Pregnancy Flashcards
During pregnancy, state:
- The changes in tissue structure
- Host response
- Causes of the host response
- Microbiology
Changes in tissue structure:
• Tissue and gingival enlargement
Host response:
• Exaggerated response to biofilm
• Microbiology leads to increased severity and prevalence of periodontal disease in pregnancy
Causes of the host response:
• Increased progesterone: leads to increased levels of GCF and elevated levels of Porphyromonas species
Microbiology:
• Increased levels of Red and Orange complexes (first and second colonisers)
Specifically talk about the microbiological changes, and mention in which trimester it occurs in.
Microbiology:
• Increase in anaerobic bacteria during the 2nd trimester
• Increase in P. intermedia
• Elevated levels of Porphyromonas species due to increased progesterone
• Increased levels of Red and Orange complexes (first and second colonisers)
List the four ways a safe radiograph can be taken during pregnancy
- Optimum filtration
- Collimation
- Use of fastest film
- Extended target film distance
Discuss the concept of teratogenic effects in terms of:
- Concept/ when the foetus is most susceptible
- Causes of teratogenic effects
- Medications that cause teratogenic effects
- Management of infections during pregnancy
Concept:
• Occurs mainly during the first trimester
• During this time, the embryo is highly susceptible to injuries as organ systems are being formed
Causes of teratogenic effects:
• This is known as teratogenic effects such as maternal poor nutrition, infection and drug intake
• Thus, no medications or other drugs should be used during pregnancy as all drugs can pass across the placenta to enter the circulation of the developing fetus
Medications that cause teratogenic effects:
• Tetracycline is well known for its effects of intrinsically staining tooth structure
Management of infections during pregnancy:
• If a mother has HIV/AIDS infection, then the prevention of perinatal HIV transmission and health of the foetus and neonate are considered in the healthcare plan
Discuss the development of the oral cavity in the foetuses and state when these stages occur (weeks/ months) • 5 - 6th week: • 7th week: • 8 - 12 weeks: • 12th week: • 4 - 5th month:
5 - 6th week:
• Tooth buds develop
7th week:
• Lips form
8 - 12 weeks:
• Palate forms
• Cleft lip is apparent by the eighth week
• Cleft palate is apparent by the twelfth week.
12th week:
• The fetus moves and swallows
4 - 5th month:
• Initial mineralization of teeth
Know the number of weeks considered to be:
- A normal gestation
- Premature birth
- Preterm birth
Normal gestation:
• 40 weeks
Premature birth:
• Birth before 37 weeks
Very preterm:
• Live birth less than 32 weeks
• Development of the embryo is dependant on the health and genes (hereditary) of mother
State what is considered a low birth weight
Low birth weight = less than 2.5 kg
Discuss the causal relationship between periodontal disease and increased risk for adverse pregnancy outcomes
Biological evidence that periodontal pathogens are associated with:
i. Inflammation of amniotic fluid
ii. Foetal inflammation
- Pregnancy periodontal disease can result in; preterm birth, growth restriction, preeclampsia, foetal loss, and still births
- Preeclampsia: a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys
- Bacterial products like endotoxin lipopolysaccharide(LPS) can lead to maternally produced inflammatory mediators
- Prostaglandins (PGs) play an important role in regulating the onset of labor, uterine contractions and delivery
- However, PGs play a role in periodontal disease and increased levels can result in premature or low birth weight babies
- Recent studies have found an association between periodontal disease and gestational diabetes
List the risk factors for pre- eclampsia
- Pre-existing diabetes
- First pregnancy
- Periodontitis
Describe pyogenic granuloma (pregnancy epulis) in terms of:
- Shape
- Location
- State (malignant or benign)
- Pain
- Causes
- Characteristics
- How long it lasts
Shape:
• It is a mushroom-like growth
Location:
• It is more common in the maxilla and in gingival papillae
State (malignant or benign):
• Not cancerous
Pain:
• Not painful
Causes:
• There is an exaggerated response to an irritation
Characteristics:
• Growth bleeds easily if disturbed
How long it lasts:
• Usually regresses after giving birth
Does periodontal treatment during birth have a negative impact on pre-term birth or low birth weight?
Does periodontal treatment during birth have a preventative impact on verse obstetric outcomes?
Based on 15 studies, insufficient evidence to determine these two points
Discuss the oral conditions often associated with pregnancy (9)
Including the statistic on gingivitis
- Periomolysis (dental erosions) due to “morning sickness”
- Xerostomia
- Other growths
- Increased vasculature and gingival enlargement
- Exaggerated response to biofilm response
- Granulomas
- High GCF levels
- Periodontal status prior to pregnancy may affect progression of disease
- Composition of microflora changes, with increased anaerobes in 2nd trimester and P intermedia
GINGIVITIS OCCURS IN 30% -100% OF WOMEN
Discuss the role of the Oral Health Therapist when treating pregnant patients
- MHx -> vomiting, pregnancy complications
- BE AWARE of physiological events, increase in vascularity and possible incidence of bleeding and gingival enlargement
- Need to discuss the oral health impact on general health, fetus and newborn
- The importance of good oral hygiene and the role of biofilm, especially ID cleaning
- Emphasize the need for regular dental hygiene appointment during and after the pregnancy
- Scaling and debridement IDEALLY done in 2nd trimester
- Discuss the importance of nutrition on the developing fetus and encourage food from all food groups whilst limiting fermentable carbohydrates
- Impact of smoking and drugs on the fetus
- X ray can be given safely at any stage, use a lead drape
Describe how the pregnant patient should lie down during dental treatment
- Avoid prolonged chair time and position patient comfortably
- To prevent compression of vena cava and “supine hypotension syndrome”, place soft wedge (E.g. rolled towel) under patient’s right side and have the patient turn to their left side
