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  • 1. Pregnancy & Breast Feeding December 4th 2005 Dr. Suresh. C. S. BDS; MDS; MDSc ( UK ) Oral Diagnosis I
  • 2. Overview  Pregnant patients are not considered medically compromised patients.  Pregnant patients poses a unique set of management considerations for the dentist.  Dental care must be rendered to the mother without adversely affecting the developing fetus.
  • 3. Overview (Cont.)  Providing routine dental care to pregnant patients is generally safe. However, the potentially harmful elements including:  Ionizing radiation  Drug administration
  • 4. Physiology & Complications  During pregnancy, several cardiovascular changes occur:  Blood volume increases 40%.  Cardiac output increases 30-40%.  RBC volume increases only about 15-20%.  Blood pressure falls (100/70 mm Hg).  Heart murmur (90% of cases).
  • 5. Physiology & Complications  During late pregnancy a supine hypotension syndrome may occur:  Abrupt fall in blood pressure  Bradycardia  Sweating  Nausea  Weakness  Air hunger when the patient is in supine position
  • 6. Physiology & Complications Normal pregnancy lasts about 40 weeks:  During the first trimester, formation of organs and systems occurs (fetus most susceptible to malformation).  After the first trimester, the majority of formation is complete (growth & maturation).
  • 7. Physiology & Complications  Complications of pregnancy  More common in expectant mothers who harbor pathogens:  Infections  Glucose abnormalities  Hypertension  Might results in perinatal abnormalities and congenital anomalies
  • 8. Dental Management  Dentist should determine the general health of the patient:  Proper medical history  Current physician  Gestational diabetes  Miscarriage  Hypertension  Morning sickness
  • 9. Dental Management Preventive program  Establish a healthy oral environment and an optimum level of oral hygiene  Minimize the exaggerated inflammatory response  Studies have shown that maternal periodontal disease increases the infant risk for low birth weight  Uses of prenatal fluoride and oral hygiene measures benefits the mother & the newborn without risk
  • 10. Dental Management Treatment Timing  Elective dental care is best avoided during the first trimester  The second trimester is the safest period which to provide routine dental care  After the middle of third trimester, elective dental care is best postponed  Prolonged time should be avoided
  • 11. Dental Management Dental Radiographs Irradiation should be avoided especially in the first trimester of pregnancy If radiographs becomes necessary, the dentist must be aware of how to proceed safely
  • 12. Dental Management Drug Administration Ideally, no drug should be administered during pregnancy, especially the first trimester. Counseling should be provided to make sure that pregnant women clearly understand the magnitude of risk associated with drug
  • 13. Dental Management Drug Administration The dentist should be familiar with FDA categorization: A: controlled studies in humans have failed to demonstrate a risk to the fetus. B: animal studies have not indicated fetal risk. C: animal studies have shown a risk. D: positive evidence of human fetal risk exists. E: evidence of fetal abnormalities and fetal risk exists.
  • 14. Dental Management Breast Feeding Careful drug selection for the nursing mother should be made. Authorities suggest that she takes the drug just after breast feeding and avoid nursing for 4 hours or more if possible.
  • 15. Oral Complications & Manifestations Pregnancy gingivitis  Exaggerated inflammatory response to local irritants.  The most common location of pyogenic granuloma is the labial aspect of the interdental papillae  A relationship between dental caries and physiologic process of pregnancy has not been demonstrated
  • 16. Pyogenic Granuloma