ESPECIALLY in developing countries such as Guyana, it is obvious that adequate human resources are essential for national development and consequently it is appropriate to call for increased procreation within socioeconomic and family planning norms.

In such a quest it is important for the would-be mothers to understand the clinical implications both for herself and her unborn child. The pregnant state entails changes in the cardiovascular (heart and blood vessels), the respiratory, the urinary, the haematologic (blood) and gastrointestinal systems which may be influenced by dental treatment.

Pregnancy is an altered physiologic state. During the first trimester (3 months) all drugs should be avoided unless the circumstances is exigent since at this time the foetal organs are forming. Distortion of this phase of development could end up with birth defects.

The presence of vomitus in the mouth during “morning sickness” or hyperemesis gravidarum, causes decalcification of the mineralised structure of the teeth from increased gastric acid production. So, women who vomit with unusual frequency will be prone to tooth decay unless preventive measures are taken.

When a woman who is seven months pregnant sits in a dental chair, the recline 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 the signs of shock (low blood pressure, rapid heartbeat, fainting etc.)

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 the 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 foetal 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 thalidomide is best known to contribute to birth defects. Penicillin is safe but ampicillin has been linked to diarrhoea and trush in breast-fed infants via the mother. Tetracycline produces yellow to brown discolouration of the teeth and bones. Chlorophenicol is best avoided during late pregnancy and lactation (milk production) as this may kill the foetus.

Aspirin is reported to have caused cleft lip and palate, growth retardation and foetal death due to prostagnandin syntase (enzyme) inhibition. Indocid has been related to non-growth of the penis and brain haemorrhage of the foetus.
There are 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.