Pregnant and nursing patient 2 - treatment and materials Flashcards
Regarding pregnancy and dental treatment, what 3 things need to be considered?
- the pregnant patient
- the unborn child
- members of the dental team
What dental problems may a pregnant patient face?
- increased caries and erosion risk (sugary diet, acid reflux)
- increased periodontal disease risk
- increased tooth mobility due to disturbances in PDL attachment
When is the foetus most prone to teratogenic effects?
1st trimester
What are teratogenic effects?
effect of drugs on the development of the foetus
Why is it important to not treat a pregnant patient supine in the 3rd trimester?
for the prevention of hypotensive syndrome
- correct positioning avoids maternal vena cava and aorta compression
What positioning do some recommend for pregnant patients in the 3rd trimester?
- right hip elevated 10-12cm
OR - 5-15% tilt to left hand side aided by positioned blanket
(correct position avoids maternal vena cava and aorta compression)
When was there first awareness that the placental barrier is imperfect?
in the late 1950s and 1960s
What does the placental barrier act as?
an interface between mother and foetus
- gas exchange and transfer of nutrients and waste products
- mother to foetus transfer of immunity
- secretion of hormones for foetal growth and development
When is the foetus at greatest risk due to the imperfect placental barrier?
during organogenesis that takes places in 1st trimester
What can the potential mechanisms of transfer across the placental barrier depend on?
- molecular weight
- lipid solubility
- degree of ionisation
- protein binding
What dental materials have been most investigated?
dental amalgam and resin composite
What determines the cellular uptake of mercury in amalgam?
the chemical form of mercury
- mercury vapour: passive diffusion
- methyl mercury: active transport by amino acid carriers
What is the use of dental amalgam NOT allowed for?
- children under 15 years old
- pregnant women
- breastfeeding women
- EXCEPT when deemed strictly necessary by the dental practitioner based on the specific medical needs of the patient
What do the restrictions on amalgam use mostly relate to?
the environmental need to reduce mercury in the environment
What component of resin composites have concerns been raised about?
elation of bisphenol A (BPA)
