitis is inflammation of the superficial gum tissue. During pregnancy, gingivitis is aggravated by fluctuations in estrogen and progesterone levels in combination with changes in oral flora and a decreased immune response. Thorough oral hygiene measures, including tooth brushing and flossing, are recommended. Patients with severe gingivitis may require professional cleaning and need to use mouth rinses such as chlorhexidine (Peridex).

PERIODONTITIS

Periodontitis is a destructive inflammation of the periodontium ( Figure 4 ) affecting approximately 30 percent of women of child-bearing age. 3 The process involves bacterial infiltration of the periodontium. Toxins produced by the bacteria stimulate a chronic inflammatory response, and the periodontium is broken down and destroyed, creating pockets that become infected. Eventually, the teeth loosen. 13 This process can induce recurrent bacteremia, which indirectly triggers the hepatic acute phase response, resulting in production of cytokines, prostaglandins (i.e., PGE 2 ), and interleukins (i.e., IL-6, IL-8), all of which can affect pregnancy. 14 Elevated levels of these inflammatory markers have been found in the amniotic fluid of women with periodontitis and preterm birth compared with healthy control patients. 15 In one study, researchers found minimal oral bacteria in the amniotic fluid and placenta of women with preterm labor and periodontitis. 16 It seems probable that this inflammatory cascade alone prematurely initiates labor. The mechanism is thought to be similar for low birth weight; the release of PGE 2 restricts placental blood flow and causes placental necrosis and resultant intrauterine growth restriction. 17

Periodontitis and Poor Pregnancy Outcomes

Periodontitis has been associated with several poor pregnancy outcomes, although the mechanism by which this occurs remains unclear and controversy exists. Preterm birth is the leading cause of neonatal morbidity in the United States, costing approximately $26.2 billion per year. 18 Studying the direct effect of any risk factor on the outcomes of preterm birth and low birth weight is extremely difficult because of the many confounding variables that may affect the same outcome.

In a recent systematic review of mainly cross-sectional, case-control, and cohort studies conducted between 1996 and 2006 in 12 countries and three states, investigators identified 24 studies demonstrating a positive relationship between periodontitis and preterm birth, low birth weight, or both. 19 These studies involved approximately 15,000 mothers. Three of the studies were randomized controlled trials (RCTs). Conversely, 14 studies reported no relationship between periodontitis and poor pregnancy outcomes. A recent, large, U.S.-based RCT found no association between periodontitis and preterm birth and low birth weight. 20

Some of the study authors have postulated that racial differences in how periodontitis affects pregnancy outcomes may explain many of the varying results. Studies that involved more black patients had participants with more periodontal-related preterm labor. Another possible explanation is that treating periodontitis during pregnancy is too late to achieve a positive result. The focus should be on improving the condition before pregnancy.

The management of periodontitis in pregnancy is based on early diagnosis and deep root scaling. The authors of one RCT demonstrated that deep root scaling reduced the risk of birth before 37 weeks' gestation (preterm birth), with a risk reduction of 0.5 (confidence interval [CI], 0.2 to 1.3). For birth before 35 weeks' gestation (very preterm birth), the risk reduction was 0.2 (CI, 0.02 to 1.4) for women with periodontitis. 21 In another RCT of deep root scaling combined with patient education, regular plaque removal, and routine chlorhexidine rinses, researchers also noted a reduction in the incidence of preterm low birth weight (risk reduction, 0.18; CI, 0.05 to 0.6). 22 These studies, in addition to a recent U.S.-based RCT that found no benefit of treatment, 20 reported no harm to the mother or fetus from treatment of maternal periodontal conditions.

Women with preexisting periodontal disease can reduce the risk of recurrence or worsening disease during pregnancy through proper oral hygiene. The American Academy of Periodontology recommends that all women who are pregnant or planning to become pregnant undergo a periodontal examination and any necessary treatment. 23

Dental Care During Pregnancy

Screening and prevention.

Every pregnant woman should be assessed for dental hygiene habits, access to fluoridated water, oral problems (e.g., caries, gingivitis), and access to dental care. Oral examination should include the teeth, gums, tongue, palate, and mucosa. Patients should be counseled to perform routine brushing and flossing, to avoid excessive amounts of sugary snacks and drinks, and to consult a dentist. Status of and plans for oral health should be documented. Many dentists are reported to be reluctant to treat pregnant women. 24 Physicians and dentists can overcome this situation through education, clear communication, and the development of ongoing collaborative relationships. Physicians can share information on the safety of dental treatment in pregnancy with dental colleagues and provide clear referral recommendations.

