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Revision > Pregnancy & dentistry > Flashcards

Pregnancy & dentistry Flashcards

1
Q

What weeks are the 1st, 2nd and 3rd trimester?

A

1st = 1-12 weeks
2nd = 13-27 weeks
3rd = 28-40 weeks+

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2
Q

What 3 types of changes orally during pregnancy?

A
  1. Hormonal
  2. Salivary
  3. Plaque
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3
Q

What 4 types of system change occur during pregnancy?

A
  1. Hormonal
  2. Vascular
  3. Respiratory
  4. Immune response
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4
Q

What changes happen with plaque?

A
  • More pathogenic organisms in plaque
  • More susceptible to effects of plaque
  • Increased inflammatory response - more prone to gingivitis
  • Resolves post partum
  • Increase in plaque deposits - epulis.
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5
Q

What changes happen with the saliva?

A
  • Change in composition
  • Decreased pH, Na concentration and phosphate and calcium
  • Increase K, cortisol, progesterone and oestrogen levels, resulting in increased plasma glucose levels.
  • Increased oestrogen leads to proliferation and desquamation of the oral mucosa, with desquamated cells providing nutrition to the oral bacteria
  • Drop in pH and buffering effect of saliva creates a thriving environment for cariogenic bacteria - increasing risk of caries
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6
Q

What does increased oestrogen levels of oestrogen in saliva cause?

A

Raised oestrogen leads to proliferation and desquamation of the oral mucosa, with desquamated cells proving nutrition to the oral bacteria.

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7
Q

What does the pH change and change in buffering effect in saliva during pregnancy cause?

A

The drop in pH and buffering effect of saliva creates a thriving environment for cariogenic bacteria - increasing risk of caries.

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8
Q

How does caries risk change during pregnancy?

A
  • Hormonal and behaviour changes increase caries risk.
  • Taste changes - preference for sweet flavours
  • Increased consumption of carbohydrates
  • Frequent consumption of snacks to satisfy cravings or ameliorate nausea
  • OH practices change - due to change in taste of TP, MW
    39.1-54.9% of women report pain with caries being the main source of pain
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9
Q

What do hormonal changes cause in the oral cavity?

A
  • Increase in progesterone
  • Pregnancy epulis - overgrowth of gingival tissues and capillaries in the ID papilla area on the labial surface.
  • 1-5%
  • Third trimester
  • Also increase in angiogenesis
  • Gingival pigmentation/skin (melasma)
  • Increased facial pigmentation - pregnancy mask

-Increased risk of constipation due to reduced gut mobility and smooth muscles relaxation.

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10
Q

Describe a pregnancy epulis

A
  • Sessile
  • Pedunculated
  • Profuse bleeding
  • Labially, ID, anterior maxillary region
  • Rarely exceed 1.5cm
  • Painless
  • Resolves post partum
  • Recurs if removed during pregnancy
  • Surgical intervention post partum if still present after maximum regression
  • One case where infant delivered due to uncontrollable haemorrhage
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11
Q

What is a severe form of nausea and vomiting and what is it morning sickness caused by?

A

Nausea and vomiting - referred to by many as morning sickness in 80%
- Increased incidence of GORD - reduced oesophageal sphincter tone and increased intra-abdominal pressure

  • Hyperemesis gravidarum - 0.3-1% = severe nausea, vomiting and weight loss during pregnancy.
  • Due to increase in HGC (human chorionic gonadotropin)
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12
Q

What oral effects can vomiting have?

A

Acid affects enamel - especially upper anteriors palatally

May prevent good OH

Increased dentine hypersensitivity

May increase gag reflex

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13
Q

What hormonal changes occurs systemically and can have effect orally?

A

Increase in circulating oestrogen.
Causes amplified capillary permeability.
This predisposes to gingivitis and gingival hyperplasia.

No predisposition to perio, but can worsen existing condition.

More favourable environment for bacteria.

Predisposes to pregnancy gingivitis.

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14
Q

What can heartburn cause?

A

30-70%
Restriction in muscle tone of lower oesophageal sphincter
Increase intragastric pressure
Reflux as foetus enlarges

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15
Q

What physiological changes occur in the cardiovascular system (systemic)?

A

Blood volume increases by 30-50%
Cardiac output increases by 40% (heart rate and stroke volume)
Functional heart murmur and tachycardia in 90% of women
Peripheral vascular resistance decreases (not always compensated by increased cardiac output) and blood pressure may fall - 2nd trimester onwards
Uterus can occlude the vena cava if supine - left lateral tilt advised
Exacerbation of existing maternal cardiac disease can be fatal.

