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Oral Medicine and Diagnosis > Caring for the Pregnant Patient > Flashcards

Caring for the Pregnant Patient Flashcards

1
Q

what are the endocrine changes in pregnancy

A

multiple hormone changes

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2
Q

what are the cardivascular changes in pregnancy

A

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

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3
Q

what are the hematologic changes in pregnancy

A

increase of 30% in maternal blood volume

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4
Q

what are the respiratory changes during pregnancy

A

increased rate of respiration

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5
Q

what is early term

A

37-38 weeks and 6 days

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6
Q

what is full term

A

39-40 weeks and 6 days

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7
Q

what is late term

A

41 weeks-41 weeks and 6 days

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8
Q

what is post term

A

42 weeks and after

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9
Q

what are the complications in pregnancy

A
  • spontaneous abortions
  • ectopic pregnancy
  • eclampsia
  • anemia
  • cardiovascular disease
  • oral
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10
Q

what is the probability of spontaneous abortions and why

A

15% during the first trimester and possible relationship to stress or bacteremia

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11
Q

what is ectopic pregnancy

A

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

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12
Q

what is pre eclampsia marked by

A

hypertensino and proteinuria

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13
Q

what is eclampsia marked by

A

malignant hypertension, seizures, and encephalopathy

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14
Q

what is eclampsia

A

a condition in which high blood pressure and proteinuria lead to encephalopathy, coma, miscarriage and death

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15
Q

hormonal changes can either cause:

A

hypertension or syncope

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16
Q

hypertension is monitored to screen for ____

A

eclampsia

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17
Q

since syncope can lead to traumatic injury, prodromal symptoms should be addressed by:

A

assuming a prone position

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18
Q

what is anemia in pregnancy caused by

A

due to increased hematologic demands

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19
Q

what is cardiovascular disease in pregnancy caused by

A

exacerbation of underlying disease in response to increased demand

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20
Q

what are the oral complications in pregnancy

A

exacerbation of underlying periodontal disease

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21
Q

pregnancy gingivitis and exacerbated periodontitis exacerbated by:

A
  • lack of attention to oral hygiene
  • increased systemic fluid levels and capillary fragility from increased progesterone and estrogen
  • increased anaerobic bacterial plaque counts
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22
Q

what lesion is common in pregnancy

A

granulomatous reaction with a vascular component
- pyogenic granuloma
- epulis gravidarum
-pregnancy tumor

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23
Q

describe the pyogenic granuloma

A
  • not an actual granuloma as there is proliferation of vascular tissues as well as proliferation of fibrous tissue
  • forms submucosally and takes the shape of a nodular growth
  • though to be exacerbated response to plaque and bacteria precipitated by the changes in hormonal levels
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24
Q

what is the treatment for pyogenic granuloma

A
  • variable
  • conservative management is an option
  • may resolve post partum
  • gently curettage with electrocautery
    -excision to the periosteum and removal of calculus and plaque
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25
Q

what are the general dental guidelines during pregnancy and in each trimester

A
  • take a history of the trimester and note complications and BP
  • first trimester: fetus is especially susceptible to teratogenic influence and abortion
  • second trimester: optimal trimester for dental care
  • third trimester: syncope and hypertension risk are greatest secondary to fetal position. cardiovascular demands are greatest, there is increased risk of anemia, the highest risk of eclampsia, and increased risk of hypertension
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26
Q

when should preventative prophylaxis be done

A

at the beginning of the second trimester and the third trimester

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27
Q

all elective dental care should be:

A

deferred

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28
Q

when should nondeferrable treatment be completed and what is an example of this tx

A
  • during second trimester
  • caries control
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29
Q

there is no risk of fetal death, malformation, growth retardation or impairment of mental facility at what mGy

30
Q

what is the fetal dose for OMR imaging

31
Q

an absorbed dose to the conceptus of ____ doubles the natural childhood cancer rate from 1 in 500 to 1 in 250

32
Q

absorbed dose of _____ increases the childhood cancer rate to 1 in 375

33
Q

what is the effective dose for the fetus for single intraoral F-speed rectangular radiographs

A

1.3 micro Sv

34
Q

what is the effective dose for the fetus for 4 BW F- speed recetangular radiographs

A

5 micro Sv

35
Q

what is the effective dose for the fetus for FMX 20 F-speed rectangular radiographs

