Chapter 8: Dental Management Of Pregnant Patients And Lactation Flashcards
Pregnant women fall into which ASA class?
II
Teratogen:
those agents that can induce or increase the incidence of congenital malformations.
Period of ovulation:
1-2 weeks
Alteration in the implantation of the embryo: all or nothing
Period of embryo?
3-8 weeks, phase of rapid differentiation. The main organs are developed, the most important organ malformations occur
Period of fetus?
12-38 weeks, alteration on fetal growth and maturation
Physiological alterations during pregnancy: cardiovascular system
increased cardiac output, heart rate, blood volume, and venous pressure (supine hypotension syndrome), and decreased blood pressure.
Physiological alterations during pregnancy: respiratory system
Mucosal edematization, hoarseness, chest enlargement, and upper costal breathing.
Physiological alterations during pregnancy: renal system
Increased urinary volume
Physiological alterations during pregnancy: digestive system
Change in appetite, nausea, vomiting, constipation, diarrhoea, and heartburn
Physiological alterations during pregnancy: dermatological changes
Chloasma (hypercaptation of melanin)
Physiological alterations during pregnancy: hematological changes
Great need for iron, anemia
Oral changes during pregnancy:
- periodontal alterations
- buccal mucosa alterations
- dental alterations
PBD
Peridontal changes:
- inc estrogen and progesterone
- p intermedia and p gingivalis
- vascular alterations: mucosal erythema, edema, hyperaemia, and tendency to bleed
- gingivitis!!!
Oral mucosa and dental alterations:
Increased estrogen and progesterone
P. Intermedia and P.gingivalis.
Vascular activation—> mucosal erythema, edema, hyperaemia, and tendency to bleed. GINGIVITIS!!!
Alterations of the oral mucosa:
Granuloma of pregnancy (EPULIS GRAVIDATUM)—> vestibular, anterior region, second trimester, <2cm, bleeding and disappears after childbirth or with surgery.
Oral sores.
Dental alterations: increase in caries due to decrease in salivary pH.
Preimplantation stage:
Threshold dose
Possible alterations
Observations
100-200mSv
1-2% embryonic death
Spontaneous abortion rate 10-30%
Organogenesis stage:
Threshold dose
Possible alterations
Observations
500mSv
Skeletal, ocular, gentian abnormalities, and growth retardation
No effect on human below 100-200mSv
Fetal period:
Threshold dose
Possible alterations
Observations
120-200mSv
Mental retardation
Severe mental retardation 500mSv
Late stage (>26 weeks):
Threshold dose
Possible alterations
Observations
100mSv
Increased cancer or leukemia
Natural congenital malformations 2-3%
Wide consensus: doses ___ do not increase the risk of congenital defects in the embryo of the foetus.
100
No RX during the ?
First quarter
There’s currently no international or national legislation that advises?
Taking any action at doses below 100mSv
FDA categories:
• A: controlled studies have shown no risk.
• B: there’s no evidence of risk in the human species.
• C: we cannot rule out the existence of risks.
• D: there’s evidence of risk to the human foetus, but its use is accepted if there’s no vital risk or for serious illness when no safer medication can be prescribed.
• X: contraindicated in pregnancy.
Gold standard of ATB in pregnancy?
Amoxicillin
Crosses placenta and is used in lactancy
Gold standard analgesic in pregnancy:
Paracetamol
Crosses placenta and is used is lactancy
Gold standard LA and VC in pregnancy:
Lidocaine
Adrenaline
Preferable moment for dental tx in pregnancy?
2nd trimester
• First trimester: emergency, hygiene recommendations, control of plaque. Prophylaxis. Don’t use nitrous oxide.
• Second trimester: ideal time for treatment.
• Third trimester:
Short consult, semi seated.
Avoid inferior vena cava syndrome (left side).
Inferior vena cava syndrome is the same the the supine hypotension syndrome, turning on the left side relieves the pressure on the inferior vena cava.
Point out the false one regarding the radiological protection of a pregnant woman who comes to consultation:
a. The main organs to protect are the thyroid gland and the gonads.
b. Leaded aprons reduce the dose received to negligible values
c. The use of digital radiology reduces the shooting time and with it the radiation
d. Pregnancy is not an absolute contraindication for dental x-rays
e. The current international legislation advises to take protection measures at doses below 100mS
E
The radiation dose that sets the threshold for possible fetal abnormalities is:
a. 200 mSV
b. None are correct
c. 500 mSV
d. 100mSV
e. 50 mSV
D
If we have to prescribe an antibiotic to a lactating patient it is false:
a. 1 to 3 hours after taking the antibiotic do not breastfeed.
b. You should take the antibiotic dose after breastfeeding.
c. Do not discard the first feeding because there is a greater risk that the child does not want to continue breastfeeding.
d. The antibiotic will be prescribed if the patient comes with an acute process and inflammation.
e. Low-dose amoxicillin does not cross the placenta.
E
A 36-week pregnant woman comes to the consultation to do a review plus hygiene, which indications we will take into account, indicate the false:
a. We will avoid taking xrays, especially periapicals
B. When we finish the treatment we will instruct the patient to get up slowly
C. We will place the patient on the left side
D. We will use the least amount of anesthetic with vasoconstrictor
E. They are all true
A
In relation to the radiological protection of a pregnant woman who comes to consultation, it is false that:
A. Leaded aprons reduce the dose received to negligible values
B. Pregnancy has no contraindication at all for dental xrays
C. Radiation risk is associated with gestational status
D. At doses below 100mSv it is not advisable to take measures
E. Doses below 100mSv do not increase the risk of birth defects in the embryo
B
Mark the incorrect answer:
a. The radioactive risk depends on the dose and the gestational week at which the exposure occurs
b. Pregnancy is not absolute contraindication for performing dental radiographs
c. During pregnancy in case of doubt we will use lidocaine without vasoconstrictor
d. At doses below 100mSV it is not advisable to take any action
e. Metamizol (nolotil) does not cross the placenta so it can be administered safely during pregnancy
E
A 5-month pregnant patient with a localized and reddish gingival enlargement in the marginal vestibular gingiva of 43, comes to her office, how would she treat her?
a. Dental prophylaxis and plaque control
b. Dental prophylaxis together with amoxicillin for 7 days
c. Dental prophylaxis and dewaxing along with amoxicillin 7 days
d. Gingivectomy with electric scalpel
e. Scaling and root planing plus chlorhexidine 0.12 for 15 days
A
A woman who is breastfeeding requires ATB treatment for a week due to the eruption of a third molar. What will you recommend?
Take ATB after breastfeeding
In relation to the radiological protection for a pregnant woman who comes for a consult, it is false that?
The pregnancy doesn’t suppose any contraindication for the realisation of dental xrays
A 6 week pregnant woman comes to the consult, which of the following lesions that she presents will be a consequence of the pregnancy?
a. Granulomatous lesion with a tendency to bleed of 5cm. Localised at the level of 46 on it’s lingual wall.
b. Melania pigmentation at the gingival mucosa because of hypercaptation of melanin.
c. Vesicular lesions localised at the lips.
d. Edema and bleeding at the gingival mucosa
e. All of these lesions will be considered normal in pregancy
D
