Oral Health Care for the Pregnant Adolescent

The AAPD recommends that all pregnant adolescents seek professional oral health care during the first trimester. After obtaining a thorough medical history, the dental professional should perform a comprehensive evaluation which includes a thorough dental history, dietary history, clinical examination, and caries risk assessment. The dental history should include discussion of preexisting oral conditions, current oral hygiene practices and preventive home care, previous radiographic exposures, and tobacco use. The adolescent’s dietary history should focus on exposures to carbohydrates, especially due to increased snacking, and acidic beverages/foods. During the clinical examination, the practitioner should pay particular attention to health status of the periodontal tissues. The AAPD’s caries-risk assessment guideline, utilizing historical and clinical findings, will aid the practitioner in identifying risk factors in order to develop an individualized preventive program. Improving the oral health of pregnant women reduces complications of dental diseases during pregnancy to both the mother and the developing fetus.
Based upon the historical indicators, clinical findings, and previous radiographic surveys, radiographs may be indicated. Because risk of carcinogenesis or fetal effects is very small but significant, radiographs should be obtained only when there is expectation that diagnostic yield (including the absence of pathology) will influence patient care. If dental treatment must be deferred until after delivery, radiographic assessment also should be deferred. All radiographic procedures should be conducted in accordance with radiation safety practices. These include optimizing the radiographic techniques, shielding the pelvic region and thyroid gland, and using the fastest imaging available.
Counseling for all pregnant patients should address: Preventive services must be a high priority for the adolescent pregnant patient. Ideally, a dental prophylaxis should be performed during the first trimester and again during the third trimester if oral home care is inadequate or periodontal conditions warrant professional care. Referral to a periodontist should be considered in the presence of progressive periodontal disease. While fluoridated dentifrice and professionallyapplied topical fluoride treatments can be effective caries preventive measures for the expectant adolescent, the AAPD does not support the use of prenatal fluoride supplements to benefit the fetus.
A pregnant adolescent experiencing morning sickness or gastroesophageal reflux should be instructed to rinse with a cup of water containing a teaspoon of sodium bicarbonate and to avoid tooth brushing for about one hour after vomiting to minimize dental erosion caused by stomach acid exposure. Women should be advised about the high sugar content and risk for caries associated with long term frequent use of over-the-counter antacids. Where there is established erosion, fluoride may be used to minimize hard tissue loss and control sensitivity. A daily neutral sodium fluoride mouth rinse or gel to combat enamel softening by acids and control pulpal sensitivity may be prescribed. A palliative approach to alleviate dry mouth may include increased water consumption or chewing sugarless gum to increase salivation.
Common invasive dental procedures may require certain precautions during pregnancy, particularly during the first trimester. Elective restorative and periodontal therapies should be performed during the second trimester. Dental treatment for a pregnant patient who is experiencing pain or infection should not be delayed until after delivery. When selecting therapeutic agents for local anesthesia, infection, postoperative pain, or sedation, the dentist must evaluate the potential benefits of the dental therapy versus the risks to the pregnant patient and the fetus. The practitioner should select the safest medication, limit the duration of the drug regimen, and minimize dosage. Healthcare providers should avoid the use of aspirin, aspirincontaining products, erythromycin estolate, and tetracycline in the pregnant patient. Non-steroidal anti-inflammatory drugs routinely are not recommended during pregnancy; if necessary, administration should be avoided during the first and third trimesters and be limited to 48 to 72 hours. Consultation with the prenatal medical provider should precede use of nitrous oxide/oxygen analgesia/anxiolysis during pregnancy. Nitrous oxide inhalation should be limited to cases where topical and local anesthetics alone are inadequate. Precautions must be taken to prevent hypoxia, hypotension, and aspiration.
Patients requiring restorative care should be counseled regarding the risk and benefits and alternatives to amalgam fillings. The dental practitioner should use rubber dam and high speed suction during the placement or removal of amalgam to reduce the risk of vapor inhalation.
Dental practitioners must be familiar with federal and state statutes that govern consent for care for a pregnant patient less than the age of majority. If a pregnant adolescent’s parents are unaware of the pregnancy, and state laws require parental consent for dental treatment, the practitioner should encourage the adolescent to inform them so appropriate informed consent for dental treatment can occur. The Health Insurance Portability and Accountability Act (HIPAA) specifically addresses minor confidentiality.