Perio - Pregnant and Nursing

Question 1

what is the first line antibiotic for spreading infection in non-pregnant patient?

Answer 1

Penicillin V, metronidazole

Question 1

what is the first line antibiotic for spreading infection in non-pregnant patient?

Answer 1

Penicillin V, metronidazole

Question 2

What are the benefits of managing periodontal disease before patient gets pregnant?

Answer 2

do not want to have bacteria and their exotoxins constantly leaking into bloodstream, triggering inflammatory responses –> LOW LEVEL CHRONIC INFLAMMATION

Question 3

when is first trimester?

Answer 3

1-12

Question 4

when is second trimester

Answer 4

13-27

Question 5

when is third trimester?

Answer 5

28-40

Question 6

what are some feelings patient may have 1st trimester?

Answer 6

1. morning sickness
2. tiredness
3. potential for anemia

Question 7

why do we get pregnancy gingivitis

Answer 7

increase in OESTROGEN AND PROGESTERONE.
- cause INCREASED VASCULAR PERMEABILITY, INCREASED SENSITIVITY TO PLAQUE, VESSELS BECOME DILATED AND MORE LEAKY.
- increase in oestrogen changes FOLLATE METABOLISM
- reduced keratin thickness
- more bacterial ingress

Answer 8

• 30-100% of pregnancies will experience PREGNANCY GINGIVITIS
• gets worse from month 2 to 8.
• drain of energy in first trimester due to PLACENTAL GROWTH.

Question 9

what should you avoid in pregnancy?

Answer 9

• amalgam
• articaine
• felypressin

Question 10

what are the reccomendations about doing periodontal care in first trimester pregnancy?

Answer 10

• avoid periodontal care completely
• provide PREVENTION (fluoride, OH etc).

Question 11

what medications are patients put in to help them support and sustain pregnancy? what is the clinical implication?

Answer 11

fragmin and aspirin. both ANTICOAGULANTS, BLOOD THINNERS, INCREASED RISK OF BLEEDING

Question 12

What antibiotics should you avoid in pregannt patients? what can you provide instead?

Answer 12

metronidazole and tetracyclines. give AMOXICILLIN

Question 13

what is a pregancy epulis? why do we get it?

Answer 13

gingival swelling. readily bleeds/ulcerates but not associated with pain. red-purple swelling. usually regresses after birth.

due to INCREASED PROGESTERONE which INCREASES VASCULAR PERMEABILITY AND DILATION.

Question 14

what is the safest trimester to treat a pregnant patient for caries?

Answer 14

second trimester

Question 15

How would you remove an amalgam in a pregnant patient to keep fetus safe?

Answer 15

1. use RUBBER DAM
2. GOOD ASPIRATION

Question 16

can you do subgingival debridement in second trimester?

Answer 16

• can provide it in SMALL NUMBER OF SITES/ TEETH (3-4 teeth per visit).
• can use ultrasonic and LA normally.
• SHOULD TREAT PERIO BECAUSE CHILD IS LEARNING IMMUNE RESPONSE, PERIO PATHOGENS CROSSING PLACENTA AND WILL RECOGNIZE THEM AS NORMAL -> MORE LIKELY TO GET PERIO LATER ON.

Question 17

what are some considerations for 3rd trimester patients?

Answer 17

• uncomfortable for longer appointments
• uncomfy if too supine
• ELEVATE THE RIGHT HIP
• AVOID FELYPRESSIN
• joints become loose (due to relaxin increase)
• MAXIMUM INCREASE IN VASCULARITY AND THUS BOP.

Question 18

What are adverse outcomes associated with periodontal disease?

Answer 18

• stimulate prostaglandings
• PREMATURE BIRTH
• LOW BIRTH WEIGHT

Question 19

what systemic conditions may patient present with in 3rd trimester?

Answer 19

• pregnancy induced diabetes
• anemia