Pregnancy and thyroid


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Oral Diagnosis I
Third Year

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Pregnancy and thyroid

  1. 1. Pregnancy & Breast Feeding December 04, 2005 Course Coordinator:Course Coordinator: DR. SURESH C.S BDS, MDS, MDSc (UK)DR. SURESH C.S BDS, MDS, MDSc (UK) Oral Diagnosis IOral Diagnosis I
  2. 2. OverviewOverview  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. 3. Overview (Cont.)Overview (Cont.)  Providing routine dental care to pregnant patients is generally safe. However, the potentially harmful elements including:  Ionizing radiation  Drug administration
  4. 4. Physiology & ComplicationsPhysiology & 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. 5. Physiology & ComplicationsPhysiology & 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).
  6. 6. Physiology & ComplicationsPhysiology & 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
  7. 7. Physiology & ComplicationsPhysiology & 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. 8. Dental ManagementDental Management  Dentist should determine the general health of the patient:  Proper medical history  Current physician  Gestational diabetes  Miscarriage  Hypertension  Morning sickness
  9. 9. Dental Management:Dental Management: Preventive ProgramPreventive 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. 10. Dental Management:Dental Management: Treatment TimingTreatment 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. 11. Dental Management:Dental Management: Dental RadiographsDental 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. 12. Dental Management:Dental Management: Drug AdministrationDrug 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. 13. Dental Management:Dental Management: Drug AdministrationDrug 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. 14. Dental Management:Dental Management: Breast FeedingBreast 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. 15. Oral Complications &Oral Complications & ManifestationsManifestations 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. 16. Pyogenic GranulomaPyogenic Granuloma