A

35 micro Sv

36
Q

what is the effective dose for the fetus for FMS 20 F-speed round radiographs

A

171 micro Sv

37
Q

what is the effective dose for the fetus for FMS 20 D-speed roundradiographs

A

388 micro SV

38
Q

what is the effective dose for the fetus for pano radiographs

A

9-26 micro Sv

39
Q

what is the effective dose for the fetus for CBCT

A

20-599 micro Sv

40
Q

what is the recommendation for radiographs for pregnant pts

A

contraindicated in all but emergency situations. when taken lead shielding is necessary

41
Q

what is the protocol for new and recall pregnant dental patients

A
  • radiographs should be postponed until post partum
  • long term benefit to the health of the mother from new patient or recall exam radiographs
  • BUT no benefit to the health of a developing child
  • unborn child faces greater risks from the radiation exposure than the mother without any benefit to their health
42
Q

what does the national council on radiation protection and measureemnts recommend

A

different radiation exposure thresholds for pregnant radiation workers than non pregnant radiation workers
- radiation exposure thresholds for pregnant radiation workers is lowered to the same thresholds as the general population

43
Q

what is the SoD recommendation for guidelines for pregnant patients

A

same as NCRP recommendations

44
Q

what is the patient shielding protocol during dentomaxillofacial radiology

A
  • 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 comtemporary maxillofacial imaging radiation doses
45
Q

what is the radiograph protocol for emergency dental patients

A
  • necessary radiographs are part of the standard of care to treat and dx a condition that threatens the health of the mother and the unborn child
  • lack of radiographs compromises the emergency care dx and tx, this will directly impact the health of the unborn child
  • primary beam is not directed toward the child bearing area
46
Q

what are the protocols for medication

A
  • there should be medical clearance for all drugs including LA, analgesics, and ABs
  • lidocaine, penicillin, erythromycin, and acetominophen are generally approved
  • aspirin and vasoconstrictors in LA and all drugs causing respiratory depression are relatively contraindicated
  • diazepam, nitrous, and tetracyline are absolutely contraindicated
47
Q

is acetominophen safe during pregnancy

48
Q

is aspirin safe during pregnancy

49
Q

is codeine safe during pregnancy

A

use with caution

50
Q

is glucocorticoids safe during pregnancy

51
Q

is hydrocodone safe during pregnancy

A

use with caution

52
Q

is IBU safe during pregnancy

A

avoid use in third trimester

53
Q

is oxycodone safe during pregnancy

A

use with caution

54
Q

what meds should you avoid in the first and third trimester

A

-aspirin
- IBU
- naproxen

55
Q

is clarithromycin safe during pregnancy

A

use with caution

56
Q

is doxycycline safe during pregnancy

57
Q

is tetracycline safe during pregnancy

58
Q

what antibiotics are safe during pregnancy

A
  • amoxicillin
  • cephalosporins
  • clindamycin
  • metronidazole
  • penicillin
59
Q

what medications should be avoided during pregnancy

A
  • ciprofloxacin
  • clarithromycin
  • levofloxacin
  • moxifloxacin
60
Q

what med do you never use in pregnancy

A

tetracycline

61
Q

what antimicrobials can be used during pregnancy

A
  • cetylpyridinium chloride mouth rinse
  • chlorhexidine mouth rinse
  • xylitol
62
Q

what anaesthetics can be used for pregnancy

A
  • lidocaine with or without epi
  • prilocaine
  • dyclonine (topical)
  • lidocaine (topical)
63
Q

lidocaine has no evidence of harm at _____ times the max recommended human dose

64
Q

prilocaine has no evidence of harm at _____ times the max recommended human dose

65
Q

what are the considerations for NO with pregnant patients

A

pregnant women require lower levels of NO to achieve sedation, consult with prenatal care health professional

66
Q

what is gestational diabeters

A

high blood sugar affecting pregnant women who have insufficient insulin production relative to metabolic needs
- some instances may be insulin resistance

67
Q

gestation diabetics are at higher risk of:

A

developing type 2 diabetes later in life

68
Q

what are the symptoms of gestational diabetes

A

generally asymptomatic

69
Q

when does gestational diabetes present

A

24-28 weeks

70
Q

what is the tx for gestational diabetes

A
  • daily blood sugar monitoring
  • special meal plans emphasizing a healthy diet
  • exercise
  • monitoring the baby
  • daily blood glucose testing and insulin injections
  • if the above considerations are not responsive and blood sugar remains high, medication is needed such as IM insulin or metformin PO
71
Q

which medication is preferred for gestational diabetes if you have to give meds

Oral Medicine and Diagnosis (12 decks)

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