The particular treatment situation
Do you know that? A pregnant patient is sitting in her treatment chair and is in pain. Even before you've pinpointed the cause, the questions start rolling in your head: Which antibiotic is safe? Local anesthesia with or without addition of adrenaline? And how was that again with the X-ray?
At such moments, many clinicians find themselves weighing up whether they should not rather refer the patient to a hospital. But with the right knowledge, you can treat pregnant patients safely and confidently.
Optimum treatment times and storage
The second trimester (14—27 weeks of pregnancy) is considered an ideal period for dental procedures. At this point, early organ development has already been completed, and the mechanical restrictions of the late third trimester do not yet exist.
Correct storage is particularly important when treating pregnant patients:
- Avoid prolonged treatments in a supine position
- Do you prefer a light left-sided position
- From the late 2nd trimester, you can put pillows under your right hip to reduce vena cava pressure
- If the patient feels unwell, immediately allow the patient to sit upright
Why the left-hand side position? In a supine position, the pregnant uterus can press on the inferior vena cava and thus trigger vena cava compression syndrome. This can lead to circulatory problems and discomfort.
Imaging diagnostics during pregnancy
“Am I even allowed to do an X-ray during pregnancy?” Many doctors are concerned with this question. The DGZMK remains remarkably vague in its 1992 statement: “In the case of an existing pregnancy, every possible way of reducing the radiation exposure of the fruit must be exploited. Unnecessary recordings must be avoided” (Sitzmann, 1992).
Such a statement creates more uncertainty than clarity. A look at the actual radiation levels helps to correctly classify the situation:
Here are the most important comparative values:
- Tooth film: approx. 5—10 µSv
- OPG: approx. 20-30 µSv
- DVT: approx. 40-200 µSv
- Long-haul flight: approx. 30—60 µSV
- Natural background radiation/year: approx. 2000-3000 µSv
A single film of teeth therefore only corresponds to about 1/400 of the natural annual radiation exposure! This classification not only helps you as a practitioner, but is also an important educational tool for your patients.
Pregnant women are part of everyday practice, and with this clear set of facts, you can alleviate their fear of the need for X-ray diagnostics. Of course, the principle of only taking medically necessary images still applies - but this applies to all patients, not just pregnant women.
Practical tips for X-ray diagnostics:
- Prefer single-tooth films instead of panoramic shots
- Use X-ray protection
- Document medical necessity
- Educate the patient about the minimal radiation exposure
Drug therapy: What you need to consider
Drug treatment for pregnant women appears complex at first. Let's focus on the most important and safe drugs for dental treatment:
1. analgesics
🟢 Paracetamol (acetaminophen)
(At the lowest effective dose and used for a short time)
2nd antibiotics
🟢 Amoxicillin (with or without clavulanic acid)
3rd local anesthetics
🟢 Articaine (with adrenaline max. 1:200,000)
How embryotox.de rightly states: “There is no 100% certainty about any medication.” But this statement shouldn't paralyze us — after all, it applies to all patients, not just pregnant women. You are on the safe side with the medications mentioned above.
Good to know:
- Ibuprofen: only up to the 28th week of pregnancy
- Doxycycline: Contraindicated in particular in T2-3 due to risks of tooth discoloration and growth disorders in the fetus
Commonly used topical preparations:
Antiseptics and fluorides
🟢 Chlorhexidine: Safe throughout pregnancy as there is little systemic absorption
🟡 Duraphate (sodium fluoride): Topical fluoride application is considered safe, minimal systemic uptake. Caution: contains alcohol
🟡 Elmex jelly (amine fluoride, sodium fluoride): Topical use safe, but as with Duraphat, the research situation is unclear
Preparations containing corticoids
🟡 Dontisolone (Prednisolone): Local use is considered safe. Systemic absorption low but not completely ruled out
🟡 Volon A (triamcinolone acetonide): Low absorption when used topically. Use sparingly
🔴 Leather mix (demeclocycline + triamcinolone acetonide): Contraindicated throughout pregnancy due to the tetracycline antibiotic contained
Mouth mucosal changes during pregnancy
In addition to the general treatment features, you should also pay attention to pregnancy-related changes in the oral mucosa:
- Pregnancy gingivitis (gingivitis gravidarum): The increase in estrogen often leads to an increased tendency of the gums to become inflamed. Regular professional dental cleanings and intensive oral hygiene instructions are particularly important here.
- Epulis gravidarum: This benign granuloma occurs in around five percent of pregnant women, usually in the front area of the upper jaw. It usually regresses spontaneously after birth. Surgical removal is only necessary for severe symptoms or bleeding.
Both changes can be worrying for patients. Explain the hormonal causes to them and emphasize that these are temporary, benign phenomena.
Special treatment situations
Emergency treatment and pain management
In case of acute pain or infection, you should not hesitate to treat. An untreated dentogenic abscess is more dangerous for mother and baby than well-planned treatment.
preeclampsia
⚠️ IMPORTANT: For blood pressure levels > 140/90 mmHg, elective treatments should be postponed. There is a risk of a hypertensive situation (= preeclampsia). In such cases, consultation with the treating gynecologist is useful.
Conclusion: How to treat pregnant patients safely and confidently
Pregnant patients are part of everyday practice. With the right knowledge, you can treat them safely and confidently. The most important points summarized:
- The best time for treatment is the 2nd trimester
- X-ray possible if medically necessary
- Using proven drugs in a targeted manner
- Make sure that it is stored correctly
- Care should be taken if blood pressure is >140/90 mmHg
- Regular prophylaxis is particularly important
With these principles and an attentive eye for the special needs of pregnant patients, nothing stands in the way of successful treatment.
