Pregnancy and Women’s Oral Health Clinical Case #2

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Question 1 of 3

1. Question
Louella is a 34 year old G3P2 patient who recently found out she is pregnant. She presents today for her first prenatal visit at 6 weeks gestation. She has moderate morning sickness. As part of your review of systems you inquire about her mouth and teeth. She has had many cavities in the past, but currently feels everything is well. Her last dental visit was 8 months ago. Your exam shows she has several existing restorations, but no untreated cavities. She has mild, generalized gingivitis (see photo).

Judith Skelton, MEd, PhD

What advice should you give Louella about dental care?
- Brush and floss twice daily and see a dentist after delivery. While brushing and flossing is an important piece of advice, there is no need to delay dental care until after her pregnancy. In fact, both the American Dental Association and the American College of Obstetrics and Gynecology recommend pregnant patients see the dentist if has been more than 6 months since their last visit.
- Make an appointment to see the dentist as soon as possible.
- Wait until after the first trimester to schedule a dental visit. There are no contraindications to dental care during the first trimester of pregnancy. If Louella is suffering from morning sickness, she can make an appointment for the afternoon. If she is seen in the first trimester, this will allow her to be seen 6 months later during the third trimester before she gets very busy with the new baby. Under some state insurance plans women only have dental insurance coverage during pregnancy. Therefore, being seen early in the pregnancy allows more time for treatment if needed.
- Recommend starting systemic fluoride supplements given her past caries history, and advise her about twice daily brushing and flossing. Brushing and flossing twice a day are good advice. Systemic fluoride supplements are not recommended for pregnant women as they have not been shown to affect the caries outcomes of infants. Preventive agents that can be recommended include topical fluoride rinses and the use of xylitol gum as well as nutritional counseling to limit the intake of sugar containing snacks and drinks. In addition, she should be advised to make a dental visit as soon as possible.
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Question 2 of 3

2. Question
Louella calls the office two weeks later. Her morning sickness is considerably worse. She has been vomiting many times a day since she last saw you. She is also complaining of sensitivity of several of her teeth. She wants to know what she can do for her teeth while she is waiting to see the dentist next week.

Which of the following is good advice for Louella regarding her morning sickness?
- Louella should rinse her mouth after each vomiting episode with baking soda and water.
- Alcohol rinses may help improve tooth sensitivity that may develop if vomiting is severe enough to cause tooth erosion. Alcohol rinses do not help sensitivity. Patients who do develop sensitivity can receive treatment at the dental office, such as fluoride varnish, or can try a toothpaste specifically formulated for tooth sensitivity.
- Louella should brush her teeth vigorously after each vomiting episode to remove stomach acid from her teeth. Patients who have persistent vomiting should be advised to not vigorously brush their teeth after vomiting because the acid may already have weakened the enamel surface and the brushing may scrub the surface off, thus weakening the tooth. Better to rinse with baking soda and water to neutralize the acid first.
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Question 3 of 3

3. Question
Louella does go to see the dentist and you receive a follow-up phone call. Louella has a dental cavity. The dentist asks if it is safe to perform an x-ray. He is concerned that radiation might cause fetal anomalies. Further, if he finds a cavity he is unsure if it is safe to use lidocaine during pregnancy.

Which of the following is appropriate advice for the dentist regarding Louella’s dental cavity?
- A dental x-ray utilizing standard lead apron shielding is safe during pregnancy.
- Lidocaine should be avoided during pregnancy because it crosses the placental barrier. Lidocaine when used in appropriate doses with or without epinephrine for local anesthesia is safe during pregnancy.
- Amalgam is safe during pregnancy. The FDA in 2020 found that certain groups may be at greater risk for potential harmful health effects of mercury vapor released from the device. The FDA now recommends certain high-risk groups avoid getting dental amalgam whenever possible including pregnant women and their developing fetuses.
- It would be best to provide the patient with acetaminophen and simply observe the painful tooth if there is no sign of overt infection on oral examination. It is unacceptable to simply observe a painful tooth for any patient. Dental x-rays are safe during pregnancy and diagnosing a cavity is important as restorative treatment can prevent further complications including increased pain, infections, and the need for extraction.
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Pregnancy and Women’s Oral Health

Pregnancy and Women’s Oral Health Clinical Case #2

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