Caring for the patient who is pregnant

Question 1

Maternal Changes in Pregnancy
(4)

Answer 1

endocrine
cardiovascular
hematologic
respiratory

Question 2

endocrine

Answer 2

multiple hromonal changes

Question 3

cardiovascular

Answer 3

increase of 20-40% in CO, tachycardia, and flow murmurs

Question 4

hematologic

Answer 4

increase of 30% in maternal blood volume

Question 5

respiratory

Answer 5

increased rate of respiration

Question 6

spontaneous abortions
probability of –% during first trimester
possible relationship to (2)

Answer 6

15
stress or bacteremia

Question 7

ectopic pregnancy

Answer 7

fertilizations and implantation of the fetus in the fallopian tube, resulting in abdominal pain and heavy bleeding

Question 8

eclampsia
pre-eclampsia is marked by (2)
eclampsia is characterized by (3)

Answer 8

hypertension and proteinuria
malignant hypertension, seizures, and encephalopathy

Question 9

Eclampsia - a condition in which high blood pressure and proteinuria lead
to (4)

Answer 9

encephalopathy, coma, miscarriage and death

Question 10

Hormonal changes can either cause (2)

Answer 10

hypertension or syncope

Question 11

— is monitored to screen for eclampsia

Answer 11

Hypertension

Question 12

Syncope can lead to traumatic injury; prodromal symptoms should be addressed
by assuming a — position

Answer 12

prone

Question 13

anemia

Answer 13

secondary to increased hematologic demands

Question 14

cardiovascular disease

Answer 14

exacerbation of underlying disease in response to increased demand

Question 15

oral

Answer 15

exacerbation of underlying periodontal disease

Question 16

Pregnancy Gingivitis and Exacerbated Periodontitis Exacerbated by:
- Lack of attention to —
- Increased (2) from increased (2)
- Increased —

Answer 16

Oral Hygiene
systemic fluid levels & capillary fragility
progesterone and estrogen
anaerobic bacterial plaque counts

Question 17

Oral Complications in Pregnancy
* Exacerbation of underlying —
* May cause a —

Answer 17

periodontal disease
granulomatous reaction with a more significant
vascular component

Question 18

Pyogenic granuloma
Epulis gravidarum
Pregnancy Tumor
(3)

Answer 18

• not an actual granuloma as there is proliferation of vascular tissues as well proliferation
  of fibrous tissue
• forms submucosally and takes the shape a nodular growth
• Thought to be an exacerbated response to plaque and bacteria precipitated by the
  changes in hormonal levels

Question 19

Pyogenic granuloma
Epulis gravidarum
Pregnancy Tumor
Treatment
(2)

Answer 19

• variable
  *conservative management is an option

Question 20

*conservative management is an option
(3)

Answer 20

• May resolve post-partum
• Gentle curettage with electocautery
• Excision to the periosteum and removal of calculus and plaque

Question 21

Dental Evaluation in Pregnancy
general guidelines

Answer 21

take a hx of the trimester and note complications and blood pressure

Question 22

Dental Evaluation in Pregnancy
first trimester

Answer 22

fetus is especially susceptible to teratogenic influence and abortion

Question 23

Dental Evaluation in Pregnancy
second trimester

Answer 23

optimal trimester for dental care

Question 24

Dental Evaluation in Pregnancy
third trimester
(2) risk are greatest secondary to —.
– demands are greatest.
there is increased risk of —, the highest risk of —, and increased risk of —

Answer 24

syncope and hx
fetal position
CV
anemia
eclampsia
htn

Question 25

Dental Evaluation in Pregnancy
specific guidelines
1. preventative dental prophylaxis should be undertaken at the …
2. all — dental care should be deferred
3. nondeferrable tx (ex caries control) should be completed during the — trimester
4. radiographs are …
5. there should be medical clearance for all drugs, including (3)

Answer 25

beginning of the second trimester and third trimester
elective
second
contraindicated in all but emergency situations. when taken lead shielding is mandatory
local anesthetics, analgesics, and abx

Question 26

New and recall pregnant dental patients:
* Radiographs should be …
* long term benefit to the health of the mother from new patient or recall exam radiographs
* BUT no benefit to the …
* unborn child faces greater risks from the radiation exposure than the mother, without any …
* National Council on Radiation Protection and Measurements (NCRP Report 177, 2019)2
recommends …
* radiation exposure thresholds for pregnant radiation workers is lowered to the same
thresholds as the —
* SoD Dental Radiography recommendation guidelines for Pregnant Patients mirrors these
NCRP recommendations

Answer 26

postponed until post-partum
health of developing child
benefit to their health
different radiation exposure thresholds for pregnant radiation workers than
non-pregnant radiation workers
general population

Question 27

Patient Shielding During
Dentomaxillofacial Radiology
Recommendations
(2)

Answer 27

• discontinuing shielding of the gonads, pelvic
  structures, and fetuses during all dentomaxillofacial
  radiographic imaging procedures
• thyroid shielding not be used during intraoral,
  panoramic, cephalometric, and CBCT imaging as the
  risks of thyroid cancer are negligible from
  contemporary maxillofacial imaging radiation doses

Question 28

Emergency pregnant dental patients:
* necessary radiographs are part of the standard of care to treat and diagnose a
condition that …
* lack of radiographs compromises the emergency care (2)
* this will directly impact the health of the —.
* primary beam is not directed toward the —

Answer 28

threatens the health of the mother and the unborn child
diagnosis and treatment,
unborn child
child-bearing area

Question 29

5. there should be medical clearance for all drugs, including local anesthetics, analgesics, and abx
   a. (4) are generally approved
   b. (3) are relatively contraindicated
   c. (3) are absolutely contraindicated
   d. (1) is now frequently prescribed BUT only in low doses

Answer 29

lidocaine, penicillin, erythromycin, and acetaminophen
aspirin and vasoconstrictors in LA and all drugs causing respiratory depression
diazepam, NO, and tetracycline
low dose ASA

Question 30

Gestational Diabetes
*
* In some instances, it may also be —
* gestational diabetics are at higher risk of
developing — later in life
* Generally —

Answer 30

high blood sugar affecting pregnant women who
have insufficient insulin production relative to
metabolic needs
insulin resistance
type 2 diabetes
asymptomatic

Question 31

Gestational Diabetes
* Presents at

Answer 31

mid term; ~24-28 weeks

Question 32

Gestational Diabetes
Treatment
(5)

Answer 32

• daily blood sugar monitoring
• Special meal plans emphasizing a healthy diet
• exercise
• monitoring the baby
• daily blood glucose testing and insulin injections

Question 33

If the above conservative measures are not
responsive and blood sugar remains high, medication
is needed
(2)

Answer 33

• IM - Insulin
• PO - Metformin (preferred)