CARIES RISK REDUCTION IN CHILDREN

Xylitol and chlorhexidine lower maternal oral bacterial load and reduce transmission of bacteria to infants when used late in pregnancy and/or in the postpartum period. Both topical agents are safe in pregnancy (U.S. Food and Drug Administration [FDA] pregnancy category B) and during breastfeeding. 25 – 27 Studies have used different dosing levels, and the optimal dose for consistent prevention is unclear.

Dental radiography may be performed in pregnancy for acute diagnostic purposes. 28 , 29 When possible, radiography should be delayed until after the first trimester. Screening radiography should be deferred until after delivery. Modern fast film, avoidance of retakes, and use of lead aprons and thyroid shields all limit risk. The teratogenic risk of radiation exposure from oral films is 1,000 times less than the natural risk of spontaneous abortion or malformation. 24

ROUTINE DENTAL TREATMENT

Ideally, dental procedures should be scheduled during the second trimester of pregnancy when organogenesis is complete. Urgent dental care can be performed at any gestational age. 23 The third trimester presents the additional problems of positional discomfort and the risk of vena caval compression. Propping a woman on her left side, repositioning often, and keeping visits brief can reduce problems. 5 Deferring dental care until after delivery can be problematic because new mothers are focused on the care of their newborn and may have dental insurance only during pregnancy. 14

MEDICATIONS FOR DENTAL PROCEDURES

Local anesthetics such as lidocaine (Xylocaine; FDA pregnancy category B) and prilocaine (Citanest; FDA pregnancy category B) mixed with epinephrine (FDA pregnancy category C) are safe for procedures when dosed appropriately. 30 Sedatives such as benzodiazepines (e.g., midazolam [Versed; FDA pregnancy category D], lorazepam [Ativan; FDA pregnancy category D], triazolam [Halcion; FDA pregnancy category X]) should be avoided. Nitrous oxide is not rated and its use in pregnancy is controversial. 31

MANAGEMENT OF ACUTE DENTAL CONDITIONS

If mild cellulitis is present, penicillin, amoxicillin, and cephalexin (Keflex; all FDA pregnancy category B) are reasonable first-line antibiotics. Erythromycin base (not erythromycin estolate, which is associated with cholestatic hepatitis in pregnancy) or clindamycin (Cleocin; both FDA pregnancy category B) can be used in the type 1 hypersensitivity penicillin–allergic patient. For severe cellulitis, the patient should be hospitalized and treated with intravenous cephalosporins or clindamycin. To manage dental pain, acetaminophen (FDA pregnancy category B), ibuprofen (Motrin; FDA pregnancy category B in the first and second trimesters, category D in the third trimester), and limited use of oxycodone (Roxicodone; FDA pregnancy category B in the first and second trimesters, category D in the third trimester) are appropriate depending on the gestational stage.

Allston AA. Improving women's health and perinatal outcomes: the impact of oral diseases. Baltimore, Md.: Women's and Children's Health Policy Center, 2002. http://www.jhsph.edu/wchpc/publications/ . Accessed August 1, 2007.

Gaffield ML, Gilbert BJ, Malvitz DM, Romaguera R. Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system. J Am Dent Assoc. 2001;132(7):1009-1016.

Kumar J, Samelson R, eds. Oral health care during pregnancy and early childhood: practice guidelines. New York, NY: New York State Department of Health, 2006. http://www.health.state.ny.us/publications/0824.pdf . Accessed August 1, 2007.

Stefanac S. How systemic conditions can affect treatment planning: pregnant patients. In: Stefanac SJ, Nesbit SP, eds. Treatment Planning in Dentistry . St Louis, Mo.: Mosby; 2001:92–94.

Wasylko L, Matsui D, Dykxhoorn SM, Rieder MJ, Weinberg S. A review of common dental treatments during pregnancy: implications for patients and dental personnel. J Can Dent Assoc. 1998;64(6):434-439.

American Dental Association Council on Access, Prevention and Interprofessional Relations. Women's oral health issues. American Dental Association, 2006. http://www.ada.org/prof/resources/topics/healthcare_womens.pdf. Accessed August 1, 2007.

Lewis CW, Milgrom P. Fluoride [published correction appears in Pediatr Rev . 2003;24(12):429]. Pediatr Rev. 2003;24(10):327-336.

