Lecture 2 Flashcards
What percentage of women do not visit a dentist during pregnancy?
Approximately 46% of women do not visit a dentist during pregnancy.
What percentage of pregnant women believe dental treatments during pregnancy are unsafe?
Some surveys show up to 40% of pregnant women believe dental treatments during pregnancy are unsafe.
What percentage of pregnant women experience gingivitis?
Approximately 60-75% of pregnant women experience gingivitis, often called ‘pregnancy gingivitis,’ due to hormonal changes.
What percentage of pregnant women have some form of periodontal disease?
About 40% of pregnant women have some form of periodontal disease.
How much more likely are pregnant women with untreated periodontal disease to experience preterm birth or have a baby with low birth weight?
Pregnant women with untreated periodontal disease are up to 7 times more likely to experience preterm birth or have a baby with low birth weight.
What percentage of all preterm births in the U.S. may be contributed to by periodontal disease?
Periodontal disease may contribute to 18% of all preterm births in the U.S.
Periodontal disease during pregnany has been linked to an increased risk of this pregnancy complication in the mother
preeclampsia; characterized by high blood pressure
Is dental treatment safe during pregnancy?
Yes, dental and dental hygiene treatment is safe during any trimester of pregnancy.
Which trimester is most ideal for dental treatment?
The second trimester is the most ideal for dental treatment.
Due to the endocrine system and hormone production, What are the symptoms felt during the first trimester of gestation?
Fatigue, syncope, and postural/orthostatic hypotension.
Due to the endocrine system and hormone production, What are the symptoms felt during the second trimester of gestation?
Few symptoms and a sense of well-being.
Due to the endocrine system and hormone production, What are the symptoms felt during the third trimester of gestation?
Increased fatigue, general discomfort, and mild depression.
What happens to blood volume during pregnancy?
Blood volume increases.
How does blood pressure change during the second trimester?
Blood pressure decreases during the second trimester.
What occurs to blood pressure in the last month of pregnancy?
Increased blood pressure during the last month.
What is a risk associated with the third trimester when putting a pregnant patient back in the chair?
Supine hypotensive syndrome.
What are some symptoms of abrupt fall of supine hypotension?
Bradycardia, sweating, nausea, weakness, and hunger.
What should a patient do to alleviate supine hypotensive syndrome?
Ask the patient to roll onto the left side to lift the uterus from the vena cava; BP rapidly returns to normal.
What is a common condition related to blood that occurs in pregnant women?
Anemia is common.
How does blood volume change in relation to RBC production in pregnant women?
Blood volume increases faster than RBC production.
What mineral deficiency is commonly found in blood-related conditions in pregnant women ?
Iron deficiency is common.
What happens to clotting factors during pregnancy?
Clotting factors increase.
By how much does the risk of thrombosis increase during pregnancy?
The risk of thrombosis increases by 7-10x.
What is thrombosis?
Thrombosis occurs when blood clots block veins or arteries.
What are some symptoms of thrombosis?
Results in pain, swelling in one leg, chest pain, numbness on one side of the body.
What serious conditions can thrombosis cause in pregnant women?
Can cause stroke, heart attack, or death.
Why do pregnant women have a reduced respiratory reserve volume?
It is a condition caused by the enlargement of the uterus and increased demand on the lungs.
What happens to the respiration rate during pregnancy?
There is an increased respiration rate.
What position aggravates respiratory issues during pregnancy?
The supine position.
What are common changes in appetite during pregnancy?
Increased appetite and food cravings are common.
What dietary factors can adversely affect oral health during pregnancy?
An unbalanced, non-nutritious diet high in sugars can have adverse effects on oral health.
With regards to nutrition, What symptoms may be worse during the first trimester of pregnancy?
Taste alteration, the gag response, nausea, and vomiting may be worse during the 1st trimester.
When does the majority of fetal development take place?
The majority of fetal development (organ systems) takes place in the 1st trimester.
When is the fetus most susceptible to malformation?
The fetus is most susceptible to malformation during the 1st trimester.
What oral structures form between the 5th and 12th weeks of pregnancy?
Tooth buds, lips, and palate form between the 5th and 12th weeks.
What primarily occurs during the remainder of pregnancy?
The remainder of pregnancy is primarily growth and maturation, except for dentition.
What is dentition susceptible to during fetal development?
Dentition is susceptible to malformation from toxins and radiation.
What is an example of a toxin that can affect dentition?
Tooth discoloration from tetracycline is an example of a toxin that can affect dentition.
When should professional dental care occur during pregnancy?
Professional dental care should occur throughout pregnancy.
What should be discussed if prenatal care is not provided?
If no prenatal care is provided, a referral should be given.
What type of guidance should be provided during pregnancy?
Anticipatory guidance should be provided during pregnancy on their diet’s effect on teeth and hormones and gingival response when there is biofilm. Education should also be given on biofilm removal.
What is the first step in dental considerations for pregnant patients?
Complete a thorough health history.
When should a medical doctor be consulted in dental care for pregnant patients?
Consult MD as needed; confirm medical prenatal care or refer to prenatal care.
What should be monitored during dental care for pregnant patients?
