Potential concerns of sedation dentistry for pregnant patients

Dental anxiety continues to be a concern for many people. This is also true among pregnant women, who are potentially more prone to serious dental health concerns, such as pyogenic granuloma and gingivitis, among others. Unfortunately for expectant mothers, the decision to seek immediate dental intervention that may require sedation doesn't come lightly.  This is given to concerns surrounding sedation effects on both the mother and the developing fetus.  

Maternally administered dental sedation medications have shown potential physiological and neurologic side effects on the mother and fetus. For this reason, healthcare providers are always cautious about recommending procedural sedation during dental treatments for pregnant women. This post addresses the concerns surrounding sedation use in pregnant patients to help physicians approach the matter reasonably and ease the nerves of pregnant women who may be shying away completely from seeking dental care. 

Is dental sedation safe for pregnant women?

The question of whether or not dental sedation is safe for pregnant women boils down to the urgency of the treatment, the nature of the dental procedure, the development stage of the fetus, and the type of sedation used. Generally, it is advisable to avoid invasive dental interventions that require sedation if such treatments are not urgent. However, in circumstances requiring urgent dental intervention, such as gum (periodontal) disease or wisdom tooth extraction, the proper safety considerations must be adhered to when administering sedation to ensure the safety of both the mother and fetus. 

It is also important to consider some obvious physiological changes during pregnancy and preexisting conditions that could worsen when sedation medications are administered. For instance, research shows that up to 50% of expectant mothers experience breathing difficulties in later pregnancy. It is, therefore, critical for physicians to consider adjusting the ventilation pattern and position to avert the risk of hypoxemia.

Where dental sedation is urgent and sedation dentistry necessary, these are some of the safest types of dental sedation for pregnant women.

• Local anesthesia. Considered the safest option, local anesthetic with or without epinephrine can be used to numb the area without posing harm to the fetus.
• Nitrous oxide. While having a relatively low risk profile, doctors must exercise caution when administering nitrous oxide to pregnant patients.

These options may not be adequate for some deeply invasive dental interventions. In critical situations, the most experienced dentist, in consultation with the obstetrician and anesthesiologist, may recommend the following types of dental sedation. 

• IV Sedation. Typically avoided during pregnancy, IV sedation may be considered if closely monitored by a professional.
• Oral conscious sedation. Valium, which is used for sedation, is generally not recommended for routine use during pregnancy. However, if the benefits outweigh the risks, the dentist may decide to use them.  The decision for use will include the gestational age of the fetus and how many doses will be needed to accomplish the needed work. 

Safe Sedation Training for dental specialties will discuss red flags and best practices for administering dental sedation to vulnerable patients.

The risks of sedation during pregnancy

So we have determined that sedation during pregnancy is generally avoided due to the potential risks associated with the medication. However, it is important to address the specific risk concerns that sedatives may have on the unborn child or the mother. 

Sedation medications are said to be teratogenic and, hence, can affect fetal development. Many of these medications can cross the placental barrier because they arefat-soluble. They can be disruptive to normal fetal development depending on the developmental age of the fetus.  Here are the risks that these sedatives can cause:

1. Increased risk of adverse effects on the developing fetus

Pregnancy can be a delicate situation – even the slightest intervention can prove dangerous to the mother or fetus. That said, certain sedation medications have the potential to harm the developing fetus. For instance, general anesthesia has been shown to cause abnormal heart rate when it passes through the placenta. Using benzodiazepines near term can cause what is called “floppy infant syndrome.” 

2. Potential impact on fetal growth and development

Sedation during pregnancy may also affect fetal growth and development. For instance, sedation medications may have neurodevelopmental effects on the fetus. Exposure to certain sedatives during critical periods of fetal brain development can potentially lead to long-term neurological issues in the offspring, including cognitive deficits, behavioral problems, and learning disabilities.

3. Risk of respiratory depression

There is a risk of respiratory depression associated with sedation during pregnancy. Certain sedative medications may depress the respiratory system, leading to reduced breathing rates and oxygen levels in first the mother and then the fetus. 

During pregnancy, it is understood that maternal oxygen consumption increases while the functional residual capacity decreases. Mild hyperventilation and decreased maternal PaCO2 are common symptoms as well. All these effects are counteracted during procedural sedation. In addition, physiological changes in the maternal airway during pregnancy increase the risk of difficult intubation.

4. Risk of allergic reactions 

Some individuals may have allergies to the medications used for sedation, which can manifest as skin rashes, itching, swelling, or even anaphylaxis. 

That said, it's important to note that the majority of these risks associated with sedation during pregnancy typically appear only with high doses or a continuous use of sedatives or the use of certain sedation techniques. 

Additionally, close monitoring by healthcare professionals during sedation procedures can help mitigate risks and ensure the safety of both the mother and the developing fetus. To ensure compliance with the best practices, medical practitioners are recommended to completely understand what medications are being used and the effects of the medications on a fetus and the age of development. Thus, they will have access to the most up-to-date material and can refresh their knowledge in a professional environment. 

Administering dental sedation to pregnant women

Administering dental sedation to expectant women requires careful consideration. The ideal dental sedation option should be safe for both the mother and the developing fetus. In retrospect, the severity of sedation effects on the fetus largely depends on three things: the use of a vasoconstrictor, the degree of protein binding, the acid dissociation constant, and the metabolic rate of local anesthetic. There is a large amount of information that has been gathered about medications and pregnancy, but there is still much that is unknown.  It is important that the dental professional has up to date knowledge of medications and the effect on the fetus.  If there is ever a question, a consult with an anesthesiologist would be a wise clinical decision.

That said, sedation should be avoided at all costs during the first and third trimesters for pregnant women. These periods are highly sensitive, and any external influence can have serious consequences for both the mother and the unborn child. During the first trimester, the fetus undergoes rapid development; therefore, sedation risks should be averted if at all possible. 

The safest option falls under the midterm stage of the pregnancy. During this stage, the fetus is in stable development, and no serious outcomes can be expected from administering sedation. But, to play it safe, oral local anesthesia should be preferred as it has been proven to be extremely safe for both the pregnant patient and the fetus. 

When pregnant women cannot avoid dental sedation in the first trimester, dentists and anesthesiologists should ensure close monitoring of the mother and fetus during and after the procedure. This is done to quickly detect any onset of an adverse effect of the sedation and take the necessary measures to mitigate the situation.