Dental considerations for pregnant and/ or breastfeeding patients.

1. Ch.22
Pregnancy and Breastfeeding
Cheyanne Rosa

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The long term physiologic and psychological consequences of
in utero drug exposure that aren’t evident at birth is a relatively
new concern

4. 1st Trimester (1-3 months)
Organs of the fetus are forming
Most critical time for teratogenicity
Abnormalities in very early development typically result in
miscarriage; With later exposure, abnormalities occur in the fetus
OHI, prophy, and examination of oral cavity without x-rays
Not an ideal time for dental treatment due to morning sickness. If
necessary, schedule afternoon appointments.
2nd Trimester (4-6 months)
Best time for dental treatment:
Pt is most comfortable
Pt should receive both OHI and prophy if needed.
Pt perio. status should be carefully evaluated.
3rd Trimester (7-9 months)
Drugs that may affect the new-born child should not be given
Uncomfortable for woman to lie prone for any length of time; may
feel more comfortable sitting or with right hip elevated.
Premature labor most likely to begin.

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7. Alcohol
 Fetal alcohol syndrome (FAS) is associated with changes in an infant exposed to
excessive alcohol intake by the mother.
 Evidence for teratogenicity of alcohol is strong
 Growth retardation, CNS abnormalities, facial dysmorphology.
 Pregnant dental patients should be encouraged to abstain from alcohol. No safe threshold
for the pregnant woman is known.

9. When would be the
more appropriate
time to perform an
elective procedure
on Ms. Watson?
 Elective dental treatment should be avoided
except in the second trimester. Being that Ms.
Watson is in her 3rd trimester, elective
procedures should be postponed until
postpartum or until finished nursing.

10. What are the
concerns
associated with
medications and
breastfeeding?
 Drugs without strong indication for use
should not be taken because nearly all drugs
given to the mother can pass into breast milk in
varying concentrations; this may affect the
baby. However, the timing of nursing can
reduce the dose to which the infant is exposed.
Nursing can be a contraindication for few
drugs. If these drugs must be given,
breastfeeding should be discontinued until the
mother stops taking the drug.

11. What factors
determine the
amount of drug that
is absorbed in
breast milk.
 The amount of drug that appears in breast
milk depends on the plasma concentration of
the drug, lipid solubility, degree of ionization,
and binding to plasma proteins.

12. Can local
anesthetics with
vasoconstrictors be
given to lactating
women? Why or
why not?
 The local anesthetics and vasoconstrictors
used in dentistry can be safely administered to
the pregnant or nursing patient. The doses of
epinephrine used in local anesthetic
formulations for dentistry are so low that they
are unlikely to significantly affect blood flow.
The benefits of epinephrine at the
concentrations found in dental anesthetic
cartridges justify their use.

13. What would you tell
Mrs. Watson about
the use of a local
anesthetic with a
vasoconstrictor?
 Epinephrine enables us to give smaller
amounts of L.A. that will last longer in the area.
However, it can cross over into breast milk and
may cause hyperactivity or irritability in the
nursing baby. To avoid this, she should nurse
her baby prior to receiving the injection.
Another option is to express the milk to use for
later before her appointment and discard milk
for 24 hours after her treatment so no drug will
be given to the baby.

14. The most important thing I
learned:
If a drug is to be administered, the risk to the fetus must be
weighed against the benefit to the mother.