Let your dentist know you are pregnant. Postpone non-emergency dental work until the second trimester or after delivery, if possible. Elective procedures should be postponed until after the delivery.
Take a pillow to help keep you and the baby more comfortable. Bring headphones and some favorite music. Want to Know More? Can I get pregnant if…? Share this post:. Share on facebook Facebook. Share on twitter Twitter. Share on linkedin LinkedIn. Share on email Email. Similar Post. Pregnancy Health and Wellness.
Your dentist will also make sure your baby is shielded from the radiation by using a lead apron and thyroid guard. Although x-rays are safe, your dentist may still recommend avoiding them during the first trimester if you're only having a routine check-up. But if you have a dental emergency or a severe, non-specific pain, x-rays could still be needed to help your dentist plan your treatment effectively.
If you need to have a dental procedure while pregnant, anaesthetic can still be used safely to help you relax and numb the pain. It's essential that you inform your dentist about your pregnancy so they can choose suitable anaesthetics and set appropriate levels. Your dentist will use the lowest concentration of anaesthesia possible for the type of procedure being carried out but still enough to help you feel relaxed.
When you feel comfortable, your body and your baby will be placed under less stress. Extractions are a last resort for dentists, who will always try to save your tooth if possible. But if your tooth is too badly damaged by decay or injury to be repaired, it could put your oral health at risk and should be removed.
Extractions can be performed any time during pregnancy, but your dentist may recommend the second trimester as the ideal time. This helps you avoid having x-rays in the first trimester when your baby is first developing, as well as the discomfort of having to lie on your back for prolonged periods during the third trimester.
If tooth decay reaches the inside of your tooth where the nerve endings are, this can be extremely painful. Root canal treatment can stop the pain by removing the infected tissue and restoring the tooth with a natural-looking crown, so the tooth would not need to be extracted.
If you have a dental emergency, a root canal can be performed at any stage of pregnancy and shouldn't be delayed. However, because x-rays are involved, the ideal time for dental surgery is during the second trimester. Teeth whitening can be performed while you're pregnant, but your dentist may recommend waiting until after the birth for most non-emergency dental treatments.
Essentially, maternally administered drugs can be transferred from the mother to the fetus and affect the fetus. Although the method of transfer varies, most drugs enter the systemic circulation of the fetus via passive diffusion. Some drugs are transferred to the fetus through various active transporters on the placenta. Drug exchange also occurs via facilitated diffusion, phagocytosis, and pinocytosis [ 17 ].
Passive diffusion is most common type of drug transfer from the mother to the fetus. Drugs are transferred according to a concentration gradient, and no energy is required for the transfer. The amount of drug transferred per unit time is determined by the concentration of the drug in the mother's circulation and the placental properties that affect the drug transfer. Drugs are transferred through the syncytiotrophoblast layer, or via water channels [ 18 ].
Passive diffusion is an important mechanism of drug transfer for drugs that have low molecular weights, have high lipophilicity, and are in unionized forms. Structurally, the placenta consists of lipid bilayers and thus lipophilic drugs that are not bound to proteins can freely diffuse across the placenta [ 19 ]. Drugs that use passive diffusion are known to follow Fick's law of diffusion.
Diffusion rates, which depend on time, are directly proportional to the surface area of the placenta and the concentration gradient, and inversely proportional to the membrane thickness. Facilitated diffusion requires carrier substances within the placenta. Facilitated diffusion does not require energy, similar to passive transfer.
Carrier-mediated transport systems for cephalosporin, cephalexin, and glucocorticoids have been reported [ 20 , 21 ]. However, drug transfer using facilitated diffusion is rare. Facilitated diffusion is largely used for transfer of endogenous compounds to the fetus to meet its functional metabolic demands [ 22 ]. In active transport, drugs are transferred via protein pumps in the placental membrane. This transfer mechanism requires energy released from adenosine triphosphate ATP hydrolysis.
Energy generated by an electrochemical gradient resulting from the transmembrane movement of ions may also be used. Carriers are required for drug transfer. Carriers may become saturated, but competitive inhibition by similar compounds does not occur. Active transporters exist in both the mother and the fetus. Drugs are transferred across the syncytiotrophoblast. Drugs administered to the mother are transferred to the fetus through the placenta, although the extent of transfer varies.
The effects of transferred drugs on the fetus can vary depending on the drug type and the fetal general conditions. Local anesthetics are the most commonly used types of drugs in dental treatment. Pregnant women are prone to develop dental diseases. Therefore, understanding the effects of local anesthetics on the fetus is crucial for performing safe and effective dental treatments in pregnant women.
Moshira et al. Similar patterns of toxic effects were observed in both groups when the concentration of local analgesic was greater than the toxic concentration [ 23 ]. Unlike what had been expected, the toxic effects of the local anesthetics were not more prominently expressed in the neonatal lamb than in the adult sheep. The volume of distribution of drugs is high in fetuses as fetuses have a large distribution of blood vessels, and this may be why fetuses have reduced sensitivity to toxic effects of drugs.
On the other hand, sensitivity to neurologic and cardiovascular toxicity of local anesthetics is increased in fetuses with asphyxia. Binding of local anesthetics to proteins is reduced in a fetus with asphyxia compared to a healthy fetus, and lidocaine becomes trapped as a result of tissue acidosis [ 24 ]. Local anesthetics must be used with caution for fetuses at high risk of asphyxia or with poor general conditions since they are likely to experience side effects from local anesthetics.
