Pregnancy and dental care
IT IS OBVIOUS to anyone that adequate human resources are essential for national development, and consequently, it is appropriate to call for increased procreation within socio-economic and family planning norms. This is so especially in the case of underdeveloped and relatively under-populated countries like Guyana. In such a quest, it is important for the would-be mother to understand the clinical implications both for herself and her unborn child.
The pregnant state entails changes in the cardiovascular (heart and blood vessels), respiratory, urinary, haematologicic (blood) and gastrointestinal systems which may be influenced by dental treatment, since it (pregnancy) is an altered physiologic state.
During the first trimester (three months), for example, all drugs should be avoided unless the circumstances are exigent, as at this time, the foetal organs are forming. Distortion of this phase of development could produce a monstrosity.
The presence of vomitus (vomit) in the mouth during “morning sickness” or hyperemesis gravidarum, causes decalcification of the mineralised structure of the teeth from increased gastric acid production. This leads to caries.
To avoid this, it is recommended that following each act of vomiting, the mother-to-be should immediately rinse her mouth with a solution of baking soda mixed in water.
When a woman who is seven months pregnant sits in a dental chair, the reclined position forces the heavy uterus against the inferior vena cava (largest vein in the body), compressing it and decreasing the venous return.
The woman could then present with signs of shock (low blood pressure, rapid heartbeat, fainting etc). She should always sit upright or sideways.
If maternal oxygen reserve is significantly decreased, that would put the pregnant patient and foetus at risk for hypoxia. In other words, the foetus can suffocate in the absence of air even for a short period. In addition, there is risk of thrombo-embolism (blood clots forming in the legs as a result of decreased velocity of the venous flow and higher levels of blood Factors 7, 8, and 10).
The objectives of treatment planning with respect to the foetus are avoidance of foetal hypoxia (lack of oxygen) or premature labour and/or abortion, and of teratogens (drugs that can produce deformed babies). General anaesthetics were found to be associated with foetal death.
The drug thalodimide is best known to produce human ‘monsters’. Penicillin is safe, but ampicillim has been linked to diarrhoea and thrush in breastfed infants via the mother. Tetracycline produces yellow to brown discolouration of the teeth and bones, while Chlorophenicol is best avoided during late pregnancy and lactation (milk production), as this may kill the foetus.
Aspirin reportedly causes cleft lip and palate, growth retardation, and foetal death due to prostagnandin syntase (enzyme) inhibition, and Indocid has been related to non-growth of the penis and brain haemorrhage of the foetus.
There is no documented cases of ill effects of local anaesthetics used in normal amounts for extractions, etc.
No law would permit experimental procedures in humans using drugs. Many of the findings published are therefore gleaned from the work of researchers, authors and scientists.