Pregnancy and dentistry: a guide for the general dental practitioner. Part 2

Providing dental treatment for a pregnant patient can be anxiety inducing for both the dentist and the patient. As with any dental treatment, the risks and benefits of all treatment options should be discussed comprehensively with the patient before proceeding.¹ Pregnancy should not be a contraindication for dental treatment, and there is no evidence to suggest that dental treatment is associated with any harm to the developing baby. However, the most critical stage of fetal development occurs in the first trimester and it would therefore be sensible to avoid elective treatment, if possible, until the second trimester. A pregnant woman may prefer, however, to delay elective treatment entirely until the baby is born. Any decision to delay treatment should be balanced against the risk of the woman developing pain and infection during pregnancy.

Patient positioning in the dental chair during the second and third trimesters is a key consideration. During these trimesters, women are advised not to lie supine on their backs as the weight of the developing baby and expanding uterus can partially occlude the inferior vena cava. Occlusion of this large vein will reduce venous return and subsequently, cardiac output. This may cause a reduction in blood flow to the fetus. Lying supine on the dental chair may also increase the risk of syncope when the patient stands up. This is due to hypotension secondary to decreased venous return in conjunction with any anxiety about dental treatment that the patient may be experiencing.