The mother’s oral health during pregnancy is related closely to the oral health of her newborn. Bad oral hygiene in pregnancy has been associated with various adverse effects, such as premature delivery, intrauterine growth restriction, gestational diabetes, and preeclampsia. Most professional authorities strongly advise pregnant women to continue their usual dental care during pregnancy. Various dental therapeutic aspects raise concern among pregnant women, such as the use of local anesthetics and radiography. However dental treatment of oral conditions is safe during pregnancy and must be managed at any time during this period. 
CARIES MANAGEMENT 
Dental caries is a prevalent chronic disease among adults of reproductive age. About 82% of 20-to-34-year-old and 94% of 35-to-49-year-old US adults had caries experience during 2011 to 2012, and about 27% of them had untreated caries. Changes in diet and oral hygiene practices and morning sickness or esophageal reflux during pregnancy can lead to tooth demineralization and thus an increase in maternal caries risk if appropriate interventions are not provided. It has been documented that cariogenic microorganisms are often transmitted from intimate caregivers, usually mothers, to children. It is essential therefore to promote maternal oral health during pregnancy through a dental home and risk-based oral health interventions. 
 
Dental treatments, such as preventive, diagnostic, and restorative services, during pregnancy have not been associated with perinatal complications or medical adverse event. The consequences of not treating an active disease process and infection during pregnancy outweigh the possible risk presented by most of the medications required for dental care. 
Hagai, Diav-Citrin, Shechtman and Ornoy performed a prospective, comparative observational study at the Israeli Teratology Information Services followed 210 pregnancies exposed to dental local anesthetics (112 [53%] in the first trimester) and compared them with 794 pregnancies not exposed to teratogens. between 1999 and 2005. the women were exposed to various dental procedures The most common dental procedure during pregnancy was endodontic treatment (43%) followed by tooth extraction (31%) and and restorations (21%). The rate of major anomalies was not significantly different between the groups.300). There was no difference in the rate of miscarriages, gestational age at delivery, or birth weight. This study’s results suggest that dental treatment during pregnancy, do not represent a major teratogenic risk. 
 
PERIODONTAL DISEASE 
Although the causes of adverse pregnancy outcomes are not well understood, bacterial infection and elevated levels of local and systemic markers of inflammation are linked to various pregnancy complications including preterm delivery. Periodontitis is an infectious disease caused mainly by anaerobic gram-negative bacteria, which can induce a variety of inflammatory mediators, such as prostaglandins, interleukins, and tumor necrosis factor. Because of hormonal and physioimmunologic changes many pregnant women experience progression of periodontal inflammation with increased vascular permeability, which can potentiate translocation of periodontal pathogens and/or their by-products to the fetal placenta unit or trigger systemic inflammatory responses via the blood circulation. 
 
Accumulated scientific evidence indicates that periodontal treatment during pregnancy, consisting of subgingival scaling and root planing, has no significant effect on preterm birth or birth weight, whereas the association of periodontitis and adverse birth outcomes and the effect of periodontal treatment may be greater among high-risk populations. 
 
FDA PREGNANCY RISK FACTORS CLASSIFICATION 
In pregnancy, it is assumed that all drugs can cross the placenta and thus affect the developing fetus.15 During the first 90 days (first trimester), organogenesis occurs and thus the fetus is most susceptible to teratogenesis. Therefore, avoiding medications during this time is desirable, although not always possible. Similarly, the approach of not prescribing any drugs to the pregnant patient carries its own risks. To determine the risks associated with the use of drugs in pregnancy, the United States Food and Drug Administration (FDA) has classified drugs based on the level of risks they pose to the fetus.  
 
