A teratogen is a drug or chemical that induces alterations in the formation of cells, tissues and organs and thus creating physical defects in a developing embryo or foetus.
Drug induced changes can occur only during organogenesis; however, drug induced toxicologic changes affect the foetus after completion of tissue or organ formation because these drugs induce degenerative changes in formed tissue or organs.
To be safe, drugs that are known to be innocuous to the embryo or foetus should be used in the dental management of pregnant women. Drugs with unknown teratogenic potential should be prescribed only after consultation with the patients gynaecologist. Drugs with known teratogenic effects should not be used during dental procedure.
|A||No risk demonstrated to the foetus in any trimester.|
|B||No adverse effects.|
|C||Only given after the risk to the foetus are considered.|
|D||Definite foetal risk; may be given in spite of risks if needed in the life threatening situations.|
|X||Absolute Foetal abnormalities; not to be used at any time during pregnancy.|
Oral health is important during pregnancy and should not be neglected. The rise in hormone levels during pregnancy causes the gums to swell, bleed and trap food causing increased gum irritation. Preventive dental work is essential to avoid oral infections such as gum disease, which has been linked to pre-term birth.
Foetal organ development occurs during the first trimester; it is best to avoid all potential risks at this time if possible. During pregnancy, avoid elective dental treatment, such as routine dental X-rays and whitening of teeth and bonding, especially during the first trimester. However, if dental pain is experienced, emergency treatment and minimal emergency X-rays should be completed immediately with consultation between dentist and obstetrician. If non-emergency dental work is needed during the third trimester, it is usually postponed until after the birth. This is to avoid the risk of premature labour.
|Asthma||Budesonide inhaled or nasal spray|
|Bladder infection (UTI)||Nitrofurantoin - Avoid in patients with possible G6PD deficiency|
|Constipation||Docusate, Milk of magnesia, Polyethyelene glycol|
|Diabetes||Insulin, Glyburide, Metformin|
|Gastroesophageal reflux disease (GERD)||Ranitidine, Cimetidine|
|Hayfever, sneezing, runny nose, itchy watery eyes||Chlorpheniramine, Diphenhydramine|
|Headache or fever||Acetaminophen, Paracetamol|
|Hemorrhoids||Tucks, Preparation H, Anusol|
|High blood pressure||Methyldopa|
|Hyperprolactinemia||Bromocriptine , Carbergoline|
|Hypothyroidism||Thyroid hormone, Levothyroxine|
|Infection||Acyclovir , Azthitromycin, Cepaholosporins (examples: Cephalexin, Cefazolin, Cefaclor, Clindamycin), Erythromycin, Penicillins (example: Amoxicillin, Clavulanate, Methicillin, Carbenicillin), Metronidazole.|
|Nasal congestion||Pseudoephedrine- avoid in first trimester.|
|Nasal congestion, sneezing, runny nose, itchy watery eyes||Triprolidine, Pseudoephedrine- avoid in first trimester.|
|Nasal congestion, sneezing, runny nose, itchy watery eyes, fever and headache||Acetaminophen, Chlorpheniramine, Pseudoephedrine- avoid in first trimester.|
|Nausea||Ginger Pyridoxine 25 mg PO TID with Doxylamine Succinate 25 mg 1/2 tablet TID, Metoclopramide|
|Vaginal yeast infection||Clotrimazole cream|
|Condition||Recommended agents||Alternative agents||Use with caution|
|Allergic rhinitis||Beclomethasone, Fluticasone, Cromolyn (Nasalcrom)||Cetirizine, Loratadine, Sedating antihistamines, Decongestants|
|Cardiovascular||Hydrochlorothiazide, Metoprolol, Tartrate, Propranolol, Labetalol||Nifedipine, Verapamil, Hydralazine, Captopril, Enalapril||Atenolol, Nadolol, Sotalol, Diltiazem|
|Depression||Sertraline, Paroxetine||Nortriptyline, Desipramine||Fluoxetine|
|Diabetes||Insulin, Glyburide, Glipizide, Tolbutamide||Acarbose||Metformin, Thiazolinediones|
|Epilepsy||Phenytoin, Carbamazepine||Ethosuximide, Valproic sodium||Phenobarbital|
|Pain||Ibuprofen, Morphine, Acetaminophen||Naproxen, Meperidine|
|Asthma||Cromolyn, Nedocromil||Fluticasone, Beclomethasone|
|Contraception||Barrier methods||Progestin-only agents||Oestrogen-containing contraceptives|