Monitor vital signs and refer as indicated.
Why is biofilm control important in pregnant patients?
Due to increased susceptibility to infection.
What dietary counseling should be provided to pregnant patients?
Limit refined carbohydrates and fluoride due to vomiting.
periodontal disease increases the risk for what during pregnancy?
Increases the risk of pre-term births, low birth weight, preeclampsia, gestational diabetes, delivery of a small-for-gestational-age infant, and fetal loss.
What implication does maternal caries have for infants?
Maternal caries increases infant caries risk.
What principle should be followed for radiographic exposure in pregnant patients?
Follow ALARA for radiographic exposure.
When is the best trimester for dental radiographic exposure?
Second trimester is best.
What type of dental care should be avoided during the first trimester?
Avoid elective care during the first trimester when possible.
What should be done in case of dental emergencies during pregnancy?
Treat dental emergencies.
Is dental hygiene care considered elective care for pregnant patients?
No, dental hygiene care is not elective care.
What are the dental considerations for drug administration during pregnancy?
Drug administration is controversial during pregnancy and breastfeeding.
It may cross the placenta and be toxic to the baby, potentially causing maternal hypoxia, resulting in fetal hypoxia, injury, or death.
What is the best recommendation for OTC pain relief during pregnancy?
Acetaminophen (Tylenol) is the best recommendation.
Patients may also be taking Aspirin for cardiovascular health.
Is local anesthesia with epinephrine safe during pregnancy?
Yes, local anesthesia with epinephrine is safe.
It crosses the placenta but does not cause fetal abnormalities when the dose is limited to the minimum needed.
Which antibiotics are considered safe during pregnancy?
Penicillin, erythromycin, and cephalosporins are safe antibiotics to use.
These antibiotics do not pose risks to the fetus.
What are the guidelines for using nitrous oxide during pregnancy?
Nitrous oxide should be used for less than 30 minutes and with at least 50% oxygen.
It is recommended only during the 2nd and 3rd trimesters and to prevent repeated exposure.
When should extensive, elective treatment be delayed?
Extensive, elective treatment should be delayed until after pregnancy.
How should gag reflex affect treatment while treating a pregnant patient?
The gag reflex may dictate treatment delay.
What can trigger the gag reflex or nausea in pregnant women during treatment?
Certain flavors or odors may trigger the gag reflex or nausea.
What is the recommended approach to medication during procedures for pregnant patients?
Utilize the safest, lowest dose of medications for procedures.
What is preferred regarding appointment length for pregnant women?
Shorter appointments are preferred.
What should be adjusted during treatment appointments for pregnant patients?
Change patient positioning as needed.
What anatomical consideration is important in the third trimester?
In the supine position, the uterus can obstruct the vena cava and aorta.
What may be necessary during appointments for pregnant patients to prevent thrombosis?
May need breaks during the appointment.
What happens to blood pressure in the third trimester?
Blood pressure increases in the third trimester.
Does increased blood pressure in the third trimester indicate hypertension?
Increased blood pressure does not mean the patient has hypertension or that they need a medical consult.
What is Pregnancy Gingivitis?
An exaggerated inflammatory response to local irritants and decreased oral hygiene with increased hormonal production.
Commonly presents with inflamed margins and interdental papilla, most often in the second month of pregnancy.
Pregnancy Gingivitis may progress to__. When is it most common during pregnancy?
Progresses to fiery red and edematous papilla that are tender to touch.
Most common in the second month of pregnancy.
What is a Pyogenic Granuloma?
“Pregnancy tumor” that is asymptomatic but may be aggravated by brushing.
When does gingivalhyperplasia happen during ? What happens to Gingival hyperplasia after pregnancy?
Happens during the second month. Gingival hyperplasia will return to normal postpartum.
What is osteoporosis?
A disease that causes bone loss and reduced bone density.
It is a skeletal disorder that compromises bone strength and predisposes a person to bone fractures.
Who is commonly affected by osteoporosis?
Commonly affects women due to changes in hormones and medications taken related to hormone replacement.
What are the two types of osteoporosis?
Primary and Secondary.
Primary affects all genders and ages, commonly >60 years, and increases with age. Secondary results from medications and conditions.
What is the primary type of osteoporosis?
Affects all genders and ages, commonly seen in individuals over 60 years, and increases with age.
What is the secondary type of osteoporosis?
Results from medications and conditions.
What are serum biomarkers used for?
Serum biomarkers are used to determine the presence of disease.
What do serum biomarkers that measure substances in the blood reflect with regard to osteoporosis?
They reflect the rate of bone formation and resorption.
What valuable information do serum biomarkers provide for osteoporosis?
They provide valuable information about bone turnover and potential risk of fractures.
With regard to osteoporosis, if bone is being broken down faster than it is being built up?
It indicates a negative balance in bone health.
In addition to serum biomarkers, What diagnostic tool can be used for diagnosis
Radiography can be used for diagnosis.
What is the function of bisphosphonates?
Bisphosphonates suppress osteoclast activity.
How can bisphosphonates be administered?
They can be administered IV and orally.
What is required for secondary osteoporosis treatment?
