Pregnancy in Dentistry

Question 1

Gestation

Answer 1

40 weeks

Question 2

1-2 weeks

Answer 2

No foetus

Question 3

0-12

Have to be cautious with?

Answer 3

First trimester
Organogenesis
Drug prescription

Question 4

13-28

Answer 4

Second trimester

Maturation and growth

Question 5

28-42

Answer 5

Third trimester

Growth and maturation

Question 6

Physiological changes
Causes
In multiple pregnancy

Answer 6

Oestrogenic/progestogenic effects 
Metabolic demands of foetus
Nutritional demands of foetus
Mass effect of uterus 
Magnified

Question 7

Respiratory system changes

Answer 7

TV increases
RR unchanged
PO2 increase
PCO2 fall 
Normal exertion dyspnoea

Question 8

Cardiovascular system changes

Answer 8

CO increase 30-50%
Blood volume increase --> dilutional anaemia 
HR increases by 10bpm
Vasodilation  
Aorta-caval compression

Question 9

GI system changes

Answer 9

Decreased tone of lower oesophagus
Delayed gastric emptying and bowel transit –> constipation
Increased intra-abdominal pressure

Question 10

GI changes can lead to Mendelson’s Syndrome

Answer 10

Chemical pneumonitis caused by aspiration during anaesthesia (due to reduced lower tone)

Question 11

Haematological changes

Answer 11

Iron deficiency anaemia
Increased clotting factor production
Increased risk of DVT

Question 12

Oral health changes

Answer 12

Hyper salivation 
Hypervascularity
Gingival hyperplasia
Altered immune response bacteria 
Gingivitis risk
Tooth mobility 
Erosion due to XS vomiting

Question 13

Pregnancy gingivitis

Answer 13

Aggravation of previous disease 
Plaque induced inflammation 
Similar histology 
Worsens through gestation period 
Usually resolves

Question 14

Pregnancy epulis

Answer 14

Granulomatous/fibrous hormonal response at pre-existing site of gingivitis
Often at labial interdental papillary gingiva upper jaw
Usually has a peduncle

Question 15

Pregnancy epulis aetiology

Answer 15

5% incidence
Plaque associated
Inflammatory cells and new capillaries and fibroblasts
Tends to regress but recur in subsequent pregnancies
Rare bone involvement

Question 16

Perio in pregnancy and adverse effects

Answer 16

Low birthweight
Preeclampsia
Prematurity and miscarriage

Question 17

Guidelines for imaging

Answer 17

Teratogenic
document status before x ray
shielding, restrict no. views/avoid completely

Question 18

Prescribing drugs

Answer 18

Highest risk 0-12 weeks

Neonatal dependence and withdrawn >28

Question 19

Antimicrobials

What to avoid

Answer 19

Avoid tetracyclines, augmenting, metronidazole before 28

Avoid ketconazole, miconazole and amphotericin

Question 20

Which antimicrobials are ok?

Answer 20

Penicillin, cephalosporins, erythromycin and nystatin

Metronidazole after 28 weeks

Question 21

Analgesis

Answer 21

Avoid NSAIDs >34

Use minimum dose of opioids for short time

Question 22

Anaesthesia

Avoid and OK

Answer 22

Avoid sedatives/hypnotics 
Avoid vasopressin (stimulant of uterus) 
Avoid GA, lowest risk in 2nd trimester 

Lignocaine/Prilocaine ok

Question 23

Amalgam

Answer 23

Exposure ~ low birth weight

avoid insertion or removal

Question 24

BF mothers

Answer 24

Drug levels lower in breast milk

Avoid tetracyclines and aspirin

Question 25

Prevention is key

Answer 25

Good OH and plaque control
Diet advice
Routine check ups