Physiology of pregnancy and oral local anesthesia considerations

Abstract

Background Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients. Methodology An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment. Results Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied. Conclusions Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.

Peripheral Giant Cell Granuloma in Pregnancy: A Case Report

“…During pregnancy, hormonal changes, particularly those involving estrogen and progesterone, promote alterations in the oral cavity. These alterations encompass physiological, vascular, microbiological, and cellular changes, creating a favorable environment for the initiation and development of various pathologies [16][17][18][19][20][21][22][23]. Among the physiological changes that significantly contribute to the prevalence of oral lesions, especially in gingival tissue, are an approximate 1500 mL increase in blood volume (normal volume in women being 4 to 4.5 L), establishing a framework clinical diagnosis for physiological anemia, which can stimulate gingival bleeding and the possible increase in blood glucose levels due to the decrease in sensitivity to insulin by pregnancy hormones, potentially generating a decrease in the elasticity and increase in the permeability of blood capillaries [16,22].…”

“…These alterations encompass physiological, vascular, microbiological, and cellular changes, creating a favorable environment for the initiation and development of various pathologies [16][17][18][19][20][21][22][23]. Among the physiological changes that significantly contribute to the prevalence of oral lesions, especially in gingival tissue, are an approximate 1500 mL increase in blood volume (normal volume in women being 4 to 4.5 L), establishing a framework clinical diagnosis for physiological anemia, which can stimulate gingival bleeding and the possible increase in blood glucose levels due to the decrease in sensitivity to insulin by pregnancy hormones, potentially generating a decrease in the elasticity and increase in the permeability of blood capillaries [16,22]. Alterations in the microcirculatory system during pregnancy involve swelling of endothelial cells, increased adhesion of platelets and leukocytes to vessel walls, microthrombi formation, changes in perivascular mast cells, increased vascular permeability, and vascular proliferation [16,22].…”

“…Among the physiological changes that significantly contribute to the prevalence of oral lesions, especially in gingival tissue, are an approximate 1500 mL increase in blood volume (normal volume in women being 4 to 4.5 L), establishing a framework clinical diagnosis for physiological anemia, which can stimulate gingival bleeding and the possible increase in blood glucose levels due to the decrease in sensitivity to insulin by pregnancy hormones, potentially generating a decrease in the elasticity and increase in the permeability of blood capillaries [16,22]. Alterations in the microcirculatory system during pregnancy involve swelling of endothelial cells, increased adhesion of platelets and leukocytes to vessel walls, microthrombi formation, changes in perivascular mast cells, increased vascular permeability, and vascular proliferation [16,22]. Estrogen and progesterone, in conjunction with inflammatory mediators, can induce changes in vascular responses and connective tissue turnover in the periodontium, leading to a higher prevalence of inflammatory processes during hormonal fluctuations [22].…”

“…Alterations in the microcirculatory system during pregnancy involve swelling of endothelial cells, increased adhesion of platelets and leukocytes to vessel walls, microthrombi formation, changes in perivascular mast cells, increased vascular permeability, and vascular proliferation [16,22]. Estrogen and progesterone, in conjunction with inflammatory mediators, can induce changes in vascular responses and connective tissue turnover in the periodontium, leading to a higher prevalence of inflammatory processes during hormonal fluctuations [22]. Hormones during pregnancy can induce an increase in Vascular Endothelial Growth Factor (VEGF) and basic Fibroblast Growth Factor (bFGF), which are activators of angiogenesis, altering the vascular response.…”

“…Combined with modifications or alterations in eating habits and oral care practices, this increases the risk of microorganism growth and the development of oral lesions [16]. These conditions generated by hormonal changes during pregnancy favor the prevalence and/or severity of certain conditions in the oral cavity [22]. This effect is particularly noticeable after the second month, as it is precisely at this point that there are increases in plasma levels of estrogen and progesterone [16,21].…”