Pregnancymod Final Cut1


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Pregnancymod Final Cut1

  1. 1. <ul><li>DENTAL MANAGEMENT IN PREGNANCY </li></ul><ul><li>PRESENTED BY </li></ul><ul><li>Feras Al-Halabi </li></ul><ul><li>Abdulaziz Al-Abdulwahed </li></ul><ul><li>Mohammed Al-Dhubaiban </li></ul><ul><li>SUPERVISED BY: </li></ul><ul><li>DR. Naveed Khawaja </li></ul>13 - Jan- 2007
  2. 2. <ul><li>Why do we discuss pregnancy ? </li></ul><ul><li>What is the definition of pregnancy ? </li></ul><ul><li>Is there any changes during pregnancy ? and, will it affect dental treatment ? </li></ul><ul><li>Is X-ray safe for a pregnant patient ? </li></ul><ul><li>Can we prescribe drugs during pregnancy ? </li></ul><ul><li>Amalgam and pregnancy, is there any concern ? </li></ul><ul><li>How to manage pregnant women in dental chair ? </li></ul>
  3. 3. Why do we discuss pregnancy ? <ul><li>Dentist throughout their professional careers will face the responsibility of providing appropriate care for the pregnant women. </li></ul><ul><li>Understanding the changes occurring in the pregnant patient is essential to deliver treatment with optimum safety to both mother & child. </li></ul>
  4. 4. Definition <ul><li>Pregnancy is the period of time between fertilization of the ovum (conception) & birth. </li></ul><ul><li>Duration: </li></ul><ul><li>280 days = 40 weeks = 9 months. </li></ul><ul><li>changes are : </li></ul><ul><li>physical, physiological & psychological. </li></ul>
  5. 5. The Changes of Pregnancy <ul><li>The cardiovascular changes </li></ul><ul><li>Respiratory changes </li></ul><ul><li>Hematological change </li></ul><ul><li>Renal changes </li></ul><ul><li>Gastrointestinal changes </li></ul><ul><li>Psychological Changes </li></ul><ul><li>Oral Changes </li></ul>
  6. 6. The Cardiovascular Changes <ul><li>The main cardiovascular changes are : </li></ul><ul><li>An increase in the total blood volume & cardiac output in late 2 nd & 3 rd trimester </li></ul><ul><li>A decrease in blood pressure in 1 st trimester </li></ul><ul><li>Dental Concern: </li></ul><ul><li>Supine hypotensive syndrome </li></ul><ul><li>Etiology </li></ul><ul><li>Signs & symptoms </li></ul><ul><li>Management </li></ul>
  7. 7. Respiratory Changes <ul><li>Main changes are: </li></ul><ul><li>Dyspnea </li></ul><ul><li>Hyperventilation </li></ul><ul><li>An increase in tidal volume </li></ul><ul><li>Dental concern: </li></ul><ul><li>placing the patient in supine position may precipitate dyspnea </li></ul>
  8. 8. Hematological change <ul><li>Hematological changes are : </li></ul><ul><li>An increase in : </li></ul><ul><li>Plasma volume </li></ul><ul><li>Red blood cells </li></ul><ul><li>White blood cells </li></ul><ul><li>All coagulation factors except factors XI and XIII </li></ul><ul><li>Dental concern: </li></ul><ul><li>The patient considered in hyper- coagulable state increasing the risk of thromboembolism. </li></ul>
  9. 9. Renal Changes <ul><li>Renal Changes are : </li></ul><ul><li>Increased glomerular filtration rate (GFR). </li></ul><ul><li>The increase in the renal plasma flow. </li></ul><ul><li>Increase frequency of urination. </li></ul><ul><li>Dental concern: </li></ul><ul><li>It is advisable to ask the patient to void their bladder before dental procedure. </li></ul>
  10. 10. Gastrointestinal Changes <ul><li>Main Changes are : </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Heartburn “Pyrosis” </li></ul><ul><li>Dental concern: </li></ul><ul><li>Avoid morning apointments. </li></ul><ul><li>Advice the patient to avoid citris and fatty food. </li></ul><ul><li>Prescribe fluoride mouth wash. </li></ul><ul><li>Advice patient to avoid brushing. </li></ul>
  11. 11. Psychological Changes <ul><li>Main changes : </li></ul><ul><li>Anxiety </li></ul><ul><li>Emotional instability frequent changes in mood, ranging from happiness to depression. </li></ul><ul><li>Dental concern: </li></ul><ul><li>The dentist should minimize disturbances & noises adjust room temperature minimizing the irritability to the patient. </li></ul>
