Elective restorative and periodontal therapies are best performed during the second trimester. However, emergency dental treatment for pain or dental infection should not be delayed during the first trimester or postponed until after delivery during the third trimester. When considering therapeutic agents for local anesthesia, infection, postoperative pain or sedation, the dental practitioner should evaluate the risks and benefits of the treatment to the pregnant patient and the fetus and discuss such issues with the patient.29 Patients should be explained the risks and benefits of amalgam fillings and alternative non-mercury containing restorations during treatment. Evidence is insufficient to support or refute that mercury exposure from dental amalgam contributes to deleterious effects for the fetus. Rubber dam and high speed suction should be used, especially during placement or removal of amalgam restorations to reduce the risk of vapor inhalation.30 Because of the release of bisphenol A (BPA) and accumulating evidence that BPA and some BPA derivatives can pose health risks attributable to their endocrine-disrupting, estrogenic properties, the use of composite restorations should be minimized during pregnancy. BPA is detectable in saliva for up to 3 hours after placement. Immediate removal of BPA is recommended after placement by having the patient gargle water for 30 seconds after placement or rubbing the restoration with pumice on a cotton ball or in a rotating rubber dental prophylaxis cup.31
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