II. Background
- Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
- Although FDA Pregnancy Categories are no longer listed, they are included here
- As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking
III. Risk Factors
- Hyperemesis Gravidarum (acid erodes teeth)
-
Tooth Decay and Dental Caries (worsen in pregnancy)
- Child's risk of Dental Caries increases if mother has Dental Caries
- Related to mutans Streptococci vertical transmission
- Xylitol or Chlorhexidine rinses lower that risk (Pregnancy Category B)
- Berkowitz (2003) J Calif Dent Assoc 31:135-8 [PubMed]
- Child's risk of Dental Caries increases if mother has Dental Caries
- Gingivitis (>50% of pregnancies)
-
Periodontitis (>30% of women of child bearing age)
- May result in recurrent bacteremia and an inflammatory cascade
- Has been linked to Preterm Labor and Intrauterine Growth Retardation
- References
IV. Symptoms
- Loose Teeth (due to high Estrogen and Progesterone levels in pregnancy)
V. Associated Conditions
VI. Management: Acute dental problems
- Safe Medications in Pregnancy (FDA pregnancy category B except where noted)
- Local Anesthetics
- Prilocaine
- Lidocaine
- Epinephrine (Pregnancy Category C)
- Antibiotics
- Penicillins or Cephalosporins
- Clindamycin
- Erythromycin (Base formulation only)
- Analgesics
- Acetaminophen
- Ibuprofen (avoid in third trimester)
- Oxycodone (avoid in third trimester)
- Local Anesthetics
- Agents to avoid in pregnancy
- Benzodiazepines
- Nitrous Oxide (unknown risk, use is controversial)
- Erythromycin Estolate
VII. Prevention
- See Oral Hygiene
- See Vomiting in Pregnancy for post-Vomiting dental care
- Identify and address pre-existing dental problems early (preconception is ideal)
- Continue routine dental care during pregnancy (second trimester is ideal)
- Maternal use of Xylitol or Chlorhexidine rinse lowers risk Dental Caries in children
- Safe in Pregnancy and Lactation (Pregnancy Category B)
- Soderling (2001) Caries Res 35: 173-77 [PubMed]