pregnancy in dental treatment
TRANSCRIPT
-
8/7/2019 pregnancy in dental treatment
1/62
Medical considerations
of the pregnancy indental treatment
Reporter :
Supervisor :
-
8/7/2019 pregnancy in dental treatment
2/62
Maternal concerns
Fetal concerns
Radiography
Medication
Summary
-
8/7/2019 pregnancy in dental treatment
3/62
Maternal concernsMaternal concerns
Fetal concerns
Radiography
Medication
Summary
-
8/7/2019 pregnancy in dental treatment
4/62
Maternal concernsMaternal concerns Anatomic change
Physiology changes
Psychological changes
-
8/7/2019 pregnancy in dental treatment
5/62
Anatomic changesAnatomic changes Uterus weight from 70gm 1 kg
Uterus volume from 10ml 5000 ml
Supine hypotensive syndrome
Acute hypotensive episode
-
8/7/2019 pregnancy in dental treatment
6/62
Supine hypotensive syndromeSupine hypotensive syndrome Third trimeter10~15%
Compression of inferior vena cava & aorta
Decrease venous return to heart Decrease uteroplacental perfusion and
fetal distress
-
8/7/2019 pregnancy in dental treatment
7/62
Prevention
Prevention
Left lateral decubitus position
Elevation the right hip 10~12cm
Sit up position
-
8/7/2019 pregnancy in dental treatment
8/62
Physiologic changes
Physiologic changes
Cardiovascular system
Respiratory system
Gastrointestinal system
Renal system
Hematological system
-
8/7/2019 pregnancy in dental treatment
9/62
Cardiovascular system
Cardiovascular system
Cardiac output increase 40%
Mean arterial BP decrease
Total blood volume increase 40~50%
(1500ml)
14th to 30th weeks heart rate increase 10
beats/min
-
8/7/2019 pregnancy in dental treatment
10/62
Respiratory system
Respiratory system
Diaphragm is displaced upward 3~4cm &
rib flare out with chest circumference of
5~7 cm
Oxygen consumption increase 15~20 %
Respiratory rate increase
-
8/7/2019 pregnancy in dental treatment
11/62
Gastrointestinal system
Gastrointestinal system
Increase gastric acid production
Decrease gastric mobility
Incompetence ofgastroesophagealsphincter
Esophageal reflux
Pernicious vomiting Constipation
-
8/7/2019 pregnancy in dental treatment
12/62
Renal system
Renal system
Increase GFR
Increase renal plasma flow
Urinary tract infection
-
8/7/2019 pregnancy in dental treatment
13/62
Hematological system
Hematological system
Plasma volume increase 40~70c.c./kg
Red cell volume increase 25-30c.c./kg
Hemoglobin & hematocrit volumedecrease
Plasma levels of factors VII, VIII, X and
fibrinogen increase Fibrinolytic activity decrease
-
8/7/2019 pregnancy in dental treatment
14/62
Psychological changes
Psychological changes
Hypersensitivity regarding her size &
appearance
Fear of pain, disability, death and for baby
Fear of dental procedures
Sedation empathy and reassurance
Minimize disturbanceinterruption & noises & toadjustroomtemperature & tominimizepossible
irritability
-
8/7/2019 pregnancy in dental treatment
15/62
Maternal concerns
Fetal concernsFetal concerns
Radiography
Medication
Summary
-
8/7/2019 pregnancy in dental treatment
16/62
Fetal concernF
etal concern Fetal development
Ovum- from fertilization to implantation period
Embryonic period- from the second through
eighth week
Fetal period- after the eighth week until term
-
8/7/2019 pregnancy in dental treatment
17/62
Ovum periodOvum period Conception() to 17 days
Cellular mitotic activity
Sensitivity to toxic substances which may
precipitate spontaneous abortion
-
8/7/2019 pregnancy in dental treatment
18/62
Embryonic period
Embryonic period
18-55 days (2nd~8th wk)
Organogenesis
Functional & morphologic malformation
-
8/7/2019 pregnancy in dental treatment
19/62
Fetal periodF
etal period 56 days until parturition
Growth & development
-
8/7/2019 pregnancy in dental treatment
20/62
The First Trimester (0-12 Weeks)
The Second Trimester (13The Second Trimester (13--28 Weeks)28 Weeks)
The Third Trimester (29-40 Weeks)
The Second TrimesterThe Second Trimester
-
8/7/2019 pregnancy in dental treatment
21/62
First trimesterF
