Dental Care Guide for Pregnant Patients.
What should you know…?

Before you have your dental appointment, always check with your obstetrician to see if they have any special precautions/instructions for you. As the dentist needs to take special considerations when using dental anesthesia during pregnancy and especially during lactation. The use of local anesthesia during pregnancy is considered safe, but even a minor miscalculation can lead to a major complication during pregnancy. 

The safety and risks for the mother and fetus must always be taken as the top priority and a strict protocol must be followed.

What should you tell your dentist, when you are pregnant…?

You should tell your dentist if you are pregnant.
Regular dental checkups can be safely done at any time during pregnancy.
All elective dental procedures should be postponed until after the delivery. 
Tell your dentist the names and dosages of all medication you are taking including pills and prenatal vitamins as well as any special precautions/instructions or medical advice your doctor has given you. Your dentist may need to alter your dental treatment plan based on this information.
Dental X-rays can be done during pregnancy. Your dentist will use extreme caution to safeguard you and the baby, such as covering your abdomen and thyroid. The recent advances in technology have made X-rays a lot safer than in the past.
Don’t skip a dental checkup appointment just because you are pregnant. In fact, it is more important during pregnancy to get your gums examined regularly, as periodontal exams are very important because pregnancy causes hormonal changes that put you at an increased risk of periodontal diseases and pregnancy gingivitis. 
Pay particular attention to your gums during pregnancy for any tenderness, bleeding or gum swelling that can occur at any time during your pregnancy, talk to your dentist as soon as possible in case if you see any of these symptoms.
Follow health oral practices to prevent any oral health problems.
 

Responsibilities of the Dentist in charge:

Proper aspiration needs to be done by the dentist to avoid intravenous injections, local anesthetics that may contain epinephrine or (adrenaline) are only safe to use during pregnancy as long as proper aspiration is done. The doctor is always required to maintain a case file for their patients, as this will help in avoiding or diagnosing any further complications.

Pre-administration Protocol for Dental Anesthesia:
Does the patient have Fever?
Has the patient ever received any Anesthetic treatment before? 
Is the patient Allergic to Anesthesia?
Does the patient have any kind of narcotic Addiction like alcoholism or smoking etc?
Is the patient Nervous about receiving dental treatment, if so why?
Does the patient have any Anxiety issues?
Has the patient been taking any medication or drugs for the past two years?
Does the patient have any allergic reactions to foods or medicine?
Does the patient have diabetes or any blood-related problems?
Does the patient have any infectious or sexually transmitted diseases?
Has the patient ever had any heart problems?
Does the patient have any type of implants, pacemaker, or metal rods?
Has the patient ever undergone surgery before?
Has the patient ever undergone any psychiatric treatment?
Is the patient Pregnant?
 

How do dental anesthesia and other drugs affect a pregnant patient…? 

The FDA has a drug classification system based on the safety and risks to pregnant women and their fetus. 

Five categories (A, B, C, D, and X.) with A being the safest and X being the riskiest.

FDA Classification of common Local Anesthetics used for dental care during Pregnancy. 

Lidocaine – B – Safest for Pregnancy.
Procaine – B – Risky, Highly Allergic
Articaine – C – Causes Vasoconstriction (“Tightening of blood vessels”)
Bupivacaine – C – Causes Vasoconstriction.
Mepivacaine – C – Causes Vasoconstriction
Benzocaine – C – Risky and Causes regurgitation
Lidocaine is the local anesthetic of choice in the treatment of pregnant women.

Procaine or (Novocaine) can cause depression, or allergies, and can react with fetus there for despite being classed as B should not be used in the case of pregnancy due to the risk of the fetus developing anemia. 

Mepivacaine, articaine, bupivacaine are given an FDA category C ranking and should be avoided or may be used with caution. 

Benzocaine increases the risk of pulmonary aspiration by relaxing the gag-reflex and causing food to regurgitate from the stomach through oral secretions and enter the airway, this is why it is ranked as category C and should be avoided. 

During lactation, local anesthesia without vasoconstriction should be considered, to avoid the possibility of idiosyncratic reactions to the fetus and the mother, caused by the preservative used to stabilize the vasoconstriction.

Epinephrine in high doses is harmful to a pregnant woman because it affects uterine blood flow. However, epinephrine causes vasoconstriction which in turn reduces the systemic distribution of the anesthetic as well as prolongs its action in addition to decreasing bleeding at the operating site, use in low doses with local anesthetic administration is warranted and safe.

In Case of an Allergic reaction:

If an allergic reaction to Local Anesthesia should occur, the patient should be treated as an emergency for anaphylaxis, according to the guidelines in the respective area of admission.

Anaphylaxis:

Anaphylaxis is a severe allergic reaction to some types of venom, food, or medication. in most cases, it is caused by a bee sting or eating foods that are known to cause allergies, such as peanuts or tree nuts. 

Symptoms;

Some of the symptoms are; rashes, low blood pressure, and shock, which is also known as anaphylactic shock.