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16
Q

What physiological changes occur in the respiratory system (systemic)?

A
  • Diaphragm pushed up by 3-4cm - uterus restricts movements.
  • Oxygen consumption increases by 15-20% to meed increased demands of foetus/placenta/maternal organs and tissues
  • Hyperventilation - may increase to 42% in late pregnancy
  • Dyspnoea (short of breath) in 50% of women - 19 weeks, 75% by 31 weeks - lying flat may exacerbate this
  • Nasal congestion - rhinitis related to hormonal changes - 20-30% usually in 2nd/3rd trimesters. Breathing through the nose may be more difficult during dental treatment.
17
Q

Which are the Food and Drug Administration USE classifications of drugs according to their safety for B and C?

A

B = no danger to humans
C = drugs where the teratogenic risk cannot be ruled out - no positive evidence of damage but caution is advised.

18
Q

What is the safest choice for LA?

A

Lidocaine is safest - Category B

Artecaine is Category C - can be considered as it has a significant shorter half life, so will limit foetal exposure

FDA suggests benefits have to outweigh use

LA crosses the placenta

19
Q

What LAs do you need to use with caution?

A
  • Prilocaine
    -Tetracaine
  • Benzocaine
  • All of the above implicated in development of acquired hemoglobinemia - oxidation of Fe in Hb - unable to transport O2
20
Q

What are safe LA which can be used as alternatives?

A
  • Mepivacaine
  • Bupivacaine
  • Artecaine
21
Q

Are vasoconstrictors safe to use in LA on pregnant women?

A
  • Vasoconstrictors prevent systemic uptake improving depth and duration
  • Minimises risk of systemic toxicity
  • Adrenaline - low dose for dental LA, so unlikely to affect uterine blood flow
22
Q

LA summarised. What to use? What to remember to do? Which one to avoid?

A

LA with vasoconstrictor (adrenaline) - just use Lidocaine with adrenaline!!

Careful aspiration - avoid inadvertent IV administration

DO NOT use felypressin (prilocaine) - related to xytocin - has the potential to cause uterine contractions, although unlikely in doses used.

23
Q

Which local anaesthetic should be used for breast feeding?

A

Similar guidance should be used for breastfeeding women

Studies show no evidence that dental LA causes complications to the foetus and there is no evidence of negative pregnancy outcomes or birth defects

24
Q

Can pregnant women use paracetamol?

A

Safe and effective during all stages

25
Q

Can pregnant women use ibuprofen in the first trimester?

A

Contraindicated

Miscarriage more likely

Development of birth defects (pulmonary valve stenosis, cleft lip/palate, gastroschisis - (defects in the abdominal wall), necrotising enterocolitis, spina bifida, hypospadias, kernicterus - type of brain damage.

Can affect the future fertility of a baby girl - but experts concur that more research is required.

26
Q

Can pregnant women use ibuprofen in the third trimester?

A

Increased risk of heart defects

30 weeks and beyond could cause premature closing of baby’s ductus arteriosus. The baby won’t receive adequate nutrients and oxygen as a result.

Premature closing can cause high BP in the baby’s lungs

Delayed onset labour and ineffective contractions

Increased risk of heart problems

Reduced amniotic fluid - helps with lung development - oligohydramnios

Possible increased risk of asthma in second and third trimester

Jaundice

Increased risk of haemorrhage to mother and baby

Abnormal Vit K levels

Does not cause low birth weight, still birth or behavioural problems

27
Q

Is codeine safe for pregnant women to use?

A

Can cause withdrawal in newborns due to habit forming potential

In third trimester dihydrocodeine during labour can cause respiratory depression in the baby

28
Q

Which analgesics are safe and which are not?

A

Paracetamol - safe

Use with caution: Aspirin, Ibuprofen, Dihydrocodeine

Aspirin can be used to prevent pre eclampsia

29
Q

Can you use conscious sedation?

A

Nitrous oxide after 1st Trimester
Use WITH CAUTION - AVOID IF POSSIBLE.

Always refer to specialist services

Risk of harm to developing baby
Risk of atypical response to sedation greater in pregnancy.

30
Q

What are the principles of prescribing in pregnancy?

A

Consider renal clearance - dose may need to be increased.
Higher clearance of drugs
Need to understand the safety aspects
Minimise adverse outcomes
Avoid teratogenic drugs

31
Q
A

Revision (9 decks)

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