irst trimester Most of the baby structure begin to
develop
Most susceptible to the risks of physical
and mental abnormalities
50% of abortion
5~7 wks in uterus cleft in lips & palate
-
8/7/2019 pregnancy in dental treatment
22/62
Fetal concernsF
etal concerns Avoidance of fetal hypoxia
Avoidance of premature abortion
Avoidance of teratogens
-
8/7/2019 pregnancy in dental treatment
23/62
Avoidance of fetal hypoxiaAvoidance of fetal hypoxia Uteroplacental blood flow & maternal
oxygenation
Hgb = 17gm/dl enhanced ability to extract
oxygen from maternal circulation
Maternal hypoxia from hypoventilation or
hypotention
-
8/7/2019 pregnancy in dental treatment
24/62
Avoidance ofpremature abortionAvoidance ofpremature abortion
Site of position
No relationship between premature labor(
) & local anesthesia
G.A. increase of fetal loss
-
8/7/2019 pregnancy in dental treatment
25/62
Avoidance of teratogensAvoidance of teratogens Before implantation (14days) death of the
ovum
14-60 days major morphologic defects
(organogenesis)
60 days later function impairment (reduce
intellect)
-
8/7/2019 pregnancy in dental treatment
26/62
Maternal concerns
Fetal concerns
RadiographyRadiographyMedication
Summary
-
8/7/2019 pregnancy in dental treatment
27/62
Radiogra
phy
Radiogra
phy
High dose (over 250rads) prior to 16 wks Microcephaly
Mental retardation
Cataracts ()
Microphthalamia
Growth retardation
Spontaneous abortion
High dose after20 wks Hair loss
Skin lesions
Bone marrow suppression
-
8/7/2019 pregnancy in dental treatment
28/62
Hazard from irradiation ofHazard from irradiation of
embryoembryo Death of embryo
Birth of a deformed child
Increase frequency ofmalignancy
decrease in childhood e.g. leukemia
-
8/7/2019 pregnancy in dental treatment
29/62
Hazard from irradiation ofHazard from irradiation of
embryoembryo 1 rad of utero radiation exposure has been
estimated to be approximately 0.1%
malignant disease
A dental periapical film 0.00001 rad (0.1
mrad)
Naturally occurring 1/2000
-
8/7/2019 pregnancy in dental treatment
30/62
RadiographyRadiography
An adverse fetal effects is unlikely to result
from exposure to less than 5 rads with lead
apron in place the female gonadal dose from asingle periapical radiographs is about 0.1
mrad.
-
8/7/2019 pregnancy in dental treatment
31/62
Procedure in making radiographsProcedure in making radiographs
forpregnancy patientsforpregnancy patients Make only the film absolutely essential for
diagnosing the conditions
Use lead-shielding Use long cone
Use propercollimation & shielding
Limited to affected tooth
Extra care should be used while taking essentialfilms to eliminate the need for repeated exposure
-
8/7/2019 pregnancy in dental treatment
32/62
Maternal concerns
Fetal concerns
Radiography
MedicationMedication
Summary
-
8/7/2019 pregnancy in dental treatment
33/62
MedicationMedication
Local anesthesia
Antibiotics
Analgesics
Corticosteroids
Sedatives
-
8/7/2019 pregnancy in dental treatment
34/62
Food and drug administrationFood and drug administration
(F.D.A) classification system(F.D.A) classification system
-
8/7/2019 pregnancy in dental treatment
35/62
Local anesthesiaLocal anesthesia
Local anesthesia are not teratogenic, and
may administered to pregnancy patient is
usual clinical doses.
Large dose ofprilocaine are know to
cause methemoglobinemia () which
could cause maternal & fetal hypoxia.
-
8/7/2019 pregnancy in dental treatment
36/62
VasoconstrictorsVasoconstrictors
Local vasoconstriction
Delay uptake from the site of injection
Increase the effectiveness & duration
There is no specific contraindication to these
vasoconstrictors in a pregnant patient although itis prudent to use minimal effective dose.
-
8/7/2019 pregnancy in dental treatment
37/62
Local anesthesiaLocal anesthesia
Convulsion in a sensitized mother could
also exert a teratogenic effect second to
hypoxia
The need for careful Hx taking & for
aspiration & slow injected technique is
obvious.
