CHAPTER 48THE PREGNANT PATIENT

LISA MAYO, RDH, BSDH

Pregnancy

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

Normal pregnancy = 40 wks Premature birth = Prior to 37wks 3 periods

1. First trimester2. Second trimester3. Third trimester

Fetal Development

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

Factors That Can Harm the Fetus Infections: rubella, rubeola, varicella, HIV, Hep B,

syphilis, gonorrhea Perio d.: 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 teratogenic effects Cont’d next slide

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

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

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, varies w/ patient needs Shorter appts best: tire easily, frequent

urination, back ache, gag issues, taste alteration

DH appts early in pregnancy 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 ConsiderationsPATIENT POSITIONING

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 concerning the withdrawal of

calcium from the mother’s teeth and its relationship to dental caries is widespread

Minerals contained in the erupted tooth enamel and dentin are not available, and no removal of minerals can occur by way of the pulp

Minerals are removed from the external surface of the enamel and exposed root surface in the process of demineralization (biofilm, diet, sickness)

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