Drugs and Pregnancy Flashcards
Oral manifestations of pregnancy may be secondary to?
What are some oral manifestations?
- increased vascular permeability
- decreased immunocompetence
- increased susceptibility to infection
Gingivitis: progesterone causes change in composition of oral flora, more pathogenic
Pregnancy epulis (granuloma): first trimester of pregnancy
Gestational diabetes: 9X more likely to have perio disease
Anaemia: iron deficiency most common
What are some complications and adverse outcomes associated with:
- periodontitis:
- poor maternal oral health:
How can this be prevented?
- periodontitis: pre-term birth, low birth weight, pre-eclampsia
- poor maternal oral health: increase risk of early childhood caries
Prevention:
- topical anti-bacterials e.g. xylitol, chlorhexidine in late pregnancy, early post-partum
Results in: reduced bacterial load, reduced transmission of oral bacteria from mother to child
What are some key concerns of LA with a pregnant patient?
- lidocaine with epinephrine, prilocaine
- mepivacaine - use with caution in early pregnancy
- articaine - use only if potential benefits outweigh risks, no information available
What does the BNF recommend when prescribing in pregnancy?
- all drugs should be avoided if possible during the first trimester
- use known safe drugs in preference to unknown drugs
- keep dosage and duration to minimum required
Which drugs should not be prescribed during pregnancy?
- aspirin - haemorrhage risk/Reye’s syndrome
- tetracyclines - dental defects
- prilocaine with felypressin (analogue of oxytocin –> theoretical risk of early labour)
- fluconazole - teratogenic
- miconazole - teratogenic
- clarithromycin (not in 1st trimester)
Which drugs are a bit of a grey area?
- ibuprofen - ok in 2nd trimester only, risk of early ductus arteriosus closure
- metronidazole - low dose acceptable if unavoidable
- corticosteroids - topical should be fine
- high dose fluorides - risk of fluorosis
- azithromycin - only if alternatives unavailable
When is the first trimester?
With regards to dental treatment, what is the best advice?
First day of LMP till end of week 12
- hypersalivation secondary to nausea
- acid erosion in hyperemesis gravida
- poor tolerance of dental treatment and OH
- highest risk of teratogenicity from drugs given to mother
- best to limit to emergency treatment only
When is second trimester and what does this indicate for treatment?
Beginning of Week 13 to end of Week 28
- morning sickenss usually abates –> better tolerance of treatment and normal OH
- fetus not big enough to produce large pressure effects when lying down
- risks of teratogenicity reduced in drugs
- good time to do treatment with reference to best practice guidelines
When is 3rd trimester and what considerations do we need to make for treatment?
Beginning of week 29 until delivery
- growing fetus can compress inferior vena cava –> unpleasant feeling, faintness, need to tilt pelvis to left
- decreased lung volume and raised oxygen demand –> lower tolerance for lying flat
- increased circulating blood volume, increased capillary vascularity –> implications for tendency to bleed
- increasing levels of relaxin –> risk of joint injury
- stick to emergency treatment or minimal procedures
What are dental cnsiderations for the 4th trimester?
4th trimester - post natal
- mother may still be in pain from trauma –> sitting comfortably for long periods not feasible
- needs to respond to baby –> time for self/health care limited
- home life redefined –> loss of routine and behaviours changed, may impact on OH
- anaemia contributes to symptoms of tiredness and oral symptoms
- sleep deprivation should not be underestimated –> impact on cognition, memory, planning
