Dental Management For Pregnant Patients

Question 1

Pregnant patients

Answer 1

• not medically compromised
• most are healthy
• Not a disease
• history of previous labor is critical

Question 2

What systems undergo change during pregnancy

Answer 2

• Cardiovascular system
• Respiratory system
• GI system

Question 3

What changes should be provided during dental treatment due to cardiovascular system?

Answer 3

• Slowly bring patient up from being reclined to up-right
  
  • vasomotor instbility— postural hypotension
• Aortocaval compression=supine–>hypotensive syndrome
  
  • signs and symptoms:
    
    • lightheaded
    • weakness
    • sweating
    • restlessness
    • tinnitus (ringing/buzzing noise in ear(s))
    • pallor (pale skin)
    • decreased BP
    • syncope
    • unconsciousness & convulsions (severe cases)
  • correct by:
    
    • pt roll on left side
    • pillow to elevate right hip & butt by 15 degress
    • lifts uterus off vena canva and re-establishes aortocaval patency

Question 4

What changes should be provided during dental treatment due to respiratory system?

Answer 4

• Increased estrogen production results in:
  
  • edema
  • nasal congestion
  • epistaxis
• Causes mouth breathing
  
  • oral dryness
  • increased decay

Question 5

What changes should be provided during dental treatment due to GI system?

Answer 5

• Increase progesterone
  
  • decrease lower esophageal tone
  • gastric and intestinal motility
• increased risk of GERD
• Stomach displaced superiorly
  
  • increases intra-gastric pressure
• chair kept uprgiht during dental tx to relieve abdominal pressure and keep patient comfortable

Question 6

Pregnant: Timing of treatment

Answer 6

• Coronal polishing, polishing and root planing
  
  • performed anytime to maintain oral health
• routine general dentistry in 2nd & 3rd Trimester
  
  • nausea and organogenesis usually stops by end of first trimester
  • more studies indicate that preventative, routine, and emergency dental procedures can be safely done
• Elective procedures con be done at any stage as long as the patient is comfortable

Question 7

Pregnancy: Radiographs

Answer 7

• Oral radiographs are safe w/:
  
  • high-speed film
  • lead apron w/thyroid collar
• no increase in congenital anomalies or intrauterine growth retardation
• BW and PAN radiograph study generates 1/3 radiation exposures w/FMS w/E-speed film and rectangular collimator

Question 8

Pregnant High Risk Factors

Answer 8

• Obstetrician consult not required in normal pregnancy
• Complications-seek obstetrician consult
  
  • pregnancy-induced hypertension
  • Gestational diabetes
  • Threat of spontaneous abortion
  • History of premature labor

Question 9

Pregnancy: HTN

Answer 9

• Record: Baseline BP, pulse, respiratory rate
  
  • required before any invasive procedure including local anesthetic
• iBP>150/100 mmHg
  
  • fear and pain can be ruled out for cause
    
    • contact obstetrician
• avoid elective dental procedures unless approved by doctor

Question 10

Pregnancy: Gestational Diabetes

Answer 10

• Patient might be on insulin
• Check blood sugar before appointment
• all precautions for diabetics need to be taken
• Baby’s growth is closely monitored
• labor may be induced before EDD (Estimated delivary date)
  
  • have that convo with your patient

Question 11

Threat of spontaneous abortion

Answer 11

• Always send a consult to OBGYN if informed
  
  • Explain to OBGYN what txs that are planned, stress level, posture, expected anesthetic agents and medicines
  • Proceed with tx ONLY after clearance from OBGYN
  • when txing-check on wellbeing frequently

Question 12

History of premature labor

Answer 12

• Obtain detailed history of patient
  
  • previous premature labor and reason
• Consult OBGYN and get clearance
• Always tx with caution ESPECIALLY IN 3rd trimester

Question 13

Periodontal disease

Answer 13

• Pregnancy gingivitis usually appears in 1st trimester
  
  • results from increased levels of progesterone & estrogen
• interproximal pappilae becomes red, edematous(swllen) and tender to palpation
  
  • bleeds easily if subjected to trauma
• In some, may progress locally to pyogenic granuloma (pregnancy tumor)
  
  • common on labial surface of papilla

Question 14

Preeclampsia

Answer 14

• rare complication
• high BP and signs of organ damage
  
  • liver and kidneys
• begins after 20 weeks of normal BP
• untreated=serious or fatal complications for mother and baby
  
  • seizures (eclampsia)
  • oran damage
• Hands, fingers, neck, and feet might swell
• can cause placenta to detach and baby baby born early
  
  • increase risk of problems for baby
• Tx:
  
  • Deliver babe=most effective
    
    • takes a while to get better after delivery
  • Magnesium sulfate
    
    • prevent stop seizures
  • Modified activity, hospitalization, drugs to lower BP
    
    • depends on severity

Question 15

Antibiotics

Answer 15

• Avoid:
  
  • ciprofloxacin
  • Levofloxacin
  • Moxifloxacin
  • Clarithromycin
• Never use:
  
  • Tetracycline

Question 16

Analgesics: Safe vs short term use

Answer 16

• Safe
  
  • acetaminophen
  • acetaminnophen + codeine
  • Hydrocodone
  • oxycodone
  • Meperidine
  • Morphine
• Short term use only (2-3 days, 2nd trimester)
  
  • Aspirin
  • Ibuprofen
  • Naproxen

Question 17

Local Anesthetics

Answer 17

• LA w/epi can be used

Question 18

Nitrous Oxide

Answer 18

• use when LA is inadequate
• require lowers doses
• conssult with OBGYN

Question 19

Mouth washes

Answer 19

• alcohol free

Question 20

Oraverse

Answer 20

• aka Phentolamine mesylate
• alpha adrenergic agonist
  
  • not competitive antagonist
• promotes vasodilation
  
  • increses speed of diffusion out of the area
  • decreases duration of action of LA
  • 60%
• only approved for 6yr and +15kg