Oral care in pregnancy: postponing treatment is riskier than carrying it out

The belief that dental treatment cannot be carried out during pregnancy is widespread among patients and occasionally among professionals, and it produces delays costing more than the risk they aim to avoid.

The positions of the major professional bodies agree: prevention, diagnosis and treatment of oral disease are safe in pregnancy and should be carried out.

Pregnancy gingivitis affects a substantial proportion of expectant mothers and has a precise hormonal basis. Rising progesterone increases vascular permeability and the inflammatory response to plaque.

The relevant point is that hormones amplify the response but do not create the problem: without plaque there is no gingivitis. This is why plaque control in pregnancy yields results disproportionate to the effort.

The pregnancy epulis is a benign lesion typically appearing in the second trimester, often interdental, bleeding and rapidly growing. It usually regresses after delivery.

The indication is observation and plaque control, unless the lesion interferes with chewing or bleeds substantially. Excision during pregnancy tends to recur.

The second trimester is the period of choice for deferrable procedures. The first involves organogenesis and greater nausea; in the third, prolonged supine positioning can compress the vena cava.

For this reason in the third trimester the patient is tilted onto the left side, or a wedge is placed under the right flank, and appointments are kept short.

Emergencies are not postponed in any trimester. An untreated odontogenic infection represents a greater risk than any correctly performed procedure.

Local anaesthetic with adrenaline at dental concentrations is considered safe, and articaine and lidocaine have the best documented profile. Avoiding anaesthesia leads to more painful and more stressful procedures, which is the opposite of the intended good.

Radiographs with adequate shielding involve negligible doses, and where needed for diagnosis they are taken. Deferring a necessary radiographic diagnosis for fear of a minimal dose is a poor trade.

Recurrent vomiting exposes enamel to gastric acid. The correct instruction is to rinse with water or a neutralising solution and not to brush for at least half an hour, so as not to abrade softened enamel.

In summary: dental care in pregnancy is safe and deferral is the real risk, pregnancy gingivitis is hormonal but plaque-dependent, the second trimester is preferable for deferrable procedures, and brushing does not follow vomiting immediately.