Dental Treatment for the Pregnant Patient Atendimento Odontológico À Paciente Gestante

Ciência Odontológica Brasileira UNIVERSIDADE ESTADUAL PAULISTA “JÚLIO DE MESQUITA FILHO” Instituto de Ciência e Tecnologia Campus de São José dos Campos LITERATUR E REVIEW doi: 10.14295/bds.2014.v17i3.1004 Dental treatment for the pregnant patient Atendimento odontológico à paciente gestante Thalita Guarda FAGONI1, Rafaela Andrade de VASCONCELOS2, Paula Elaine CARDOSO2, Ana Paula Martins GOMES2, Carlos Henrique Ribeiro CAMARGO2, Simone Helena Ferreira GONÇALVES1 1 – Department of Bioscience and Oral Diagnosis – School of Dentistry – Institute of Science and Technology – UNESP – Univ Estadual Paulista – São José dos Campos – SP – Brazil. 2 – Department of Restorative Dentistry – School of Dentistry – Institute of Science and Technology – UNESP – Univ Estadual Paulista – São José dos Campos – SP – Brazil. ABSTRACT RESUMO Dental treatment of pregnant women should O tratamento odontológico da gestante deve ser be accomplished with safety. Consequently, the realizado com segurança, e para isto deve-se avaliar dental professional should evaluate its real need a real necessidade de sua execução e os riscos que and risks for the mother and child. This paper o mesmo poderá trazer para a mãe e para o bebê. reports through a literature review, the caution Este artigo relata, com base em uma revisão de with the clinical dental procedures commonly literatura, os cuidados com os procedimentos clínicos performed and possible risks of the therapeutic comumente realizados no consultório odontológico e agents used, allowing the dentist to evaluate the os possíveis riscos dos agentes terapêuticos utilizados, treatment and the drug to be administered to the permitindo ao clínico avaliar o tratamento e a droga pregnant women. a serem administrados às gestantes. KEYWORDS PALAVRAS-CHAVE Pregnant women; Dental treatment; Medicaments. Gravidez; Tratamento odontológico; Medicamentos INTRODUCTION Notwithstanding, many professional still are afraid of treating and many women fear about the negative consequences of the treatment to the baby [2]. ver the last decades, Dentistry has undergone O many changes especially regarding to The American Congress of Obstetricians and prevention practice. Aiming to promote health many Gynecologists and the American Academy of Pediatrics dental professionals early provide dental prevention advise the pregnant women to continue “dental to pregnant women. This is so-called Intrauterine treatment during pregnancy”, including toothbrushing Dentistry, which has commonly comprised a and flossing, programmed preventive prophylaxis and multidisciplinary team of dentists, obstetricians and any dental treatment requirement [3]. pediatricians. During pregnancy, dental procedures can be The obstetrician provides additional performed; however, additionally to the obstetrician information on the health state of the patient, but following-up, precautions ought to be made to assure the dentist is legally responsible by any dental the safe of both the pregnant woman and baby because therapeutic interventions or omissions [1]. Dental the former may show complications and alterations treatment should not be postponed or interrupted requiring special needs [4]. Dentists should encourage after pregnancy confirmation, but caution and that all women of reproductive age to seek guidance attention should be given during the treatment for on oral health as soon as they discover pregnancy. pregnant women. At pregnancy, the dentist ought The large amount of hormones induced by pregnancy to begin the prevention aiming to promote the provokes alterations in the mother’s body, and the oral comprehensive health of both mother and child. cavity is not an exception [5]. 3 Braz Dent Sci 2014 Jul/Sep;17(3) Fagoni TG et al. Dental treatment for the pregnant patient This literature review reports the caution with aggression; a greater number of miscarriages occur; the clinical dental procedures commonly performed and the pregnant woman is more prone to nausea. and possible risks of the therapeutic agents used, Morning sickness has been attributed to increase in allowing the dentist to evaluate the treatment and chorionic gonadotropin and hypoglycemia [9]. If the drug to be administered to the pregnant women. dental treatment is required, especially due to pain, it ought to be performed regardless of the pregnancy LITERATURE REVIEW trimester, because anxiety associated with acute pain may result in muscle contraction and possible Pregnancy x Dentistry bleeding [10]. Surely, dental professional must be aware of Most of obstetricians (94%) affirmed the special needs of pregnant women.Anesthesia, that treatment can be performed at any period, th nd radiographs and use of drugs will always be well preferably between the 16 and 32 weeks