Category A and B: are considered safe as no adverse effects have been shown in humans.  
Category C: are ones in which adverse effects on the fetus have been shown in some animal studies, but there are no adequate and well-controlled studies in humans. In this category drugs may still be used if the benefits outweigh the risks.  
Category D: should be avoided as some studies demonstrated clear teratogenic effects in humans. 
USE OF LOCAL ANAESTHETICS 
Lidocaine appears to be safe in the pregnant patient, with few reported findings of anomalies. One should note that local anesthetic agents exhibit a more rapid onset and longer duration during pregnancy. Local anaesthetics administered with adrenaline are considered safe during pregnancy; this is assuming that careful aspiration is carried out to minimise the potential risk of intravascular injection. Lignocaine and prilocaine are given a FDA category B ranking and, thus, may be considered the safest local anaesthetics to give to a pregnant patient. Of these two agents, lignocaine may be considered ideal because of its lower concentration (2%) compared to prilocaine (4%), with the result of less drug being administered per injection. Mepivacaine, articaine and bupivacaine are given an FDA category C, making them a less favourable choice during pregnancy. Among topical preparations benzocainemust be used with precautions because it is ranked as C by the FDA. 
Taken from Ouanounou a. Haas. A. (British Dental Journal 2016). 
Taken from Ouanounou a. Haas. A. (British Dental Journal 2016). 
ANALGESICS 
A pregnant patient should not have to suffer from dentally-related pain. if symptomatic relief is needed, an analgesic should be given as an adjunctive measure. In general, if used properly, the analgesics used commonly in dental practice are safe. The most common analgesic prescribed during pregnancy is paracetamol which has an FDA rating of B. However, recent studies demonstrated that taking paracetamol during pregnancy may increase the future risk of attention deficit hyperactivity disorder (ADHD) in the newborn. 500–1000 mg every four hours to a maximum of four grams per day is considered safe in the pregnant patient. 
 
The nonsteroidal anti-inflammatory drugs (NSAIDs) even thought are very advantageous in dentistry, their application during pregnancy is less favourable. Ibuprofen is given a Category B ranking in the first and second trimesters; however, in the third trimester it is given category D and thus should not be prescribed during that time. 
This is because it has been shown that the use of NSAIDs late in pregnancy may prolong the length of the pregnancy through ineffective contractions during labour.In some cases, where pain is moderate to severe and cannot be managed with paracetamol alone. trimesters), opioids can be given. In this category, commonly prescribed drugs include codeine and oxycodone, usually given in combination with paracetamol or acetylsalicylic acid (ASA). Oxycodone is the safest as it has a category B ranking, whereas codeine has a category C ranking since its use has been reported to cause increased risk of congenital malformations including cleft lip and palate and other cardiac and circulatory malformations. 
ANTIMICROBIALS 
As a general rule, antimicrobials used in the dental practice are safe during pregnancy. In general, it should be noted that antibiotics are not asubstitute to incision and drainage and thus, if a patient presents with an infection, the first line of treatment should be drainage of the infected site. If, however, the patient presents with extensive swelling and/or other systemic involvement (for example, fever) an antibiotic should be prescribed. Specifically, penicillin and amoxicillin are category B drugs and thus can be prescribed safely. If a patient is allergic to penicillin, clindamycin can be given as it is also in category B. Erythromycin is given category B ranking, nonetheless, it is no longer considered a preferred alternative and is best avoided. 
 
BIBLIOGRAPHICAL REFERENCES 
Ouanounou a. Haas. A. Drug therapy during pregnancy: implications for dental practice. BRITISH DENTAL JOURNAL VOLUME 220 NO. 8 APR 22 2016. 
Lawrenz D. Whitley B. Helfrick J. Considerations in the Management of Maxillofacial Infections in the Pregnant Patient. J Oral Maxillofac Surg 54:474-485, 1996. 
Lida H. Oral Health Interventions During Pregnancy. Dent Clin N Am 61 (2017) 467–481. 
Aharon H. Orna D. Svetlana S. Asher O. journal of the American Dental Association. August 2015, 572-580. 
Taken from Ouanounou a. Haas. A. (British Dental Journal 2016). 
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