Week 4 - Pregnancy & MRONJ Flashcards
pregnancy: what are they key concerns when it comes to dental treatment?
- LA
- radiography
- amalgam
- prescribing
pregnancy: which stages in the pregnancy should we avoid elective dental care?
- first trimester
- final part of third trimester
pregnancy: when is the best stage of pregnancy to do treatment?
second trimester; 14-20 weeks best. low risk of pregnancy loss, more comfortable for pt
pregnancy: alternative materials to amalgam should be used for what type of patients?
- children with primary teeth
- pregnant patients
pregnancy: antibiotics - which ones are not known to be harmful?
amoxicillin cefalexin cefradine clindamycin co-amoxiclav erythromycin phenoxymetyl penicillin
pregnancy: treatment of bacterial infections:
antibiotics - which one should be avoided in high dose regimens?
metronidazole
pregnancy: treatment of viral infections: which medication is not known to be harmful? use only when?
- aciclovir
- use only when potential benefits outweigh risks
pregnancy: treatment of fungal infections - prescribe what?
nystatin suspension can be given
pregnancy: treatment of pain: which painkiller is not known to be harmful?
paracetamol
pregnancy: local anaesthetic - which ones can be given?
- lidocaine with epinephrine, prilocaine
- mepivacaine: use with caution in early pregnancy
- articaine: only if benefit outweighs risk, no info available
pregnancy: the oral manifestations in pregnancy are secondary to what factors?
- increased vascular permeability
- decreased immunocompetence
- increased susceptibility to infection
pregnancy: changes in what lead to the occurrence of pregnancy gingivitis?
- progesterone: it changes the composition of oral flora to be more pathogenic
pregnancy: what other oral manifestations are seen?
- ptyalism: excess production of saliva that is linked to nausea (settles at 12-14 weeks)
- erosion: secondary to vomiting and GORD
- increased dental caries
pregnancy: pregnant women with gestational diabetes, more likely to have what oral disease?
- perio disease
pregnancy: oral health - complications & adverse outcomes: association between periodontitis and what factors?
- pre-term birth
- low birth weight
- pre-eclampsia
pregnancy: poor maternal oral health, increased risk of?
how to prevent? prevention measures result in?
- early childhood caries in child
- topical antibacterials e.g. xylitol, Chx in late pregnancy + post partum
- reduced bacterial load, reduced transmission of oral bacteria from mother to child
MRONJ: definition?
exposed bone or bone that can be probed through an intra-oral or extra-oral fistula in the maxillofacial region jaw that has persisted for more than 8 weeks
no history of radiation therapy to the jaws or metastatic disease to the jaws
MRONJ: medications associated with MRONJ?
- bisphosphonates
- RANK ligand inhibitor: denosumab
- anti-angiogenic medications:
1) tyrosine kinase inhibitors,
2) monoclonal antibodies against vascular endothelial growth factor
MRONJ: action of bisphosphonates?
- deposited in bone where they persist
- inhibit the formation, recruitment and function of osteoclasts
- increase apoptosis of osteoclast
- anti-angiogenic
MRONJ: indications for bisphosphonates?
- osteoporosis
- osteogenesis imperfecta
- primary hyperparathyroidism
- paget’s disease
- fibrous dysplasia
- cystic fibrosis
- multiple myeloma
- breast cancer
- prostate cancer
- bony metastatic lesions
- hypercalcaemia of malignancy
MRONJ: route of administration for bisphosphonates?
- oral: osteoporosis, osteopenia etc
- intra venous: cancer related conditions, yearly for osteoporosis
MRONJ: denosumab action?
- antibody against RANK ligand
- inhibits osteoclast function
- inhibits bone resorption
- *does not bind to bone
MRONJ: denosumab indications?
osteoporosis
metastatic bone disease
MRONJ: anti-angiogenics?
sunitinib (TKI)
bevacizumab (anti-VEGF)
MRONJ: anti-angiogenics indications?
RANK
MRONJ: pathogenesis?
- reduced bone turnover
- reduced vascularity
- inflammation/infection
- adverse effects on soft tissues
- immune dysfunction
MRONJ: risk factors?
- potency
- route of administration
- cumulative dose
- anti-angiogenic + bisphosphonate medication?
MRONJ: when is a pt low risk?
oral or intravenous bisphosphonate/denosumab treatment for osteoporosis or Paget’s disease
MRONJ: when is a pt high risk?
IV bisphosphonates,
denosumab,
anti-angiogenics for malignant conditions
- previous MRONJ
- systemic corticosteroids
- immunosuppresants
- coagulopathy
- chemotherapy
- radiotherapy
MRONJ: risk factors for dental procedures?
dento-alveolar periodontal deep root planing periapical complex restorations implants
