Guidelines for treating the pregnant dental patient

pregnant womanWhat are the FDA Categories for pregnant and Lactating Patients?
Animal studies have not indicated fetal risk, and there are no human studies; or animal studies have shown a risk, but controlled human studies have not.

What are the FDA drug classes for Antibiotic commonly used in dentistry?
Class B: Penicillin, Erythromycin, clindamycin, cephalosporins, metronidazole,
Class D: tetracycline, quinolones

What are the FDA drug classes for analgesics?
Class B:
Ibuprofen (can be given in the first 32 weeks)
Acetaminophen, Oxycodone, Morphine, Fentanyl, Meperidine, Hydrocodone
Class C:
Codeine: associated with First trimester Malformations: can be used in the second or third trimesters, Aspirin: Associated with late-term intrauterine growth restriction

What are the FDA drug classes for common local anesthetics used in dentistry?
Category B: Lidocaine, Prilocaine, Etidocaine
Category C: Articaine, Bupivacaine, Mepivacaine

What level of x-ray radiation to a fetus will cause teratogenicity?
Diagnostic radiographs that deliver <0.05 to 0.1 Gy are not believed to be teratogenic.
CT scan irradiation delivers <0.01 Gy to the fetus.

What is the incidence of a teratogenic malformation from two Periapical radiographs on a properly shielded pregnant patient in her first trimester?
Nine in 1 Billion. Background radiation in the US is 0.0008 cGy daily. The exposure to two Periapical films is 700 times < the average background radiation in 1 day.

What are common radiation dosages for radiographic studies performed in dentistry?
(1cGy = 0.01 Gy = 1 rad; 0.001 rad = 1 mrad)
Full dental series <0.01 mrad ∙ Skull <0.01 mrad ∙ Cervical spine <0.01 mrad ∙ chest <0.06 mrad ∙ CT scan (head) 0.1-0.3 mrad

How should a pregnant patient be positioned for dentistry?
During the second and third trimester, a decrease in blood pressure can occur while the patient is in supine position. Position the patient in the left lateral decubitus position by placing the patient in a 5%-15% tilt during dentistry.

Is N²O contraindicated in pregnant patients?
Potential teratogenic effects of N²O are related to its ability to inactivate methionine synthase. Rowland, Baird, and Shore et al. looked at dental assistants who showed a higher level of spontaneous abortion when they were exposed for >3 hours/week.
Axelson, Ahlborg and Bodin et al showed that midwives who worked at night had a higher correlation of spontaneous abortion from heavy work and night hours than exposure to N²O.

What is the risk of using NSAIDs during pregnancy?
The PDA, which joins the fetal aorta to the pulmonary artery, begins to close at birth. After 32 weeks, its remaining open is dependent on fetal prostaglandins. Inhibiting these prostaglandins at this point may result in fetal death secondary to compromised fetal circulation.

What is the incidence of closure of the PDA following oral NSAID use?
There has never been a documented case of PDA closure following oral NSAID use; it is avoided for its theoretical and medicolegal ramifications.

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