Dental Care for Pregnant Patients

Dental Care Considerations for Pregnant Patients

• Pregnant patients require special management considerations in dentistry to ensure the mother's health and the developing fetus's safety.
• Dental care must balance benefits with minimizing exposure to potentially harmful procedures, such as ionizing radiation and drug administration.

Physiological Changes During Pregnancy

• First trimester:
  • Fatigue with psychological impact
  • Syncope and postural hypotension
• Second trimester:
  • Relatively few symptoms
• Third trimester:
  • Increasing fatigue and discomfort
  • Mild depression
  • Cardiovascular changes:
    • 40-50% increase in blood volume
    • High-flow, low-resistance circulation
    • Tachycardia and heart murmurs
    • Cardiac output increases by 30-50%
    • Blood pressure falls (usually to ≤100/70 mm Hg) during the second trimester, with a modest increase in the last month of pregnancy
    • Benign systolic ejection murmur is common, disappears after delivery

Supine Hypotensive Syndrome

• Occurs in late pregnancy when the patient is in a supine position
• Causes an abrupt fall in blood pressure, bradycardia, sweating, nausea, weakness, and air hunger
• Resulting from impaired venous return to the heart due to compression of the inferior vena cava by the uterus
• Treatment: roll the patient over onto her left side, which lifts the uterus off the vena cava

Blood Changes

• Anemia: blood volume increases more rapidly than RBC mass (insufficient iron)
• Decreased hematocrit value
• Hypercoagulable state: increased coagulation factors, combined with venous stasis, leading to a risk of thromboembolism
• White blood cell (WBC) count increases progressively
• Immune system shifts from helper T-cell 1 (TH1) dominance to TH2 dominance, leading to immune suppression

Changes in Respiratory Function

• Elevation of the diaphragm, which decreases the volume of the lungs in the resting state
• Ventilatory changes: increased rate of respiration (tachypnea) and dyspnea, worsened by the supine position

Other Changes

• Increased appetite and craving for unusual foods (unbalanced diet)
• Weight gain
• Taste alterations and increased gag response
• Nausea and vomiting, or "morning sickness" (between 4 and 8 weeks)

Pattern of Fetal Development

• Normal pregnancy lasts 40 weeks
• First trimester: organs and systems are formed (organogenesis), susceptible to malformation
• After the first trimester: growth and maturation, malformation diminished, with the exception of the fetal dentition

Common Complications

• Infection
• Inflammatory response
• Glucose abnormalities
• Hypertension: endorgan damage or preeclampsia
• Insulin resistance contributing to gestational diabetes