pregnancy and perio

Question 1

what is the 1st line of antibiotics if NOT pregnant? and what else should be done

Answer 1

-pen v and metronidazole

local measures and a review appt

Question 2

what weeks cover the 1st trimester of pregnancy?

Answer 2

1-12 weeks

Question 3

when are you more prone to teratogenic effects?

Answer 3

1st trimester

Question 4

do antibiotics cross the placenta in the 1st trimester?

Answer 4

YES

Question 5

are radiographs safe during pregnancy?

Answer 5

yes

Question 6

what other symptoms may be seen in the mouth in this trimester but also in others?

Answer 6

erosion- due to morning sickness

Question 7

what should you give you notice dental erosion in a patient?

Answer 7

-fluoride mouthwash
-OHI- do not brush teeth straight after

Question 8

what causes pregnancy gingivitis?

Answer 8

increased E and P

Question 9

In what 3 ways do E and P lead to gingivitis?

Answer 9

cause an increase in bacteria due to:

• increased vascular permeability
  -increased dilation of vessels
  -increased sensitivity to plaque

Question 10

how does E lead to an increase in bacterial ingress?

Answer 10

causes a reduction in keratin- meaning their is a less effective barrier to bacteria

Question 11

when does placenta growth begin?

Answer 11

1st trimester

Question 12

how may placental growth affect the patient?

Answer 12

uses lots of energy- pt will be tired

Question 13

what type of LA should be avoided during pregnancy?

Answer 13

articaine- has not been licensed for pregnancy and avoid prilocaine with felypressin in the 3rd trimester as this cause early labour

Question 14

what should the treatment be for a perio patient in the 1st trimester?

Answer 14

focus on prevention- the increased bacteria will be increasing the inflammatory response- best not to heighten this

Question 15

what is the risk of leaving perio treatment in the first trimester?

Answer 15

progression

Question 16

why would a patient also be taking fragmin and aspirin?

Answer 16

anticoagulants- to reduce the risk of clots in placenta (miscarriage) if previous pregnancy problems

Question 17

what weeks cover the second trimester?

Answer 17

weeks 12-28

Question 18

what antibiotics are safe during pregnancy?

Answer 18

amoxicillin and clindamycin

Question 19

what may a patient present with on the gum during pregnancy?

Answer 19

epulis- bleeding but no pain swelling

Question 20

what may cause an epulis?

Answer 20

changes in hormones- progesterone

Question 21

what would the treatment be for an epulis?

Answer 21

-ohi as will regress post- partum

Question 22

what is the safest trimester to do treatment?

Answer 22

the 2nd trimester

Question 23

if perio treatment is required in the 2nd semester, how would you go about it?

Answer 23

in small sections over several appts-as will increase bacteria in blood and increase inflammatory response

Question 24

when should you remove an amalgam restoration during pregnancy?

Answer 24

ONLY if the patient is in pain- use dental dam and good suction

Question 25

what weeks cover the 3rd trimester?

Answer 25

29-40 weeks

Question 26

in what trimester will BOP and pregnancy gingivitis be at its worse?

Answer 26

3rd trimester

Question 27

what trimester will the pt have problems in the supine position?

Answer 27

trimester 3

Question 28

how should you position a patient in the 3rd trimester and why?

Answer 28

either lying on their left side or elevating hip with a pillow- this is to prevent compression of IVC and aorta

Question 29

what systemic problem may occur in the 3rd trimester?

Answer 29

pregnancy induced diabetes

Question 30

if perio problems are left untreated, how may this cause problems in the 3rd trimester?

Answer 30

increased inflammatory response may stimulate prostaglandins- which can lead to premature birth and low birth weights

Question 31

how may increased prostaglandins affect birth?

Answer 31

-premature labour/birth
-low birth weights

Question 32

in what trimester may patients miss appts?

Answer 32

4th

Question 33

how may patients be feeling in the 4th trimester?

Answer 33

tired

Question 34

what is the caries risk for new mums?

Answer 34

increased as likely poorer diet/poorer OH than normal

MUST PROVIDE GOOD OHI

Question 35

should you replace amalgam after birth?

Answer 35

no- mercury can still be passed through breast milk

Question 36

what does breast feeding create for newborns?

Answer 36

a good microbiome and good immune system

Question 37

why should aspirin be avoided during pregnancy?

Answer 37

risk haemorrhage

Question 38

when should clarithromycin be avoided in pregnancy?

Answer 38

1st trimester

Question 39

what antibiotics cause teratogenic effects?

Answer 39

“zoles”

Question 40

what other antibiotics should be avoided during pregnancy?

Answer 40

tetracyclines