U.S. Depa. of Health and Human Services, National Institute of Dental and Craniofacial Research. Oral Health in America: A Report of the Surgeon General. NIH publication no. 00-4713. Rockville, Md.: U.S. Public Health Service, Dept. of Health and Human Services; 2000.

Hey-Hadavi JH. Women's oral health issues: sex differences and clinical implications. Women's Health Prim Care. 2002;5(3):189-199.

Berkowitz RJ. Acquisition and transmission of mutans streptococci. J Calif Dent Assoc. 2003;31(2):135-138.

Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med. 1996;41(7):467-470.

Scheutz F, Baelum V, Matee MI, Mwangosi I. Motherhood and dental disease. Community Dent Health. 2002;19(2):67-72.

American Academy of Periodontology. Periodontal (gum) diseases. http://www.perio.org/consumer/2a.html . Accessed August 1, 2007.

Boggess KA, Edelstein BL. Oral health in women during preconception and pregnancy: implications for birth outcomes and infant oral health. Matern Child Health J. 2006;10(5 suppl):S169-S174.

Dörtbudak O, Eberhardt R, Ulm M, Persson GR. Periodontitis, a marker of risk in pregnancy for preterm birth. J Clin Periodontol. 2005;32(1):45-52.

Goepfert AR, Jeffcoat MK, Andrews WW, et al. Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstet Gynecol. 2004;104(4):777-783.

Offenbacher S, Lieff S, Boggess KA, et al. Maternal periodontitis and prematurity. Part I: obstetric outcome of prematurity and growth restriction. Ann Periodontol. 2001;6(1):164-174.

Help reduce cost: the economic costs. March of Dimes. http://www.marchofdimes.com/prematurity/21198_10734.asp . Accessed July 1, 2007.

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Management of Pregnant Patient in Dentistry

Sophia kurien.

New Horizon Dental College & Hospital, Department of Oral Medicine and Radiology, Chattisgarh, India

Vivekanand S Kattimani

S D Dental College and Hospital, Department of Oral and Maxillofacial Surgery, Maharashtra, India

Roopa Rani Sriram

Department of Oral and Maxillofacial Surgery, Mansarovar Dental College, Bhopal (M.P.), India

Sanjay Krishna Sriram

Department of Conservative and Endodontics, Mansarovar Dental College, Bhopal (M.P.), India

Prabhakara Rao V K

GITAM Dental College and Hospital, Department of Periodontics, Andhra Pradesh, India

Anitha Bhupathi

S D Dental College and Hospital, Parbhani, Department of Periodontics, Maharashtra, India

Rupa Rani Bodduru

Namrata n patil.

S D Dental College and Hospital, Parbhani, Department of Oral Pathology, Maharashtra, India

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.

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 .

Introduction:

Pregnancy causes many changes in the physiology of the female patient. These alterations are sometimes subtle but can lead to disastrous complications if proper precautions are not taken during dental treatment. Physiologically, changes occur in the cardiovascular, hematologic, respiratory, gastrointestinal, genitourinary, endocrine, and oro-facial systems ( Table 1 ). The changes that occur are the result of increasing maternal and fetal requirements for the growth of the fetus and the preparation of the mother for delivery. Increased hormonal secretion and fetal growth induce several systemic, as well as local physiologic and physical changes in a pregnant woman. Local physical changes occur in different parts of the body, including the oral cavity. These collective changes may pose various challenges in providing dental care for the pregnant patient. Treatment of the pregnant patient has the potential to affect the lives of two individuals (the mother and the unborn fetus). Certain principles must be considered in the treatment of the pregnant patients so that, it benefits to the mother while minimizing the risk to the fetus.

Physiology of pregnancy and its considerations in the management:

Cardio Vascular System and its implications:

Compared with the non pregnant patient, the pregnant patient shows significant changes in blood volume and cardiac output and changes in systemic vascular resistance, decrease in blood pressure, and the potential occurrence of the supine hypotensive syndrome. 1 - 8 Cardiac output increases 30% to 50% during pregnancy, secondary to a 20% to 30% increase in heart rate as well as a 20% to 50% increase in stroke volume. 7 , 9 These changes produce a functional heart murmur and tachycardia in 90% of women, which disappears shortly after delivery. 10