The severity of the effects of a local anesthetic on a fetus is determined by the amount of local anesthetic delivered across the placenta. The amount of local anesthetic delivered during local anesthesia is determined not only by the amount of local anesthetic administered, but also the method of administration, whether vasoconstrictors have been used, the metabolic rate and half-life of the local anesthetic in the mother, the extent of fetal and maternal protein binding, and the pKa acid dissociation constant of the local anesthetic [ 25 ].
Local anesthetics can be classified as two types: ester or amide. Ester-type local anesthetics are hydrolyzed by esterase in the plasma and have a shorter duration of action than the amide-types. Ester-types are rapidly hydrolyzed in the mother's plasma, and thus have few effects on the fetus. Allergic reactions caused by local anesthetics can pose a danger for both the mother and the fetus, and ester-types are more likely to induce these allergic reactions.
In comparison, the likelihood of amide-type local anesthetics inducing allergic reactions is very low. Amide-type local anesthetics, which are widely used clinically, exert different kinds of effects depending on their type. The amount of amide-type anesthetic delivered to a fetus is largely affected by the extent of maternal protein binding. Only free compounds that do not bind proteins are transferred to the fetus through the placenta.
Therefore, the fetal-to-maternal ratio of a local anesthetic is determined by the extent of protein binding of the local anesthetic. Among the amide types, bupivacaine is known to have the lowest fetal-to-maternal ratio [ 26 ]. Theoretically, bupivacaine should have the smallest effects on the fetus among all amide types.
For this reason, bupivacaine is widely used as a local anesthetic in the field of obstetrics. However, at toxic levels, bupivacaine inhibits cardiac conduction, which leads to cardiac arrest with low chances of survival. For this reason, high-concentration bupivacaine is currently not used to induce local anesthesia in dental treatment. Lidocaine is the most commonly used local anesthetic in a dental cartridge.
The extent of protein binding of lidocaine is smaller than that of bupivacaine. The proportion of free lidocaine is relatively high, so the amount of lidocaine transferred from the mother to the fetus is also relatively high. As a result, lidocaine has a relatively high fetal-to-maternal ratio [ 26 ]. Vasoconstrictors are added to lidocaine to reduce the absorption of the local anesthetic, reduce toxicity, and increase the analgesic effects.
Epinephrine is commonly added to lidocaine contained in a dental cartridge as a vasoconstrictor. Vasoconstriction induced by epinephrine delays the absorption of local anesthetics by the mother, allowing the absorption of lidocaine to gradually occur in the maternal systemic circulation, while also allowing blood levels of lidocaine to gradually increase.
The local anesthetic is transferred to the fetus slowly, and its margin of safety is also increased. Considering how local anesthetics have small direct effects on the fetus even at submaximal doses [ 27 ], lidocaine may be considered relatively safe for use in pregnant women.
However, epinephrine can reduce blood flow within the uterus to an extent that is proportional to its dose and reduce uterine contractile force [ 28 ]. The Food and Drug Administration FDA has proposed a classification system that classifies drugs according to their risk [ 29 ] Table 1.
Drugs under categories A and B are considered to pose no danger to humans. Categories A and B differ by whether the drug has been tested in human subjects or not. Drugs whose teratogenic risk cannot be eliminated are classified under category C. Category D includes drugs with positive evidence of human fetal risk.
Drugs in category X are not recommended for use by pregnant women. The FDA categories and maximal dose of local anesthetics are presented in Table 2 [ 26 , 30 ]. Toxic concentrations of local anesthetics are similar between the fetus and the mother, and the toxicity of drugs is equipotent in the fetus and the mother. When using local anesthetics in pregnant women, the effects of the local anesthetics on the mother and the fetus must be considered, and the drug dose must be determined carefully.
The mother and the fetus undergo different changes as pregnancy progresses. Following the implantation of a fertilized egg on the uterine wall, the fetus undergoes various stages of development as gestational age increases. Organs develop in the early pregnancy period, and the formed organs and tissues undergo volumetric growth in the middle and late stages of pregnancy [ 31 ].
Therefore, an identical drug may have different effects on the fetus and the mother depending on gestational age. Understanding the difference in the potential effects of a maternally administered drug according to gestational age will allow local anesthetics to be safely used in dental treatments associated with pregnancy.
Starting from 1 month after fertilization, a closed neural tube, a beating heart, and blood cells form. The embryonic stage is the period until 10 weeks after implantation, and the first trimester is the period until 13 weeks after implantation. During this period, the development of the most important structures is complete, limbs form, and the fetus starts to move. Important structures formed during this period undergo further growth throughout the pregnancy period, and the likelihood of an organ deformity developing after this period is relatively low.
A fetus may develop a birth defect when exposed to chemicals that can induce mutations in the process of cell growth and chromosome proliferation. Organogenesis is actively underway during weeks gestational age , so teratogenic effects may appear upon fetal exposure to drugs during this period.
Removing or replacing existing fillings that contain mercury and are in good condition isn't recommended, however, unless medically necessary. The removal process might cause a temporary increase in exposure to mercury vapor.
If you have questions or concerns about dental care during pregnancy, talk to your health care provider. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. A single copy of these materials may be reprinted for noncommercial personal use only. This site complies with the HONcode standard for trustworthy health information: verify here.
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