Pregnancy.CH48
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Transcript Pregnancy.CH48
CHAPTER 48
THE PREGNANT PATIENT
LISA MAYO, RDH, BSDH
Pregnancy
Review Sheet CH48 #1
Prenatal care
Supervised
preparation for childbirth that helps
the mother enjoy optimum health during
Provides the maximum chance for the baby to be
born healthy
Fetal Development
Review Sheet CH48 #2
Normal pregnancy = 40 wks
Premature birth = Prior to 37wks
3 trimesters
Fetal Development
Review Sheet CH48 #3
First trimester
Embryo highly susceptible to injuries and malformations
Teratogenic effects
All organ systems are forming (organogenesis)
12 weeks = fetus moves and swallows
Oral cavity development
Teeth: Tooth buds 5-6wk, initial mineralization occurs 4-5mo
Second trimester
All organs completed, growth & maturation continue
Fetal wt: changes 1oz every 3mo
Review Sheet CH48 #4-5
Factors That Can Harm the Fetus
Infections: rubella, rubeola, varicella, HIV, Hep B, syphilis,
gonorrhea
Perio: pre-term, low birth weight babies
Medications and other drug use (Table 48-1)
Nearly all drugs can pass across the placenta to enter the
circulation of the developing fetus
Many drugs have tetratogenic effects
Cont’d next slide
Review Sheet CH48 #4-5
Factors That Can Harm the Fetus
Meds
Tetracycline
Intrinsic staining of teeth
Herbal supplements: efficacy not regulated by FDA
Therapy for HIV
Some antiretroviral meds are NOT withheld because of
pregnancy
Consideration by the mother can be given to withholding the
antiretroviral tx 1st 14 weeks of pregnancy
Review Sheet CH48 #6, 12
Oral Findings During Pregnancy
Gingivitis
Clinical
appearance will vary
Shows
characteristics of inflamed tissues
Predisposing
factors
Local
irritation & infection because of poor oral
hygiene
Hormonal changes that may alter the tissue reaction
Microbiology
↑
Prevotella intermedia (NBQ)
Oral Findings During Pregnancy
Pyogenic granuloma / Epulis gravidarum / Pregnancy Tumor /
Pregnancy granuloma
Benign inflammatory lesion
Isolated, discrete, soft, round enlargement near the gingival
margin usually associated with an interdental area
Painless
Color varies w/vascularity
Bleeds readily
Review Sheet CH48 #6-7
Pyogenic Granuloma
DENTAL MANAGEMENT
OF
PREGNANT PATIENT
Oral Findings During Pregnancy
Enamel erosion
Morning sickness w/ vomiting over extended periods of time
Recommendations
Sodium bicarb rinses
Sugarless gum after eating (xylitol the best)
Gentle toothbrushing – low abrasive tp
Radiography
Not done unless necessary
Protection
Lead
apron
Thyroid collar
Exposures
Minimum
# of films as possible
Overall Treatment Considerations
Appointment planning
Frequency:
monthly or 3x during 9-mo pregnancy
Shorter appts best
2nd trimester best for dental tx (NBQ)
Consult w/ OBGYN prior to tx
Clinical care: Table 48-2, p.748
Overall Treatment Considerations
PATIENT POITIONING
Supine Position:
Weight of developing fetus in the uterus bears down
directly on the major vessels, aorta, inferior vena
cava
Vessels are pressed between the spinal column &
uterus
Overall Treatment Considerations
PATIENT POSITIONING
Review Sheet CH48 #14
Supine Hypertensive Syndrome
Emergency: Patient is lying in supine position. Abrupt fall in
blood pressure
Impaired venous return - pressure of uterus on inferior vena
cava
Loss of consciousness
Emergency Tx
Roll the patient over to her left side to relieve pressure of
uterus on vena cava
Roll to left side!
Dental Hygiene Care
Ultrasonic not contraindicated
LA used in moderation
No nitrous 1st trimester
2nd/3rd
= great precaution, length 30min w/O2 50%
Patient Instruction
Emphasis on general health
Anticipatory guidance for child
Dental biofilm control
Prevent perio
Smoking cessation
Dental Caries Control
Incidence during pregnancy: rsrch says increase
risk for caries not related to pregnancy itself, but
indirectly
Contributory factors
Previous neglect
Diet during pregnancy
Neglect of personal oral care
Dental Caries Control
Calcium and the mother’s teeth
Misconception
calcium withdrawal from moms teeth
Minerals contained in the erupted tooth enamel &
dentin are not available = no removal of minerals
can occur by way of pulp
Minerals are removed from the external surface of
the enamel and exposed root surface in the process
of demineralization
Dental Caries Control
Fluoride program
Topical
solution, gel, varnish after scaling and root
planing
Fluoride dentifrice
Pregnant adolescent = comprehensive fluoride plan
Special Problems for Referral
Domestic Violence
Identification
Common
sites of injury: head, face, neck
Miscarriages, spontaneous/mult abortions, substance
abuse, depression, suicide attempts
What to do: provide pt info about intervention
programs, ask pt if they want help, police, refer