  12. 12. Oral Changes <ul><li>Pregnancy gingivitis </li></ul><ul><li>Pregnancy tumor </li></ul><ul><li>Tooth mobility </li></ul><ul><li>Dental caries </li></ul><ul><li>Facial pigmentation (melasma) </li></ul>
  13. 13. Pregnancy gingivitis
  14. 14. <ul><li>Effect of periodontal disease on the fetus : </li></ul><ul><li>chronic periodontal disease during pregnancy increases the likelihood of preterm delivery by 4 to 7 fold. </li></ul><ul><li>positive correlation between periodontal disease and low birth weight </li></ul>Pregnancy gingivitis
  15. 15. Pregnancy tumor
  16. 16. Tooth mobility
  17. 17. Dental caries
  18. 18. <ul><li>Effect of the caries on the fetus : </li></ul><ul><li>A recent study has found a significant association between high levels of actinomyces naeslundii , an oral bacterium associated with dental caries, and low birth weight and preterm delivery </li></ul>Dental caries
  19. 19. Facial pigmentation (melasma)
  20. 20. Dental Radiographs for Pregnant Women <ul><li>Do we use radiographs In pregnant patients? </li></ul>
  21. 21. Dental Radiographs for Pregnant Women Full month series, 1 X 10 -5 (18 intraoral D film, lead apron) Panoramic film 15 X 10 -5 Daily radiation (cosmic) 4 X 10 -4 Skull 4 X 10 -3 Chest 8 X 10 -3 Radiographs Exposure in Gy
  22. 22. <ul><li>Although, the practitioner must use the necessary precautions, such as the use of : </li></ul><ul><li>High-speed film </li></ul><ul><li>Filtration, </li></ul><ul><li>Collimation </li></ul><ul><li>Lead aprons . </li></ul><ul><li>greatly reduce exposure and the use of digital radiography </li></ul>Dental Radiographs for Pregnant Women
  23. 23. <ul><li>& the use of digital radiography will greatly reduce the exposure </li></ul>
  24. 24. What About Teratogenicity ? <ul><li>Depends on fetal age and the dose of radiation. </li></ul><ul><li>Fetus age : 0-18 weeks </li></ul><ul><li>Dose of radiation : 0.01Gy , The chance of teratogenicity is about 0.1% </li></ul><ul><li>Although the chance of teratogenicity is minimal, the radiographic examination should be limited to the effected tooth </li></ul>
  25. 25. Dental drug prescription & pregnancy
  26. 26. <ul><li>Category A includes drugs that have been studied in humans and have evidence supporting their safe use. </li></ul><ul><li>Category B drugs show no evidence of risk in humans. </li></ul><ul><li>Category C includes drugs for which teratogenic risk cannot be ruled out. </li></ul><ul><li>Category D includes drugs that have demonstrated risks in humans. </li></ul><ul><li>Category X includes agents that have been shown to be harmful to the mother or fetus. </li></ul>Dental drug prescription & pregnancy
  27. 27. <ul><li>common drugs used : </li></ul><ul><li>Lidocaine “xylocaine” B </li></ul><ul><li>Aspirin C “ D in the 3 rd trimester ” </li></ul><ul><li>Acetaminophen “Panadol” B </li></ul><ul><li>Ibuprophen B </li></ul><ul><li>delayed labor “ D in the 3 rd trimester ” </li></ul><ul><li>Amoxcillin B </li></ul><ul><li>Clindamycin B </li></ul><ul><li>Metronidazole B </li></ul>Dental drug prescription & pregnancy
  28. 28. Dental Amalgam & Pregnancy <ul><li>Amalgam restorations release vaporized mercury during function. </li></ul><ul><li>Mercury is known to cause congenital malformations </li></ul><ul><li>The amount of mercury absorbed from amalgam restorations (2.0-5.0µg per day) is minimal, not clinically significant to the dental patients, and well below the toxic level ) </li></ul>
  29. 29. <ul><li>The U.S.Public Health Service and Health Canada advice dentists that amalgam restorations should not be removed from or placed into a pregnant patient. This statement reflect the need for more research and not related to the potential effect of amalgam on the fetus. </li></ul>Dental Amalgam & Pregnancy
