Pregnancy. Dental Approach

The pregnant woman is a special case, which requires many precautions. Any medical procedure, from anesthesia to antibiotics and X-rays, must take into account the potential risk to the baby.

A woman’s body undergoes continuous and unpredictable changes and imbalances which narrow the range of interventions that a dentist can perform.

Each step is a question mark with a confusing answer.

  • Can antibiotics be administered in pregnancy?

  • In the first trimester, when organogenesis, the formation of fetal organs, takes place, any medication should be avoided, but some doctors recommend certain antibiotics.

  • Are anesthetics recommended in pregnancy?

  • In the first and third trimesters, anesthetics with adrenaline are contraindicated.

  • Some doctors do not use adrenaline anesthesia at all in either trimester, others use adrenaline anesthesia in the second trimester.

  • Can X-rays be taken during pregnancy?

  • Not recommended in either trimester, but some doctors request them, with the mention of protecting the mother’s abdomen and thyroid gland.

With so many uncertainties, it is recommended that medical problems be dealt with before pregnancy or after pregnancy, even though the second trimester is said to be the safest for treatments or dental appointments.

The pregnant woman, the special patient

Pregnancy is a phenomenon of unparalleled magnitude, fascinating but also extremely unpredictable. It is the period when the body undergoes radical changes. The changes are on all levels and their diversity is as miraculous in some respects as it is uncomfortable when we talk about disorders of the body, and here we are referring to the disorders that arise or are accentuated in pregnancy.

Thus, from the first months of pregnancy, significant changes occur:

  • increased levels of hormones (estrogen and progesterone)

  • increased blood production, blood vessels carry 30%-50% more blood than usual

  • muscle, joint and ligament relaxations occur, due to the hormone relaxin, which will cause locomotor instability.

  • A “cocktail” of hormones:

  • HCG – Human Chorionic Gonadotropin

  • estrogen

  • progesterone

  • relaxin

  • insulin

  • oxytocin

  • prolactin

  • cortisone

This is how metamorphosis of the human body is possible during pregnancy.

Pre-existing conditions also arise or worsen during pregnancy. Thus, you may find out during pregnancy that you have anemia without having been anemic, pregnancy thrombocytopenia, pregnancy prurigo or more complicated conditions such as HELLP syndrome.

During pregnancy, one of the most important nutrients is calcium, which is necessary for the growth and strengthening of fetal bone. Lack of calcium in your body during pregnancy can affect your bones, nervous system or fetal muscles and make you more prone to osteoporosis.

The inevitable loss of calcium, intense hormonal activity will also cause dental conditions such as:

  • tooth decay

  • gum disease (gingivitis)

  • dentine hyperesthesia

  • periodontal disease

  • pregnancy granuloma.

Therefore, the chances of contacting the dentist during pregnancy are high because the mother’s oral health influences the general health and oral health of the baby.

During the 9 months of pregnancy, you will face:

  • toothaches

  • tooth decay or erosion

  • various forms of periodontal disease

  • mouth ulcers

  • oral herpes

  • dental abscesses

All of these normally involve medication, dental X-rays, and all of these situations raise questions about the safety of the child. It is therefore preferable for the mother-to-be to have her dental problems taken care of before pregnancy in order to avoid risks, small or large, that may affect her and her baby’s health.

For a pregnant woman, even the dental chair becomes problematic because of muscle and joint pain, etc.

Then the newborn baby has a sterile oral cavity. The mother is the person she will be in constant contact with, so if you have unresolved dental problems, there is a risk of contaminating the baby’s oral cavity with a variety of microbes.

Dental treatments in pregnancy

The first question a pregnant woman will ask herself, if dental conditions have not been resolved, is when and what medications or dental actions should be avoided.

Thus, in the first trimester of pregnancy, taking any type of medication and X-rays should be avoided. As organogenesis takes place during this period, anesthesia should be performed with great caution.

Any external action may affect the baby’s life. Any lack of attention or care may have consequences for the fetus.

You should be aware that in the first and third trimesters, visits to the doctor involving extensive surgery, X-rays or anesthesia with adrenaline, antibiotics or other drugs are not recommended.

In the third trimester any source of stress can cause premature birth. Knowing the potential stress that dental appointments can cause, they should be avoided in the third trimester.

The safe, low-risk trimester for dental appointments and treatments is the second trimester. Thus, if the mother-to-be is known to have unresolved dental problems, it is advisable to visit the dentist in the second trimester of pregnancy.


Certain treatments should not be carried out under any circumstances during pregnancy:

  • anesthesia with adrenaline-can cause contractions triggering miscarriage or premature birth. The least risky anesthetics are lidocaine or mepivacaine (they do not contain adrenaline).