During the second and third trimesters, a decrease in blood pressure and cardiac output can occur while the patient is in a supine position. It is due to the decreased venous return to the heart from the compression of the inferior vena cava by the gravid uterus, which can result in a 14% reduction in cardiac output. 11 , 12 Current data implicate various mediators like progesterone, prostaglandins, and nitric oxide for causing peripheral vasodilatation and venodilation 6 , 8 , 13 Hypotension, bradycardia, and syncope characterize supine hypotension syndrome. 13 The resulting decrease in the stroke volume stimulates the baroreceptors as a normal compensatory mechanism to maintain cardiac output. This leads to hypotension, nausea, dizziness, and fainting. To prevent supine hypotensive syndrome in the dental chair, the pregnant woman should have the right hip elevated 10 to 12 cm or placing the patient in a 5% to 15% tilt on her left side can relieve pressure on the inferior vena cava. If hypotension is still not relieved, a full left lateral position may be needed. 8

Respiratory system changes and its implications:

The respiratory changes occurring during pregnancy are to accommodate the increasing size of the developing fetus and the maternal-fetal oxygen requirements. Enlarged fetus pushes the diaphragm up by 3 to 4 cm causing an increase in intra thoracic pressure. This leads to an increase in chest circumference that results in out flaring of the ribs. 15 The diaphragmatic displacement leads to a 15% to 20% reduction in functional residual capacity.

Hyperventilation begins in the first trimester and may increase up to 42% in late pregnancy. Approximately 50% of pregnant women complained of dyspnea by gestation week 19, which increased to 75% by 31 weeks. Pregnant patients (25%) develop moderate hypoxemia and some develop an abnormal alveolar-arterial oxygen gradient when placed in the supine position 1 , 19 . Ventilation patterns and patient position must be adjusted for the pregnant patient so as to avoid hypoxemia 1 , 20 .

The mucosa of the upper airways has a tendency to become friable and edematous due to increased serum estrogen concentrations in pregnant women2,. Up to one third of pregnant women experience severe rhinitis, which predisposes them to frequent nosebleeds and upper respiratory tract infections 1 , 2 .

Circulatory system changes and its implications:

In pregnancy, changes will include increase in the number of erythrocytes and leukocytes, erythrocyte sedimentation rate, and most of the clotting factors, causing a hypercoagulable state. 2 , 10

Disproportionate rise in red blood cell mass accounts for the "hemodilution" or physiologic anemia of pregnancy that is maximal by approximately 30 to 32 week's gestation. 1 These changes will protect the mother from volume depletion due to excessive peripartum hemorrhage and to lessen the chance of thrombotic event occurrence.

Increased levels of circulating catecholamines and cortisol contribute to the leukocytosis seen in pregnancy. 2 , 22 Clotting factors VII-X are increased and anti clotting factors XI and XIII are decreased. Therefore, pregnancy is considered to be a hyper coagulable state, increasing the risk for thromboembolism. 17 Pregnant women have a fivefold increase in the likelihood of thromboembolic events, compared with non-pregnant patients. 1 , 25 Acute thromboembolism during pregnancy requires intravenous anticoagulation for 5 to 10 days, followed every 8 to 12 hours by subcutaneous injections to prolong the partial thromboplastin time at least to 1.5 times control throughout the dosing interval. Treatment with heparin, aspirin, or intravenous immunoglobulin's decreased the fetal loss rate 26 and heparin is preferred because it does not cross the placenta, has a much more predictable dose response because of low protein-binding (unlike unfractionated heparin), and has been demonstrated to be more effective than heparin for prophylaxis and less likely to cause major spontaneous bleeding. 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 the peak frequency at the end of the first trimester. 1 , Pyrosis (heartburn) occurs in approximately 30% to 50% of pregnant women. Reflux occurs as a result of an increased intra gastric pressure due to the enlarging fetus, slow gastric emptying rate, and decreased resting pressure of the lower gastroesophageal sphincter. 27 , 31 Pathophysiology of nausea and vomiting during pregnancy is thought to be due to the hormonal effects of estrogen and progesterone. 32 Other changes include hepatic dysfunction and iron deficiency.

Liver dysfunction may lead to preeclampsia (a placental-induced triad of hypertension, proteinuria, and edema), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), obstructive cholestasis, and acute fatty liver of pregnancy. 35 The exact cause of preeclampsia has not been identified. Pregnant women with elevated blood pressure should be referred to the primary physician or obstetrician to be evaluated for possible developing preeclampsia.