-
8/7/2019 pregnancy in dental treatment
38/62
AntibioticsAntibiotics
PenicillinPenicillin FDAB
All trimester are safe
No teratogenic
Pass the placenta
Inhibit cell wall synthesis
-
8/7/2019 pregnancy in dental treatment
39/62
TetracyclineTetracycline
Contraindication
Chelation with calcium & deposited in the
skeleton of the fetus resulting indepression of bone growth
Discoloration
Maternal fatty liver degeneration FDAD
-
8/7/2019 pregnancy in dental treatment
40/62
Chloramphenicol
Bone marrow depression irreversible
aplastic anemia agranulocytosis
FDAC
Gray-baby syndrome
Contraindication
-
8/7/2019 pregnancy in dental treatment
41/62
AminoglycosideAminoglycoside
Ototoxicity
Nephrotoxity
FDAD
-
8/7/2019 pregnancy in dental treatment
42/62
AnalgesicsAnalgesics
Identify the cause of the pain
Eliminate it rather than relying on
symptomatic relief with analgesic
medication
-
8/7/2019 pregnancy in dental treatment
43/62
AcetaminophenAcetaminophen
No teratogenesis
Most frequency used
Analgesic and antipyretic but no anti-
inflammation activity
-
8/7/2019 pregnancy in dental treatment
44/62
AspirinAspirin
Oral clefts and other defects
Intrauterin death,growth retardation,pulmonary
hypertention Longer pregnancies & longer the average period
of labor
Tetralogy of Fallot(Raot, RVhyperatrophy,Vsepdef,Pula.steno)
Increase the risk of antepartum and postpartumhemorrhage.
-
8/7/2019 pregnancy in dental treatment
45/62
NSAIDNSAID
Contraindication
Inhibit synthesis of postaglandins.
Constrict the ductus arteriosus &
persistent pulmonary hypertension &
increase mortality
-
8/7/2019 pregnancy in dental treatment
46/62
CorticosteroidCorticosteroid
Cleft palate
Inhibit brain growth
Indicated only for treatment of severe
systemic maternal illness (e.g. RA)
-
8/7/2019 pregnancy in dental treatment
47/62
Sedative agentsSedative agents
Barbiturates
Anxiolytic agents
Inhalational sedative
-
8/7/2019 pregnancy in dental treatment
48/62
BarbituratesBarbiturates
Cross the placental membrane
Chronic barbiturate use-withdrawal
syndrome
Cleft palate-lip
-
8/7/2019 pregnancy in dental treatment
49/62
Anxiolytic agentsAnxiolytic agents
Diazepam
Cleft lip and palate
Chronic diazepam user-tremors in infants
Accumulate in the tissue of fetus
-
8/7/2019 pregnancy in dental treatment
50/62
Inhalation sedativesInhalation sedatives
Increase the rate of spontanous abortion
in chronic exposed perons
Vit-B12cofactor of foliate metabolism
Foliate metabolism-thymidine formation
(DNA base)
N2Ooxidase Vit-B12
-
8/7/2019 pregnancy in dental treatment
51/62
The most care & consideration should be
given to use ofnonpharmalogical technique
such as good patient management verbalsedation.
-
8/7/2019 pregnancy in dental treatment
52/62
Obstetrical emergences in dentalObstetrical emergences in dental
officeoffice Syncope
Morning sickness
Seizure
Bleeding & cramping
-
8/7/2019 pregnancy in dental treatment
53/62
SyncopeSyncope
All trimester
Hypotensive, dehydration, anemia,
hypoglycemia and neurogenic disorder
Not revived with ammonia
Oxygen, vital sign, drinking fluid.
Cardiac dysrhythmia
-
8/7/2019 pregnancy in dental treatment
54/62
Morning sicknessMorning sickness
Enhanced gag reflex and decreased
gastric empting time
Aspiration of vomiting matter
Oropharygeal suction
Recumbent position
Chest compression
-
8/7/2019 pregnancy in dental treatment
55/62
SeizureSeizure
Eclampsia
Mortality rate17%
Under age 20,older than 35 and first-time
pregnancy,chronic hypertensive
pregnancy,obese pregnancy,multiple
gestation.
-
8/7/2019 pregnancy in dental treatment
56/62
SeizureSeizure
Aspiration of gastric content & hypoxia
Control ofairway
On herleft side
Oxygen & suction
Transfer
-
8/7/2019 pregnancy in dental treatment
57/62
PreclampsiaPreclampsia
Generalized edema
Elevated blood pressure
Proteinuria over 300mg
Hyperuremia
Headache, blurred vision, abnormal pain
-
8/7/2019 pregnancy in dental treatment
58/62
Bleeding & crampingBleeding & cramping
Precedes miscarriage
Active bleeding or painful contraction on
left site and oxygen,transfer
Minor contraction not painful on left site
not an emergency
-
8/7/2019 pregnancy in dental treatment
59/62
High risk pregnancyHigh risk pregnancy
Recent cramping
Light or intermittent bleeding or frank
bleeding
Diabetes
Hypertention preclampsis or elamposia
Multiple spontaneous abortion
-
8/7/2019 pregnancy in dental treatment
60/62
If question arise regarding a particular patient
status, consult the obstetrician before
beginning treatment.
-
8/7/2019 pregnancy in dental treatment
61/62
SummarySummary
Supine hypotensive syndrome
Radiography minimal
Medication penicillin ,ACT
Emergency A,B,C
History taking, medical consultation, transfer
-
8/7/2019 pregnancy in dental treatment
62/62
Thanks forUrAttention !
The End