Periodontology And Pregancy Flashcards
(25 cards)
Breastfeeding up to _____ months is associated with a decreased risk of _____
12 month; tooth decay
First trimester perio issue: rising estrogen and progesterone in the pregnant woman can cause…
Increased vasodilation so more bleeding on probing.
First trimester: how else might pregnant patients be at risk of periodontal pocketing?
Folate metabolism changes more at risk of bacteria ingression = deeper pockets.
What LA is avoided in pregancy?
Articaine and anaesthetics with felypressin (i.e. prilocaine)
Where can you find guidelines for treating pregnant patients?
EFP guidance
Periodontitis treatment may be avoided by dentists, why would this be detrimental?
- Periodontitis will worsen, crossing pocket wall could contribute to immune response
- Should deliver basic care OHI, fluoride use, PREVENTION
Why might a pregnant patient be on Fragmin and how would this affect dental care?
Reduces risk of blood clots (blood thinners), check anticoagulant guidelines.
Second trimester?
Weeks; 28 weeks (will be having scans/midwifery care)
Second trimester: antibiotics?
Avoid metronidazole/tetracyclines.
Amoxicillin is opted for.
Second trimester: What is this?
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.
Second trimester; caries control management?
The safest trimester to treat!
Patient is feeling their best right now.
Don’t remove amalgams (unless in the patients best interest).
If you had to remove the amalgam, to keep it safe you would…
Rubber dam, good aspiration, discuss with patient. Simple cut and flick out.
Second trimester: SUBGINGIVAL PMPR?
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.
Third trimester?
Weeks; 29-40 weeks.
Third trimester: positioning?
Elevation of the right leg.
NOT SUPINE.
Avoid compression of vena cava.
Third trimester: guidelines
Avoidance of felypressin.
Third trimester: bleeding on probing?
At its maximum
Third trimester: periodontal precautions?
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.
What other conditions can occur during the third trimester that are linked to periodontitis?
Pregnancy induced diabetes and anemia
Fourth trimester: treatment for periodontitis and removal of restorations?
- 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.
Benefits of breast feeding
- 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).
summary of treatment for the pregnant patient
Main issues with periodontitis in a pregnant patient
- Miscarriage
- Pre-eclampsia
- Preterm low birthweight
Why my periodontal disease cause preterm labour ?
Increased cytokines levels
