II. Background

  1. Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
    1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
    2. Although FDA Pregnancy Categories are no longer listed, they are included here
      1. As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking

III. Risk Factors

  1. Hyperemesis Gravidarum (acid erodes teeth)
  2. Tooth Decay and Dental Caries (worsen in pregnancy)
    1. Child's risk of Dental Caries increases if mother has Dental Caries
      1. Related to mutans Streptococci vertical transmission
      2. Xylitol or Chlorhexidine rinses lower that risk (Pregnancy Category B)
      3. Berkowitz (2003) J Calif Dent Assoc 31:135-8 [PubMed]
  3. Gingivitis (>50% of pregnancies)
  4. Periodontitis (>30% of women of child bearing age)
    1. May result in recurrent bacteremia and an inflammatory cascade
    2. Has been linked to Preterm Labor and Intrauterine Growth Retardation
    3. References
      1. Boggess (2006) Matern Child Health J 10:S169-74 [PubMed]
      2. Clothier (2007) Best Pract Res Clin Obstet Gynaecol 21:451-66 [PubMed]
      3. Dortbudak (2005) J Clin Periodontol 32: 45-52 [PubMed]

IV. Symptoms

  1. Loose Teeth (due to high Estrogen and Progesterone levels in pregnancy)

VI. Management: Acute dental problems

  1. Safe Medications in Pregnancy (FDA pregnancy category B except where noted)
    1. Local Anesthetics
      1. Prilocaine
      2. Lidocaine
      3. Epinephrine (Pregnancy Category C)
    2. Antibiotics
      1. Penicillins or Cephalosporins
      2. Clindamycin
      3. Erythromycin (Base formulation only)
    3. Analgesics
      1. Acetaminophen
      2. Ibuprofen (avoid in third trimester)
      3. Oxycodone (avoid in third trimester)
  2. Agents to avoid in pregnancy
    1. Benzodiazepines
    2. Nitrous Oxide (unknown risk, use is controversial)
    3. Erythromycin Estolate

VII. Prevention

  1. See Oral Hygiene
  2. See Vomiting in Pregnancy for post-Vomiting dental care
  3. Identify and address pre-existing dental problems early (preconception is ideal)
  4. Continue routine dental care during pregnancy (second trimester is ideal)
  5. Maternal use of Xylitol or Chlorhexidine rinse lowers risk Dental Caries in children
    1. Safe in Pregnancy and Lactation (Pregnancy Category B)
    2. Soderling (2001) Caries Res 35: 173-77 [PubMed]

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