For pregnant women with hyperemesis morning appointments should be avoided. They should be advised to avoid citrus drinks or fatty foods as they may cause gastric upset or delay gastric emptying. Pregnant women should be advised to sip small volumes of salty liquids such as sports beverages to prevent dehydration due to recurrent vomiting. During dental procedures, pregnant patients should be seated in a semi supine or comfortable position. The procedure should be stopped immediately if patient experiences nausea and the chair should be repositioned upright. Increased episodes of gastric reflux and regurgitation warrant special consideration, because they can lead to aspiration of gastric contents and, in some cases, death. 1 , Additional supplements like Iron is required for fetal erythropoesis and folic acid for amino acid and nucleic acid synthesis. 38 , 39

Renal and genitourinary changes and its implications:

The principal renal and genitourinary changes in pregnant patients are increased glomerular filtration rate (GFR), biochemical changes in the urine and blood, urinate more frequently and have a greater risk of urinary tract infections. 1 , 2 , 40 , 41 The most significant physiologic urinary tract change is ureteral dilation. Hydroureter is found in almost 90% of pregnancies by the third trimester. The relative urinary stasis may account for the higher incidences of pyelonephritis during pregnancy.

Asymptomatic bacteriuria in the pregnant patient can progress to urinary tract infection and eventually pyelonephritis if untreated. 1

As a result of the increased filtration, clearance of creatinine, uric acid, and urea is increased, which results in a decline in serum creatinine and blood urea nitrogen. When drugs with renal clearance are used in pregnancy, their doses may need to be increased to account for their more rapid clearance. Ask the patient to empty the bladder just prior to starting the dental procedure.

Endocrine changes and its implications:

Hormones are responsible for most of the physiologic changes during pregnancy those are the female sex hormones (estrogen, progesterone, and human gonadotrophin) and secreted primarily by the placenta. In addition, there is also an increase in thyroxine, steroids, and insulin levels. About 45% of pregnant women are unable to produce sufficient amounts of insulin to overcome the antagonistic action of estrogen and progesterone, and as a result develop gestational diabetes. Women who are obese and with a positive family history of Type II diabetes mellitus have a higher risk of developing gestational diabetes.11 Estrogen and progesterone are insulin antagonists and the increased levels of these hormones lead to insulin resistance, thus insulin levels are elevated in pregnant women to compensate for this resistance.

Oro-facial changes and its importance:

Oral changes include gingivitis, gingival hyperplasia, pyogenic granuloma, and salivary changes. Increased facial pigmentation is also seen. Elevated circulating estrogen, which causes increased capillary permeability, predisposes pregnant women to gingivitis and gingival hyperplasia. 43 Pregnancy does not cause periodontal disease but does worsen an existing condition. Increased angiogenesis, due to sex hormones coupled with gingival irritation by local factors such as plaque, is believed to cause pyogenic granuloma in 1%-5% of patients, which occurs during the first and the second trimesters and may regress after the child's birth. The change in composition includes a decrease in sodium and pH, and an increase in potassium, protein, and estrogen levels. Due to increase in salivary estrogen the proliferation and desquamation of the oral mucosal cells provide a suitable environment for bacterial growth which predisposes the pregnant woman to dental caries. Good oral hygiene will help to prevent or reduce the severity of the hormone-mediated inflammatory oral changes.

Facial changes as "mask of pregnancy," appearing as bilateral brown patches in the mid-face begin during the first trimester51 and are seen in up to 73% of pregnant women. Melasma usually resolves after parturition. Preterm low birth weight baby reported with periodontal disease. It seems to be an independent risk factor and was decreased by good oral hygiene and periodontal treatment.

Pharmacotherapy in pregnancy:

Higher volume of drug distribution, lower maximum plasma concentration, lower plasma half-life, higher lipid solubility, and a higher clearance of the drugs is seen in pregnancy. Certain drugs are known to cause miscarriage, teratogenicity, and low birth weight of the fetus. Most drugs are excreted in breast milk, exposing the newborn to the drugs. toxicity to new born depends on the chemical properties, dose, frequency, duration of exposure to the drugs, and amount of milk consumed. The FDA has categorized teratogenic drugs which cause birth defects and provided the definitive guidelines for prescribing drugs during pregnancy. They are as follows( Table -2 ). Understanding the safety aspects of commonly used and prescribed medications minimizes adverse outcomes.( Table- 3 ) Fortunately, there is a small number but a wide variety of drugs that are teratogens (ie, drugs that can cause either structural or functional birth defects).( Table- 4 ) Several categories of drugs are known to be teratogenic, including alcohol, tobacco, cocaine, thalidomide, methyl mercury, anticonvulsant medications, warfarin compounds, angiotensin-converting enzyme (ACE) inhibitors, retinoids, and certain antimicrobial agents.