  30. 30. Dental Management of Pregnant Patient <ul><li>Goals : </li></ul><ul><li>To develop efficient & effective treatment & compatible with the patient’s physical & emotional ability to undergo and respond well to dental care. </li></ul><ul><li>Maintain the safety & well-being of the developing fetus or newborn. </li></ul>
  31. 31. <ul><li>Patient assessment </li></ul><ul><li>Preventive strategies </li></ul><ul><li>Therapeutic strategies </li></ul>Dental Management of Pregnant Patient
  32. 32. Therapeutic strategies <ul><li>Classification of dental treatments : </li></ul><ul><li>Emergency treatment </li></ul><ul><li>Non emergency but necessary treatment </li></ul><ul><li>Elective treatment </li></ul><ul><li>Timing of dental treatments : </li></ul><ul><li>First trimester (conception to 14th week) </li></ul><ul><li>Second trimester (14th to 28th week) </li></ul><ul><li>Third trimester (29th week until childbirth) </li></ul>
  33. 33. Timing of dental treatments <ul><li>1 st trimester (conception to 14th week) </li></ul><ul><li>Educate the patient about maternal oral changes during pregnancy. </li></ul><ul><li>Emphasize strict oral hygiene instructions and thereby plaque control. </li></ul><ul><li>Limit dental treatment to periodontal prophylaxis and emergency treatments only. </li></ul><ul><li>Avoid routine radiographs. Use selectively and when needed </li></ul><ul><li>morning appointments should be avoided. </li></ul>
  34. 34. <ul><li>2 nd trimester (14th to 28th week) </li></ul><ul><li>Oral hygiene, instruction, and plaque control. </li></ul><ul><li>Scaling, polishing, and curettage may be performed if necessary. </li></ul><ul><li>Control of active oral diseases, if any. </li></ul><ul><li>Elective dental care is safe. But it is best to deferred until after parturition. </li></ul><ul><li>Avoid routine radiographs. Use selectively and when needed </li></ul>Timing of dental treatments
  35. 35. <ul><li>3 rd trimester (29th week until childbirth) </li></ul><ul><li>Oral hygiene, instruction, and plaque control. </li></ul><ul><li>Scaling, polishing, and curettage may be performed if necessary. </li></ul><ul><li>Avoid elective dental care during the second half of the third trimester. </li></ul><ul><li>Avoid routine radiographs. Use selectively and when needed. </li></ul>Timing of dental treatments
  36. 36. Points to be considered <ul><li>Consultation with the patient’s physician should be undertaken. </li></ul><ul><li>Keep appointment times short. </li></ul><ul><li>Intermission in the middle of a sitting could be a great help, since the pregnant patient feels discomfort remaining in one position too long. </li></ul><ul><li>It is advisable to ask the patient to void the bladder just prior to starting the dental procedure. </li></ul><ul><li>Emergency treatment should be performed regardless to the pregnancy stage. </li></ul><ul><li>The dentist should adapt conversation and instructions to her receptiveness. Also, it is recommended to minimize disturbance, interruptions and noises </li></ul><ul><li>Finally remember It is important to remember that treatment is being rendered to 2 patients: mother and fetus . </li></ul>
  37. 37. Conclusion <ul><li>In the 1st trimester rapid cell division and active organogenesis occur; also the patient may suffer from nausea and vomiting so it is advisable to limit dental treatment to emergency and periodontal prophylaxis. </li></ul><ul><li>The 2nd trimester is considered the safest period for providing dental care because organogenesis is completed and the fetus has not grown to a potentially uncomfortable size. </li></ul><ul><li>Lastly, in the 3rd trimester the pregnant patient experience increasing fatigue and finds it increasingly difficult to assume and maintain a comfortable position. So, limited dental treatment is advisable. </li></ul>
  38. 38. any
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