Estudiante De Odontologia

Clinical

practicE

Oral Health Care for the Pregnant Patient
James A. Giglio, DDS, MEd; Susan M. Lanni, MD; Daniel M. Laskin, DDS, MS;
Nancy W. Giglio, CNM

Contact Author
Dr. Giglio
Email: jagiglio@vcu.edu

ABSTRACT
Pregnancy is a unique time in a woman’s life, accompanied by a variety of physiologic,
anatomic and hormonal changes that can affect how oral health care is provided.However, these patients are not medically compromised and should not be denied
dental treatment simply because they are pregnant. This article discusses the normal
changes associated with pregnancy, general considerations in the care of pregnant
patients, and possible dental complications of pregnancy and their management.

For citation purposes, the electronic version is the definitiveversion of this article: www.cda-adc.ca/jcda/vol-75/issue-1/43.html

M

ost pregnant patients are generally
healthy and need not be denied dental
t reatment solely because they are
pregnant. However, even a healthy pregnancy
c auses major changes in maternal anatomy,
physiology and metabolism. These can include
changes in the cardiovascular, respiratory and
gastrointestinal systems, aswell as changes in
t he oral cavity and increased susceptibility to
oral infection. Although these adaptations of
maternal organ systems are normal, they do
necessitate consideration and adjustments in
t reatment by any dentist who is providing oral
health care and prescribing medications for
t he patient. This article discusses the various
changes that occur during normal pregnancy
a ndsuggests modifications in dental management that should be considered.
Systemic Changes
Cardiovascular System
Cardiovascular changes in pregnancy
i nclude increases in cardiac output, plasma
volume and heart rate. A benign systolic ejection murmur, caused by increased blood flow
across the pulmonic and aortic valves, occurs


i n 96% of pregnant women,1 but no treatment is
required. Inaddition, as a result of vasomotor
i nstability, pregnant patients are susceptible to
postural hypotension. Consequently, changes
i n dental chair position from reclining to upright should be performed very slowly. As the
uterus increases in size, it causes pressure on
t he vena cava and aorta, which can result in
decreases in cardiac output, venous return
a nd uteroplacental blood flow.Aortocaval
compression, which occurs specifically in the
supine position, leads to supine hypotensive
syndrome, which is characterized by symptoms and signs such as lightheadedness, weakness, sweating, restlessness, tinnitus, pallor,
decrease in blood pressure, syncope and, in
s evere cases, unconsciousness and convulsions. Patients who experience this syndrome
a re usually aware of itsoccurrence and can
a lert their caregivers if they begin to notice
symptoms developing. The condition can be
corrected by having the patient roll on her left
side and placing a pillow or rolled towels to
elevate her right hip and buttock by about 15°.
Th is manoeuvre lifts the uterus off the vena
cava and re-establishes aortocaval patency.2

JCDA • www.cda-adc.ca/jcda • February 2009, Vol.75, No. 1 •

4

––– Giglio –––

Oral changes
Gingivitis
Pyogenic granuloma
Ptyalism
Enamel erosion
Xerostomia
Tooth mobility

Pregnant dental patient

Radiography
(if necessary for diagnosis)
Panoramic radiographs
Periapical radiographs as
needed
Bitewing radiographs
Digital radiographs

Emergency care
Perform at any time in
pregnancy for pain relief and
infectioncontrol (pulp
extirpation, incision and
drainage, uncomplicated
extractions)
Notify obstetrician of
patient’s condition

Systemic changes
Increased cardiac output,
plasma volume and heart rate
Systolic ejection murmur
Supine hypotensive syndrome
Nasal congestion, epistaxis
Increased intragastric
pressure, gastric acid reflux

Elective care
Scaling and curettage
Routine restorations...