Most antibiotics do cross the placenta and thus have the potential to affect the fetus. The macrolides, such as erythromycin, azithromycin, class of anti-inflammatory analgesics, cyclooxygenase (COX)-2 inhibitors (celecoxib and rofecoxib) is classified as category C medication and clarithromycin, do not cross the placenta to any significant extent. They do not cause fetal anomalies. The tetracyclines are to be avoided in the pregnant patient and in children up to 12 years of age because of permanent dental staining. Use of metronidazole justified for significant oral and maxillofacial infections in the pregnant patient because of its less effects.

Obstetricians have discouraged pregnant women from taking analgesic doses of aspirin; mainly because of the wide spread availability of acetaminophen, which causes less gastric irritation, but also because of the concerns listed earlier. Use of nonsteroidal anti-inflammatory drugs, ibuprofen, naproxen, and ketoprofen drugs in early pregnancy has been associated with an increased risk of cardiac septal defects. By inhibiting prostaglandin synthesis, they also may cause dystocia and delayed parturition. A new based on animal studies. Like other NSAIDs, COX-2 inhibitors should be avoided in late pregnancy because they may cause premature closure of the ductus arteriosus; they are also classified as category C medications. In general, nonsteroidal anti-inflammatory drugs should be avoided, especially during late pregnancy.

Pregnant patient management guidelines:

Based on the earlier review of gravid and fetal physiology, the adjustments documented here in the treatment of the pregnant patient should be implemented by dentists. Initial assessment includes a comprehensive review of the patient's medical and surgical history. All elective surgical procedures should be postponed until postpartum. Minor/outpatient oral and maxillofacial surgical procedures should follow some basic guidelines.

The supine position should be avoided for a variety of reasons: to avoid the development of the "supine hypotensive syndrome" in which a supine position causes a decrease in cardiac output, resulting in hypotension, syncope, and decreased uteroplacental perfusion. In addition, the supine position may cause a decrease in arterial oxygen tension (PaO2) and increase the incidence of dyspepsia from gastoresophageal reflux secondary to an incompetent lower esophageal sphincter. Finally, the supine position poses an increased risk of developing DVT, by compression of the inferior vena cava, leading to venous stasis and clot formation. The ideal position of the gravid patient in the dental chair is the left lateral decubitus position with the right buttock and hip elevated by15°.

Radiographs, Pregnancy, And the Fetus: A radiation dose of 10 Gy (5 Gy in the first trimester, when organogenesis is initiated) causes congenital fetal abnormalities 1 . It has been estimated that the dose to the fetus is approximately 1/50,000 of that to the mother's head in any of the exposure ranging from full mouth x-ray to CT images of head and neck. The exposure of any radiographic films required for management of the pregnant patient in most situations should not place the fetus at increased risk. Adequate shielding and protective equipment must be used at all times.

First trimester (conception to 14th week): The most critical and rapid cell division and active organogenesis occur between the second and the eighth week of post conception. Therefore, the greater risk of susceptibility to stress and teratogens occurs during this time and 50% to 75% of all spontaneous abortions occur during this period. 33

The recommendations are:

Educate the patient about maternal oral changes during pregnancy.
Emphasize strict oral hygiene instructions and thereby plaque control.
Limit dental treatment to periodontal prophylaxis and emergency treatments only.
Avoid routine radiographs. Use selectively and when needed.

Second trimester (14th to 28th week):

Organogenesis is completed and therefore the risk to the fetus is low. Some elective and emergent dentoalveolar procedures are more safely accomplished during the second trimester.

Oral hygiene instruction, and plaque control.
Scaling, polishing, and curettage may be performed if necessary.
Control of active oral diseases, if any.
Elective dental care is safe.

Third trimester (29th week until childbirth):

Although there is no risk to the fetus during this trimester, the pregnant mother may experience an increasing level of discomfort. Short dental appointments should be scheduled with appropriate positioning while in the chair to prevent supine hypotension. It is safe to perform routine dental treatment in the early part of the third trimester, but from the middle of the third trimester routine dental treatment should be avoided.