Secondary osteoporosis requires more aggressive treatment.
What are the oral manifestations of osteoporosis?
They affect maxillary and mandibular bone density and height.
Do low alveolar bone mineral density cause other periodontal changes?
No, low alveolar bone mineral density does not cause other periodontal changes.
What periodontal disease risk factors increase osteoporosis progression?
Risk factors include smoking, alcohol, nutrition (calcium, Vit. D), and hormones.
What modifications to the patient chair might osteoporosis patients need?
Patients may need extra padding.
What type of dental procedures should be cautioned for osteoporosis patients?
dental surgeries involving bone like extractions and implants.
What are some health promotion strategies to reduce risk of osteoporosis progression in osteoporosis patients?
Health promotion strategies include managing alcohol use, smoking, supplements, and physical activity.
What is Osteonecrosis?
A disease that results from poor blood flow to the bone.
What happens when blood flow to bone is disrupted?
It results in the death of bone tissue.
What can occur as a result of Osteonecrosis?
The bone can break down and the associated joint will collapse.
What is a serious oral complication of cancer treatment?
Osteonecrosis.
What medication is Osteonecrosis previously associated with?
Bisphosphonates.
What risk do dental patients taking bisphosphonates face?
They are at risk for osteonecrosis of the jaw (ONJ).
What type of bisphosphonates carries the highest risk for ONJ?
IV bisphosphonates.
Is Osteonecrosis usually symptomatic?
Usually asymptomatic; pain may start with the onset of infection.
What are the dental treatments for Osteonecrosis?
Debridement, curettage, antibiotic irrigation, hyperbaric oxygen therapy.
What is the first step in dental management for patients taking bisphosphonates?
Medical consult to determine diagnosis, cause, and treatments.
What protocol should be followed for patients with cancer taking bisphosphonates?
Follow protocol for safe treatment of patients who have cancer.
What type of dental care should be provided to patients taking bisphosphonates?
Provide routine dental care: use anesthesia if needed.
How should trauma and bleeding be managed during dental procedures for osteonecrosis patients?
Minimize trauma and bleeding during procedures.
Which periodontal procedures present the greatest risk for patients taking bisphosphonates?
Periodontal procedures with bone manipulation present greatest risk.
How should infections be treated in patients taking bisphosphonates?
Treat infections aggressively with antibiotics.
What are normal physiologic changes in the musculoskeletal system for geriatric patients?
Bone mass decreases; loss of muscle function; stiff joints
What are normal physiologic changes in the cardiovascular system for geriatric patients?
Decreased cardiac output; decreased blood vessel flexibility; fatty deposits line inner walls
What are normal physiologic changes in the respiratory system for geriatric patients?
Decreased breathing efficiency; weakened respiratory muscles; reduced effective ventilation; less effective cough reflex
What are normal physiologic changes in the gastrointestinal (GI) system for geriatric patients?
Decreased production of secretions (ex. Hydrochloric acid); slowed peristalsis; decreased absorptive functions
What is the age range for geriatrics?
Age 65 & Up
What are normal physiologic changes in the Central Nervous System for geriatrics?
Slowed intellectual/cognitive function; short-term memory declines; difficulty with complex tasks.
What are the changes in the Peripheral Nervous System for geriatrics?
Decreased tactile sensitivity; decreased proprioception.
What sensory changes occur in geriatrics?
Age-related vision and hearing changes; decreased olfaction.
What endocrine changes are observed in geriatrics?
Decreased thyroid efficiency results in decreased basal metabolic rate and cold sensitivity.
What changes occur in the Immune System for geriatrics?
Decline; changes in skin and mucosa decrease protective factors; decrease in T-cell production results in immune system decline.
What cognitive changes are seen in geriatrics?
Excess light and noise are distractions; changes in cognitive function may lead to tooth loss and gingival inflammation.
What are the most common chronic conditions in geriatric patients?
Osteoarthritis, visual and hearing impairments, cardiovascular diseases, diabetes, alzheimer’s disease, Alcoholism, osteoporosis, sexually transmitted diseases, respiratory disease.
What is Alzheimer’s Disease?
A type of dementia characterized by severe impairment of cognitive abilities (thinking, memory, and judgement).
Aging associated soft tissue oral changes
• Lips lose elasticity
• Angular cheilitis more frequent
• Vitamin B and candidiasis
• Oral mucosa thinner and drier
• Items may stick to mucosa and cause discomfort
• Tongue
• Atrophic glossitis
• Anemia
• Lingual varicosities prominent
• Xerostomia
• Medications, autoimmune issues, systemic disease
• Oral Candidiasis
• Medication induced or caused by local factors such as ill-fitting
Aging-Associated
Changes in the Dentition
• Tooth color darkens
• Pulp shrinks
• Attrition is present from wear, malocclusion
• Abrasion may be present from long-term habits
• Root caries increase due to decreased ability to perform oral hygiene
Aging-Associated
Changes in the periodontium
The Periodontium
• Recession and bone loss are commonly present in the oral cavity of a geriatric patient
• “Long in the tooth”
Treatment considerations for geriatric patients
