Pregnancy & dentistry Flashcards
What weeks are the 1st, 2nd and 3rd trimester?
1st = 1-12 weeks
2nd = 13-27 weeks
3rd = 28-40 weeks+
What 3 types of changes orally during pregnancy?
- Hormonal
- Salivary
- Plaque
What 4 types of system change occur during pregnancy?
- Hormonal
- Vascular
- Respiratory
- Immune response
What changes happen with plaque?
- 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.
What changes happen with the saliva?
- 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
What does increased oestrogen levels of oestrogen in saliva cause?
Raised oestrogen leads to proliferation and desquamation of the oral mucosa, with desquamated cells proving nutrition to the oral bacteria.
What does the pH change and change in buffering effect in saliva during pregnancy cause?
The drop in pH and buffering effect of saliva creates a thriving environment for cariogenic bacteria - increasing risk of caries.
How does caries risk change during pregnancy?
- 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
What do hormonal changes cause in the oral cavity?
- 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.
Describe a pregnancy epulis
- 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
What is a severe form of nausea and vomiting and what is it morning sickness caused by?
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)
What oral effects can vomiting have?
Acid affects enamel - especially upper anteriors palatally
May prevent good OH
Increased dentine hypersensitivity
May increase gag reflex
What hormonal changes occurs systemically and can have effect orally?
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.
What can heartburn cause?
30-70%
Restriction in muscle tone of lower oesophageal sphincter
Increase intragastric pressure
Reflux as foetus enlarges
What physiological changes occur in the cardiovascular system (systemic)?
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.
What physiological changes occur in the respiratory system (systemic)?
- 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.
Which are the Food and Drug Administration USE classifications of drugs according to their safety for B and C?
B = no danger to humans
C = drugs where the teratogenic risk cannot be ruled out - no positive evidence of damage but caution is advised.
What is the safest choice for LA?
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
What LAs do you need to use with caution?
- Prilocaine
-Tetracaine - Benzocaine
- All of the above implicated in development of acquired hemoglobinemia - oxidation of Fe in Hb - unable to transport O2
What are safe LA which can be used as alternatives?
- Mepivacaine
- Bupivacaine
- Artecaine
Are vasoconstrictors safe to use in LA on pregnant women?
- 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
LA summarised. What to use? What to remember to do? Which one to avoid?
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.
Which local anaesthetic should be used for breast feeding?
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
Can pregnant women use paracetamol?
Safe and effective during all stages