of indicated by evaluating the benefit-cost ratio, so pregnancy [1]. Morning appointments should be that borderline situations ought to be discussed avoided by pregnant women because of the higher with the obstetrician. Notwithstanding, regardless chance of nausea [5]. Barriers to receiving dental of either the pregnancy period or the health state of care during pregnancy include lack of knowledge the pregnant woman, it is important that they seek on the safeness and importance of dental treatment prevention of possible oral problems, at least every for the health of the mother and baby. Many women three months. are unaware that severe periodontal infection may put the baby at risk. Many do not seek restorative Despite of the potential benefits of dental or preventive care because of the same reason and care, relatively few women received dental treatment they do not know about the transmissible nature of during pregnancy [3]. Some women affirmed that it dental caries [6]. is normal to show poor oral health during pregnancy and believed some dental treatments are harmful to Dental treatment at first trimester the baby [6]. Since the pregnancy onset, the patient should In Brazil, despite of lack of nationwide studies, be instructed to seek the dentist aiming at prevention. regional researches demonstrated that untreated oral The dentist must begin the first appointment with problems are evident in pregnant women with low a comprehensive anamnesis. Routine preventive level of education and income. Additionally to its high procedures such as supragingival and subgingival cost, the access difficulties and cultural beliefs that scaling followed by prophylaxis can be normally dental treatment is harmful to the baby, jeopardize performed; however, elective treatment ought to be the search for dental care [1]. Dental care during avoided but not contraindicated. Still, it is important pregnancy should be encouraged as public health to instruct the patient on the importance of diet and measure aiming to the multidisciplinary approach oral hygiene to keep oral health and consequently among obstetricians, dentists and nurses [1]. general health of both the mother and the baby. Dental treatment Notwithstanding, there is a concern on preforming treatment during the first trimester. Whether dental treatment should or should First of all, the developing fetus is at higher risk of not be performed during pregnancy, it is fair to say teratogens during embryogenesis. Secondly, during that it can be performed at any pregnancy period, the first trimester, it is known that one at every five although the second and third trimesters are ideal pregnancies may result in spontaneous miscarriage. because of the greater stability, thus whenever Dental procedures executed just before a spontaneous possible choosing the former due to the small risk miscarriage can be considered as its cause, worrying of miscarriage or premature delivery and great both the patient and the dentist whether the disposition of the woman [7]. miscarriage could have been avoided [5]. At the first trimester of pregnancy, drugs and Dental treatment at the second trimester radiographs should be avoided because of fast embryo development [8]. At this period, the nerve cells of The dentist should follow-up the possible the embryo increase and multiply being sensitive to alterations in oral cavity and executes routine 4 Braz Dent Sci 2014 Jul/Sep;17(3) Fagoni TG et al. Dental treatment for the pregnant patient preventive procedures. Whenever necessary, treatment [8,9,11]. In these cases, it is necessary dental treatment may be performedrelatively safely to promote pain relief, because whenever present, it [8,11,12]. Diagnosis radiographs, periodontal favors the releasing of adrenalin and corticosteroids, treatment, restorations and extractions are safer increasing the metabolism and decreasing energy. and better accomplished during the second With the metabolism increasing, higher doses of trimester [10]. anesthetic drugs are required. In these situations, the minimum dose required for effective pain Dental treatment at the third trimester control is obviously advisable, thus 2% lidocaine At this period, the following routine procedures with epinephrine 1:100,000 (two cartridges- 3.6 ml) can be executed: prophylaxis, scaling, tooth polishing, with slow injeccion, may be the ideal local anesthetic and fluoride application. Curative dental treatments for a pregnant patient [9]. Intrapulpal anesthesia is must be postponed because at this phase, the required whether the aforementioned formula is not pregnant woman is very anxious due to the proximity enough to relieve pain. of the delivery and is very uncomfortable due to the belly volume. Commonly, the pregnant woman Oral hygiene experiences

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