  • X-rays – although some doctors do not rule them out, they are contraindicated in the first trimester of pregnancy. Only in cases of extreme urgency can they be carried out in this first trimester, but even then, the mother’s abdomen and thyroid gland must be protected and hermetically covered. As a controversial issue with many unknowns, dental X-rays should be avoided in pregnancy.

  • Lower radiation doses (5-10 rad) have no teratogenic effect (do not adversely affect fetal development), according to studies. In the first trimester of pregnancy, only emergencies that cannot be postponed can be treated.

  • Tetracycline, streptomycin, kanamycin, gentamicin are absolutely forbidden in pregnancy, but also after birth during breastfeeding.

Cosmetic dental interventions should be postponed until the second trimester.

Prophylaxis (scaling and professional brushing) can also be carried out in the first trimester of pregnancy. This prevents severe pregnancy-related diseases, gingivitis or periodontitis.

Dental diseases in pregnancy

  • Pregnancy gingivitis involves inflammation of the gum tissue and is the most common dental disease in pregnant women.

Most pregnant women who have experienced gingivitis before this period, during pregnancy, this condition can become more acute. But there are many cases of gingivitis occurring during pregnancy with no previous cases.

The periodontium, in the context of hormonal changes, especially progesterone, becomes vulnerable. Progesterone increases and increased progesterone levels negatively influence microvascularization and the immune system. The de-immunized periodontium becomes the breeding ground for the selective growth of bacteria that will lead to gingivitis or, worse, periodontitis.

Poor oral hygiene is, of course, an asset for the selective growth of bacteria, especially anaerobic bacteria.

Thus, in pregnancy gingivitis, the interdental papillae are inflamed, swollen, prone to constant, enlarged, painful bleeding.

Pregnancy gingivitis may degenerate into epulis or granuloma of pregnancy, manifest in the gingiva of the maxillary front teeth, on the buccal surface, representing a flattened, round, painless gingival mass of normal size.

If this gingival mass becomes enlarged it becomes uncomfortable to chew, ulcerates and causes pain. Under these conditions, rigorous hygiene is essential to protect the periodontium. Pregnancy gingivitis can regress after childbirth or, on the contrary, it can become chronic.

  • Tooth decay – during pregnancy the risk of pulp complications and caries increases by up to 30%, especially in the first two trimesters. The fetus’s need for calcium and nutrients, in the context of hormonal imbalance, can trigger a veritable explosion of caries. Cavities are a very intense microbial environment and can pose a danger to the baby’s sterile oral cavity.

  • Dentin hyperesthesia – a condition manifested by extremely painful reactions to stimuli such as hot, cold, sweet, sour.

  • Periodontal disease – is a severe condition of the periodontium, the supporting tissue of the tooth. During pregnancy you may notice a slight mobility of the teeth due to the activity of a complex of hormones that determine the elasticity of the ligaments, and therefore the dental ligaments, slowed blood circulation and poor oral hygiene. This is physiologically relatively normal during this period. However, if you notice gum changes, heavy bleeding from the gums, halitosis, it means that you have had gingivitis that has degenerated into periodontitis. In this case, you should see your dentist as a matter of urgency.

Antibiotics in pregnancy

Severe dental conditions cannot be treated without antibiotics. Any dental infection, especially in pregnancy, should not be ignored, as they can enter the bloodstream and change blood parameters.

However, there is a wide range of antibiotics that are considered to be contraindicated in pregnancy, and only your dentist can prescribe an antibiotic during this period. So, if you made a habit of self-medicating before pregnancy for dental conditions, abandon it and see your dentist!

Penicillin, amoxicillin, cephalexin can be given during pregnancy, except in the first trimester.

Tetracycline, streptomycin, kanamycin, gentamicin are absolutely forbidden in pregnancy, but also after childbirth during breastfeeding.

To avoid delicate situations, it is advisable that dental problems are dealt with before or after pregnancy.

Indications in pregnancy

  • Tooth brushing after each meal

  • Flossing

  • Mouthwash, only on the recommendation of the dentist. Avoid products with chlorhexidine!

  • Tell your dentist that you are pregnant!

  • Healthy eating.

  • Visits to the dentist for scaling and brushing, but also for other conditions. This way you can avoid severe dental problems.

  • Don’t go to the dentist in the morning, when nausea and vomiting usually occur.

  • Use the toilet before your appointment.

If you have any questions about dental consultations and treatments that can be carried out during pregnancy, do not hesitate to contact us.

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