Pregnancy

Question 1

Normal pregnancy

Answer 1

40 weeks
No baby for 1st  2 weeks
1st trimester 0-12/40
-organogenesis
2nd trimester 13-28/40
-maturation and growth
3rd trimester 28-42/40
-growth and maturation

Question 2

Physiological changes in pregancy

Answer 2

Oestrogenic and progestogenic effects
Metabolic demands of fetus
Nutritional demands of fetus
Mass effect of uterus
All effects magnified in multiple pregnancy

Question 3

Respiratory systen

Answer 3

PO2 rises
PCO2 falls
Tidal volume increases
RR unchanged
Exertional dyspnoea normal

Question 4

CV system

Answer 4

Cardiac output increases 30-50%
HR increases ~10bpm
Dilutional anaemia
> clotting factors
Vasodiation
Aorta-caval compression

Question 5

GI system

Answer 5

< tone lower oesophagus
Delayed gastric emptying and bowel transit
> intra-abdo pressure

Question 6

Haematological system

Answer 6

Iron deficiency anaemia

> risk of DVT

Question 7

Implications for dental practice

Answer 7

Procedures <20-30 min
Defer procedures in 1st and 3rd trimester
Avoid supine posture >20/40
If unavoidable: 15 degrees left lateral tilt, oxygen, thromboprophylaxis

Question 8

OH during pregnancy

Answer 8

Hyper salivation
> vascularity
Gingival tissue growth
Altered immune response to bacteria
Tooth mobility
Effects of excessive vomiting

Question 9

Pregnancy gingivitis

Answer 9

Aggravated pre-existing disease
Plaque induced inflammation
Histologically similar to non-pregnant disease
Worsens through pregnancy
Usually resolves after

Question 10

Pregnancy epulis

Answer 10

Granulomatous/ fibrous hormonal response at pre-existing sit of gingivitis
Often at labial interdental papillary gingiva upper jaw
Usually pedunculated

Question 11

Pregnancy epulis incidence

Answer 11

5%

Question 12

Pregnancy epulis associated with

Answer 12

Plaque

Question 13

Pregnancy epulis microscopy

Answer 13

Inflammatory cells, new capillaries and fibroblasts

Question 14

Pregnancy epulis prognosis

Answer 14

Tends to regress but recur in subsequent pregnancies

Bone involvement rare

Question 15

Periodontal disease and adverse perinatal outcome

Answer 15

Low birth weight
Pre-eclampsia
Prematurity and pregnancy loss
Unclear it treatment improves outcome

Question 16

Implications for dental practice

Answer 16

Good oral hygiene & plaque control
Dietary advice
Routine dental checkups, scale and polish in 2nd trimester ideally
Give advice re infant dental care and diet
Persistent vomiting: see your Obstetrician, avoid brushing more than bd

Question 17

Effect of pregnancy on dental care

Answer 17

Imaging
Prescribing
Amalgam
Breast feeding
Periodontal disease

Question 18

Imaging

Answer 18

X-rays are teratogenic
Foetal exposure from 18 oral views = 800x CXR
Document pregnancy status prior to any X-ray
Strategies: shielding, restrict number of views, avoid

Question 19

Prescribing

Answer 19

Almost all drugs cross placenta & enter breast milk
Highest risk during organogenesis
Dependence & Neonatal withdrawal >28/40

Question 20

Antimicrobials

Answer 20

Penicillins, Cephalosporins, Erythromycin, Nystatin ok
Avoid Tetracyclines
Avoid Augmentin
Avoid Metronidazole before 28/40 in some patients
Avoid Ketoconazole, Miconazole, Amphotericin

Question 21

Analgesics

Answer 21

Avoid NSAIDs especially >34/40

Use minimum dose of opioids for shortest time

Question 22

Anaesthesia

Answer 22

Avoid sedatives and hypnotics, Entenox ok for 20-30 min
Lignocaine / Prilocaine +/- adrenaline ok
Avoid vasopressin (uterine stimulant)
Avoid GA, risks lowest in 2nd trimester
Specialist anaesthetic input advised

Question 23

Amalgam

Answer 23

Exposure during pregnancy associated with low birth weight

DOH advises Mercury amalgam fillings should not be inserted or removed during pregnancy

Question 24

Breast feeding mothers

Answer 24

Levels lower in breast milk compared to blood**
Advise taking after breast feeding
Avoid Tetracyclines, Aspirin

Question 25

Key messages - general

Answer 25

Care is free
Document pregnancy status of all women 13-50yrs prior to X-rays and any treatment
Alter prescribing during pregnancy, remember Metronidazole, Augmentin

Question 26

Key messages - treatment

Answer 26

Treatment is generally the same with specific exceptions
Reassure treatment is safe
Limit to essential treatment, in 1st & 3rd trimeters
Treat infection & pain
Limit procedures to 20-30 min until 3/12 postnatal
Avoid supine position >20/40