Pregnancy and Perio

Question 1

pregnancy is associated with an increased sensitivity of periodontal tissues to the presence of plaque, what condition does this cause?

Answer 1

pregnancy gingivitis

Question 2

what is the prevalence of pregnancy gingivitis?

Answer 2

30-100%

Question 3

What months does pregnancy gingivitis get progressively worse between

Answer 3

the 2nd and 8th month,

Question 4

occasionally a localised fibrogranulonatous growth occurs during pregnancy, what is this called?

Answer 4

a pregnancy epulis

Question 5

true or false: a pregnancy epulis does not readily bleed

Answer 5

false - a very vascular lesion which readily bleeds

Question 6

what causes pregnancy gingivitis?

Answer 6

the increased levels or oestrogen and progesterone reduce the thickness of the keratin in the gingival epithelium, therefore less effective a barrier

high levels of progesterone affects the local vasculature, increasing vascular permeability and vessel dilation = gingival exudate and swelling

Question 7

an increase in what hormone increases vascular permeability and vessel dilation of the gingiva?

Answer 7

progesterone

Question 8

Under the 2017 perio guidelines, what is pregnancy gingivitis classified under?

Answer 8

Gingivitis - dental biofilm induced

Question 9

What are the 4 sub categories of potentially modiying factors of plaque induced gingivitis (sex hormones)

Answer 9

• puberty (increase in steroid hormone levels)
• menstrual cycle (very small number of women)
• oral contraceptions (early high dose oral contraceptions, current ones no association)
• pregnancy

Question 10

in pregnant patients where condition is mild, what are the SDCEP perio treatment guidelines?

Answer 10

• OHI using TIPPS
• smoking cessation is applicable

Question 11

in pregnant patients where condition is severe, what are the SDCEP perio treatment guidelines?

Answer 11

• OHI and smoking cessation
• Debridement
• highlight to patient where supra-gingival deposits found
• may require more frequent recalls
• remove local plaque retentitive factors (over hangs etc)
• explain condition is likely to resolve after birth

Question 12

what oral bacteria can mimic the host receptors that trigger thrombus formation within the vascular system - therefore could cause inappropriate clotting if they enter the blood stream?

Answer 12

Streptococcus sanguis and P. gingivalis

Question 13

What medications should you NOT prescribe during pregnancy?

Answer 13

Aspirin
Tetracyclines
prilcocaine with felypressin
flucanazole
miconazole
clarithromycin

Question 14

What medications are there some grey areas about prescribing during pregnancy?

Answer 14

Ibuprofen - okay during 2nd trimester
metronidazole
cortocosteroids
high doses of flourides

Question 15

what anatomical and physiological changes may occur during the first semester?

Answer 15

• hypersalivation secondary to nausea
• acid erosion in hyperemesis gravida (vomiting)
• poor tolerance to dental treatment and oral hygiene
• highest risk of teratogenicity from drugs given to the mother

Question 16

what anatomical and physiological changes may occur during the second semester?

Answer 16

• more sickness usually abates - better tolerance to treatment and normal OH
• foetus not big enough to produce large pressure effects when lying down
• risks of teratogeniciity reduced in drugs

Question 17

what anatomical and physiological changes may occur during the second semester?

Answer 17

• growing foetus can compress inferior vena cava - unpleasant feeling, faintness (tilt pelvis to left to relieve)
• decreased lung volume and raised O2 demand - lower tolerance to lying flat
• increased circulating blood volume, increased capillary vascularity - implications for tendancy to bleed
• increasing levels of relaxin - increased joint injury