Pregnant Safe Patient Care (E,D&I)

Question 1

First aim of any patient appointment

Answer 1

Pain relief!

Question 2

Pregnant patient: need to take out infected amalgam fillings?

Answer 2

Avoid where possible. Where necessary discuss risks with patient, use rubber dam/high speed (this will mitigate risk).

Question 3

Pregnant patient: how would it affect your patient if you didn’t remove painful amalgam fillings?

Answer 3

Could cause further stress down line (bad for the baby), as well as may require painkillers which are limited when pregnant.

Question 4

Pregnant patient: How would you discuss the need for radiographs with a concerned patient?

Answer 4

Radiation does is incredibly low (i.e. transatlantic flight/some bananas). Moreover, the x-ray beams are not pointing anywhere near the developing baby.

Question 5

Pregnant patient: why would you encourage the patient to continue with treatment?

Answer 5

Less chance of infection, inflammation. No evidence for negative impacts.

Evidence for not treating has been shown to have signs of preeclampsia, low birth weight.

Question 6

Pregnant patient: What may you be cautious of a pregnant women in the first trimester?

Answer 6

Morning sickness (can occur at any time of day —> ask patient when suits THEM best.)

Question 7

Pregnant patient: positioning in the chair

Answer 7

Question 8

Breastfeeding up to _____ months is associated with a decreased risk of _____

Answer 8

12 month; tooth decay

Question 9

First trimester perio issue: rising estrogen and progesterone in the pregnant woman can cause…

Answer 9

Increased vasodilation so more bleeding on probing.

Question 10

First trimester: how else might pregnant patients be at risk of periodontal pocketing?

Answer 10

Folate metabolism changes more at risk of bacteria ingression = deeper pockets.

Question 11

What LA is avoided in pregancy?

Answer 11

Articaine and anaesthetics with felypressin (i.e. prilocaine)

Question 12

Where can you find guidelines for treating pregnant patients?

Answer 12

EFP guidance

Question 13

Periodontitis treatment may be avoided by dentists, why would this be detrimental?

Answer 13

Periodontitis will worsen, crossing pocket wall could contribute to immune response
Should deliver basic care OHI, fluoride use, PREVENTION

Question 14

Why might a pregnant patient be on Fragmin and how would this affect dental care?

Answer 14

Reduces risk of blood clots (blood thinners), check anticoagulant guidelines.

Question 15

Second trimester?

Answer 15

Weeks; 28 weeks (will be having scans/midwifery care)

Question 16

Second trimester: antibiotics?

Answer 16

Avoid metronidazole/tetracyclines.

Amoxicillin is opted for.

Question 17

Second trimester: What is this?

Answer 17

Pregnancy epulis/granuloma. Swelling on gingival that bleeds on brushing - isn’t painful.

Very vascular, due to hormones high levels of progesterone and vascularity (will go away after birth).

Treatment: increase OH, monitor - will go away post-partum.

Question 18

Second trimester; caries control management?

Answer 18

The safest trimester to treat!
Patient is feeling their best right now.

Don’t remove amalgams (unless in the patients best interest).

Question 19

If you had to remove the amalgam, to keep it safe you would…

Answer 19

Rubber dam, good aspiration, discuss with patient. Simple cut and flick out.

Question 20

Second trimester: SUBGINGIVAL PMPR?

Answer 20

Keep it supragingival - safe.

Risks associated with SUBGINGIVAL debridement —> ingress of bacteria into the bloodstream, thus inflammatory response will increase.

SUBGINGIVAL is ok but provide small treatment per appointment e.g. 3-4 teeth per session.

Question 21

Third trimester?

Answer 21

Weeks; 29-40 weeks.

Question 22

Third trimester: positioning?

Answer 22

Elevation of the right leg.

NOT SUPINE.

Avoid compression of vena cava.

Question 23

Third trimester: guidelines

Answer 23

Avoidance of felypressin.

Question 24

Third trimester: bleeding on probing?

Answer 24

At its maximum

Question 25

Third trimester: periodontal precautions?

Answer 25

Periodontal disease at this time can stimulate prostaglandins;

Therefore adverse effects associated with this disease can be preterm labour/premature birth.

VERY important that treatment is given to prevent this.

Question 26

What other conditions can occur during the third trimester that are linked to periodontitis?

Answer 26

Pregnancy induced diabetes and anemia

Question 27

“Fourth” trimester: treatment for periodontitis and removal of restorations?

Answer 27

Mother’s condition: very difficult for the mother as they are caring for the baby. May be feeling unmotivated/low = postpartum depression due to hormones dropping.
Articaine isn’t licensed for breast feeding.
Caries rate is high due to poorer diet at this time.
Amalgam restoration should be avoided - this can still pass through into breast milk.

Question 28

Benefits of breast feeding

Answer 28

IgA antibody protection for baby.
Full of vitamins/fat/nutrients.
Majority of the components of breast milk are not being absorbed by the baby - they are supporting the microbiome (prebiotics).

Question 29

Main issues with periodontitis in a pregnant patient

Answer 29

Miscarriage
Pre-eclampsia
Preterm low birthweight

Question 30

Why my periodontal disease cause preterm labour ?

Answer 30

Increased cytokines levels

Question 31

Things to not prescribe to a pregnant patient

Answer 31

Aspirin - haemorrhage risk/reye’s syndrome
Tetracyclines - dental defects
Prilocaine w/ felypressin - oxycitocitic effects —> early labour?
Fluconazole - teratogenic
Miconazole - teratogenic
Clarithromycin - not in trimester 1st.
Ibuprofen - grey area
Metronidazole - grey area
Corticosteroids - grey area (topical should be fine)
High does fluorides - fluorosis risk
Azithromycin - only if alternatives unavailable