At a first trimester comprehensive exam for diagnosis and treatment planning:
Needed dental radiographs can be undertaken safely to diagnose disease processes that need immediate treatment at any time.
Follow ALARA (as low as reasonably achievable) principles; use lead aprons with thyroid collars to protect and reduce thyroid exposure to radiation during pregnancy which has been associated with low birth weight.
Although routine dental radiographs are recommended, radiographs such as full mouth series, panoramic and cephalometric radiographs may be postponed.
Treatment may be limited as a result of morning sickness during the first trimester.
The second trimester is an ideal time for routine general dentistry, since generally nausea has ceased, organogenesis is complete and the size of the uterus has not increased to the point that it is uncomfortable for the pregnant female to be treated in the dental chair.
During the third trimester lying back in the chair can be uncomfortable.
Past 20 weeks of gestation, wedge a towel or place a pillow under the right hip in the dental chair if the patient is to be placed in a flat supine position to move the uterus off the vena cava avoiding supine hypotensive syndrome.
Treatment may be impeded due to increased physical discomfort so keep appointments short.
Be aware of complications which may arise during dental procedures, i.e., syncope, enhanced gag reflex in the supine position, hypotensive syndrome, seizures, gestational hyperglycemia.
Complete restorations with permanent material, if possible, during pregnancy and prior to delivery.
Use rubber dam or a high speed ejector isolation system.
Use safe amalgam and composite practices.
Limit exposure to unpolymerized dental materials during pregnancy due to potential adverse developmental effects after prenatal exposure to BPA. Consider wiping composite restoration post curing with a wet cotton pellet to remove non-cured resin.
Counsel the patient concerning the harmful effects of tobacco, alcohol and recreational drugs.
Consult with the prenatal provider care provider when considering postponing treatment due to pregnancy morbid conditions (diabetes, hypertension or heparin treated thrombophilia) or when considering intravenous sedation, nitrous oxide or general anesthesia to complete the dental procedure.28