Avoid elective dental care during the second half of the third trimester.

In conclusion it is important to remember that treatment is being rendered to two patients: mother and fetus. All treatment should be done only after consultation with the patient's gynecologist. It is best to avoid drugs and therapy that would put a fetus at risk in all women of child-bearing age or for whom a negative pregnancy test has not been ensured. Oral and maxillofacial surgeons should avoid elective surgery in the pregnant patient, if possible. Routine dental health procedures should be accomplished before conception in planned pregnancies and during the middle trimester in unplanned pregnancies. Oral and maxillofacial surgeons may be called on to treat urgent or emergency cases involving trauma, infection, and pathology whose treatment cannot be postponed. Active treatment is directed toward optimizing maternal health while minimizing fetal risk.

Source of Support: Nil

Conflict of Interest: None Declared

Contributor Information

Sophia Kurien, New Horizon Dental College & Hospital, Department of Oral Medicine and Radiology, Chattisgarh, India.

Vivekanand S Kattimani, S D Dental College and Hospital, Department of Oral and Maxillofacial Surgery, Maharashtra, India.

Roopa Rani Sriram, Department of Oral and Maxillofacial Surgery, Mansarovar Dental College, Bhopal (M.P.), India.

Sanjay Krishna Sriram, Department of Conservative and Endodontics, Mansarovar Dental College, Bhopal (M.P.), India.

Prabhakara Rao V K, GITAM Dental College and Hospital, Department of Periodontics, Andhra Pradesh, India.

Anitha Bhupathi, S D Dental College and Hospital, Parbhani, Department of Periodontics, Maharashtra, India.

Rupa Rani Bodduru, S D Dental College and Hospital, Parbhani, Department of Periodontics, Maharashtra, India.

Namrata N Patil, S D Dental College and Hospital, Parbhani, Department of Oral Pathology, Maharashtra, India.

References:

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COMMENTS

Pregnancy and Dental Work
Some women may elect to avoid dental work during the first trimester knowing this is the most vulnerable time of development. However, there is no evidence suggesting harm to the baby for those electing to visit the dentist during this time frame. Also, if non-emergency dental work is needed during the third trimester, it is usually postponed ...
Is It Safe To Go to the Dentist While Pregnant?
Local anesthetics (such as lidocaine) are considered safe to use during a dental procedure while pregnant, says Dr. Peskin. Studies show that any chance of a negative effect on you or the fetus is ...
When to Visit the Dentist During Pregnancy
The first trimester of your pregnancy (the first 13 weeks) is the time in which most of the baby's major organs develop. If you go to the dentist during your first trimester, tell your dentist that you're pregnant and have only a checkup and routine cleaning. If possible, postpone any major dental work until after the first trimester.
Pregnancy
Oral health care, including having dental radiographs taken and being given local anesthesia, is safe at any point during pregnancy. 1, 2 Further, the American Dental Association and the American College of Obstetricians and Gynecologists (ACOG) agree that emergency treatments, such as extractions, root canals or restorations can be safely performed during pregnancy and that delaying treatment ...
Can I go to the dentist when I'm pregnant?
However, the second trimester is the safest trimester in which to get dental treatment. The third trimester is safe, but the patient might have a hard time laying back for extended period of time. ... Schedule your baby's first dentist appointment at six months or when the first tooth comes in. The dentist will check for tongue-tie and other ...
7 things to know about dental care during your pregnancy
Stick to your regular six-month cleaning schedule and visit whenever that falls, she says. One exception to that may be if you have bad nausea or vomiting, a typical occurrence in the first trimester. When that subsides, make that dental appointment, and be sure to inform the staff about your pregnancy. 6.
Can You Go to the Dentist When You're Pregnant?
Yes. Seeing the dentist during pregnancy every six months as usual is important so you can keep your mouth clean and (fingers crossed) cavity-free. Go to your regular twice-a-year appointments, and if your dentist recommends X-rays, don't worry: Dental X-rays are completely safe during pregnancy. If avoiding radiation from X-rays is on your ...
Dental Care Before, During, and After Pregnancy
Tell your dentist (and doctor) if you are pregnant. Routine dental care can be done any time during pregnancy. Any urgent procedure can be done, as well. All elective dental procedures, however ...
Prenatal care: First trimester visits
Prenatal care: First trimester visits. Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more. By Mayo Clinic Staff. Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife ...
Dental Care Is Safe and Important During Pregnancy
Dental care is safe and important during pregnancy. Seek routine and emergency dental care at any stage of pregnancy. Learn how to prevent oral diseases. Oral diseases cause pain and disability for millions of Americans and cost taxpayers billions of dollars each year. Dental care is safe and important during pregnancy.
Dental Care During Pregnancy
Regular visits to your dentist during pregnancy are important to prevent problems. Tell your dentist that you are pregnant. Dental X-rays and local anesthesia are generally safe during pregnancy. Most dental work can be done while you are pregnant. If you go to the dentist during the second or third trimesters, you may be more comfortable ...
Pregnancy and dental health: What you need to know
Dental x-rays are now considered safe during all stages of pregnancy by the American Dental Association. X-rays can be vital in catching major problems that cannot be seen otherwise, like tooth decay, bone loss and infected root canals. Dental x-rays are not believed to cause birth defects, although a 2004 study did find an increase in low ...
Dental health during pregnancy
You can buy them over the counter without a prescription from your provider. But don't take any medicine—even OTC medicine—without talking to your provider first. Visit your dentist for a regular dental checkup every 6 months (twice a year), even during pregnancy. At your checkup, tell your dentist that you're pregnant.
Oral Health Care During Pregnancy and Through the Lifespan
At the first prenatal visit, health care providers should assess a woman's oral health. A simple approach to prenatal assessment can be accomplished by using the questions provided in Box 1. As part of routine counseling, health care providers should encourage all women to schedule a dental examination if it has been more than 6 months since ...
Do's and don'ts during the first trimester of pregnancy
The ACOG reports that 40% of pregnant Americans have some degree of periodontal disease and that the physical changes from pregnancy can affect the gums and teeth. A dental visit can identify any potential dental needs early. Do stay hydrated. Hydration helps prevent preterm labor. It also helps prevent headaches, kidney stones and dizziness.
When to Visit the Dentist During Pregnancy
The first trimester of your pregnancy (the first 13 weeks) is the time in which most of the baby's major organs develop. If you go to the dentist during your first trimester, tell your dentist that you're pregnant and have only a checkup and routine cleaning. If possible, postpone any major dental work until after the first trimester.
Pregnancy and oral health
Dental treatment is considered safe at any time during pregnancy, but you might be more comfortable during your second trimester. Nausea and vomiting are more common during the first trimester, 4 which could make treatment difficult. During the third trimester, the weight of the baby may cause you to be uncomfortable or even lightheaded during treatment. 5 If so, tell your dentist so he or she ...
Safely caring for pregnant dental patients
Among Americans without a dental visit in the past 12 months, ... 70% to 80% of women experience nausea and vomiting during the first trimester. 21 Some women may opt to postpone routine dental care until they reach the second trimester. If the patient has pain or issues that cannot wait to be addressed, dental care providers should do their ...
Your Guide to the First Trimester: Symptoms, Prenatal Visits ...
From weeks 10 to 13, the fetus grows from one to three inches. By the end of the first trimester, the fetal organs start to function. The fetal heart beats, and the kidneys process waste. Preventing developmental problems in the first trimester Though you won't feel any movement yet, critical development happens in the first trimester.
Dental Considerations in Pregnancy-A Critical Review on the Oral Care
For the first trimester (1-12 weeks) During the first trimester, it is recommended that the patients be scheduled to assess their current dental health, to inform them of the changes that they should expect during their pregnancies, and to discuss on how to avoid maternal dental problems that may arise from these changes.
Pregnancy Dental Concerns
Pregnancy tumors are overgrowths of tissue that can develop on the gums, usually during the second trimester. These growths are not cancer, just a form of swelling that typically shows up between teeth. They may be related to an excess buildup of plaque in between teeth. Pregnancy tumors often bleed easily and have a red, raw-looking, raspberry ...
Oral Health During Pregnancy
Dental radiography may be performed in pregnancy for acute diagnostic purposes. 28, 29 When possible, radiography should be delayed until after the first trimester. Screening radiography should be ...
Management of Pregnant Patient in Dentistry
Hyperventilation begins in the first trimester and may increase up to 42% in late pregnancy. Approximately 50% of pregnant women complained of dyspnea by gestation week 19, which increased to 75% by 31 weeks. ... but from the middle of the third trimester routine dental treatment should be avoided. The recommendations are: Oral hygiene ...