Periodontology And Pregancy

Question 1

Breastfeeding up to _____ months is associated with a decreased risk of _____

Answer 1

12 month; tooth decay

Question 2

First trimester perio issue: rising estrogen and progesterone in the pregnant woman can cause…

Answer 2

Increased vasodilation so more bleeding on probing.

Question 3

First trimester: how else might pregnant patients be at risk of periodontal pocketing?

Answer 3

Folate metabolism changes more at risk of bacteria ingression = deeper pockets.

Question 4

What LA is avoided in pregancy?

Answer 4

Articaine and anaesthetics with felypressin (i.e. prilocaine)

Question 5

Where can you find guidelines for treating pregnant patients?

Answer 5

EFP guidance

Question 6

Periodontitis treatment may be avoided by dentists, why would this be detrimental?

Answer 6

1. Periodontitis will worsen, crossing pocket wall could contribute to immune response
2. Should deliver basic care OHI, fluoride use, PREVENTION

Question 7

Why might a pregnant patient be on Fragmin and how would this affect dental care?

Answer 7

Reduces risk of blood clots (blood thinners), check anticoagulant guidelines.

Question 8

Second trimester?

Answer 8

Weeks; 28 weeks (will be having scans/midwifery care)

Question 9

Second trimester: antibiotics?

Answer 9

Avoid metronidazole/tetracyclines.

Amoxicillin is opted for.

Question 10

Second trimester: What is this?

Answer 10

Pregnancy epulis/granuloma. Swelling on gingival that bleeds on brushing - isn’t painful.

Very vascular, due to hormones high levels of progesterone and vascularity (will go away after birth).

Treatment: increase OH, monitor - will go away post-partum.

Question 11

Second trimester; caries control management?

Answer 11

The safest trimester to treat!
Patient is feeling their best right now.

Don’t remove amalgams (unless in the patients best interest).

Question 12

If you had to remove the amalgam, to keep it safe you would…

Answer 12

Rubber dam, good aspiration, discuss with patient. Simple cut and flick out.

Question 13

Second trimester: SUBGINGIVAL PMPR?

Answer 13

Keep it supragingival - safe.

Risks associated with SUBGINGIVAL debridement —> ingress of bacteria into the bloodstream, thus inflammatory response will increase.

SUBGINGIVAL is ok but provide small treatment per appointment e.g. 3-4 teeth per session.

Question 14

Third trimester?

Answer 14

Weeks; 29-40 weeks.

Question 15

Third trimester: positioning?

Answer 15

Elevation of the right leg.

NOT SUPINE.

Avoid compression of vena cava.

Question 16

Third trimester: guidelines

Answer 16

Avoidance of felypressin.

Question 17

Third trimester: bleeding on probing?

Answer 17

At its maximum

Question 18

Third trimester: periodontal precautions?

Answer 18

Periodontal disease at this time can stimulate prostaglandins;

Therefore adverse effects associated with this disease can be preterm labour/premature birth.

VERY important that treatment is given to prevent this.

Question 19

What other conditions can occur during the third trimester that are linked to periodontitis?

Answer 19

Pregnancy induced diabetes and anemia

Question 20

Fourth trimester: treatment for periodontitis and removal of restorations?

Answer 20

1. Mother’s condition: very difficult for the mother as they are caring for the baby. May be feeling unmotivated/low = postpartum depression due to hormones dropping.
2. Articaine isn’t licensed for breast feeding.
3. Caries rate is high due to poorer diet at this time.
4. Amalgam restoration should be avoided - this can still pass through into breast milk.

Question 21

Benefits of breast feeding

Answer 21

1. IgA antibody protection for baby.
2. Full of vitamins/fat/nutrients.
3. Majority of the components of breast milk are not being absorbed by the baby - they are supporting the microbiome (prebiotics).

Question 22

summary of treatment for the pregnant patient

Answer 22

Question 23

Main issues with periodontitis in a pregnant patient

Answer 23

1. Miscarriage
2. Pre-eclampsia
3. Preterm low birthweight

Question 24

Why my periodontal disease cause preterm labour ?

Answer 24

Increased cytokines levels

Question 25

Things to not prescribe to a pregnant patient

Answer 25

1. Aspirin - haemorrhage risk/reye’s syndrome
2. Tetracyclines - dental defects
3. Prilocaine w/ felypressin - oxycitocitic effects —> early labour?
4. Fluconazole - teratogenic
5. Miconazole - teratogenic
6. Clarithromycin - not in trimester 1st.
7. Ibuprofen - grey area
8. Metronidazole - grey area
9. Corticosteroids - grey area (topical should be fine)
10. High does fluorides - fluorosis risk
11. Azithromycin - only if alternatives unavailable