this presentation show the means by which dental practitioners should manage pregnant women and patients with respiratory disorders.

1. FRED WAICHERE
Moi University School of Dentistry

2. PREGNANCY AND DENTISTRY
• Pregnancy is not a disease, but a normal state of
a woman’s body; however, special treatment is
required when the woman is about to undergo
dental surgery, so that the developing embryo
and the mother herself are not at risk.
• The most important risks are noted in the first
trimester, because every intervention that may
cause hypoxia may have a harmful effect on the
embryo or be responsible for spontaneous
abortion.

3. Stages of pregnancy

4. Questions that a dentist may ask?
• Can I take X-rays?
• Can I inject local anaesthesia with
epinephrine?
• What medication can I prescribe?
• When should I perform necessary procedures?

5. Consideration divided into:
• Maternal concerns
• Fetal concerns
• Radiographic
• medication

6. 1. Maternal concerns
• This arise due to anatomic, physiologic and
psychological changes in the pregnant woman
Anatomic
Supine hypotensive syndrome: due to weight of
uterus compressing on inferior vena cava.

7. Maternal concerns cont’
• There are also a number of pysiological
changes in the body.
• GIT = increased gastric acid production,
increased esophageal reflux, excessive and
uncontrolled vomiting. Avoid morning
treatment.
• Renal system = increased renal plasma flow,
frequency and reduced bladder capacity. Ask
patient to void bladder before procedure

8. Maternal concerns cont’
• Psychological changes include : fear of pain,
disability, death of baby and fear of dental
procedures
• Hence minimize disturbance, interruption and
noise in dental clinic.
• Adjust room temperature to minimize
irritability
• Reassure the patient.

9. 2. Fetal concerns
First trimester
Most critical period of fetal development, with
rapid cell division and active organogenesis
especially 2nd to 8th week.
• Limit dental treatment to periodontal
prophylaxis and emergency treament
• Avoid routine radiographs. Use selectively
when needed.

10. Fetal concerns cont’
Second trimester
Organogenesis is completed
• Safest period for providing dental treatment
• Perform elective treatment
• Avoid routine radiographs but use selectively when
needed.
Third trimester
There is no risk to fetus in this trimester but the mother may
experience increased level of disturbance
• Safe to provide dental care in early part of trimester; avoid
elective care in second half of trimester.
• Use routine radiographs when needed.
• Give short dental appointments

11. Radiographic concerns
Hazards of irradiation to embryo:
1. Death to embryo
2. Birth of deformed child
3. Increased frequency of malignancy
4. Growth retardation
5. Spontaneous abortion (esp in 1st trimester)
6. Mental retardation of child

12. Radigraphic concers cont’
Prevention of these complications is done through:
• Avoid radiation exposure in 1st timester
• Avoid radiation expore in 2nd and 3rd trimester
but use selectively if need be, but keep exposure
as low as possible.
• Always use lead apron
• Use long cone and proper collimation
• Use fast films
• Use extra care when taking radiographs to avoid
repeat radiographs.

13. Medication concerns
• Avoid use of drugs contraindicated in pregnacy.
That is FDA class D and X.
Analgesics
• Eliminate rather than relying on symptomatic
relief.
• Common analgesics: paracetamol, ibuprofen,
oxycodone, codeine.
• Asprin may cause maternal and fetal hemorrage
and oral clefts, IU death, growth retardation and
pulmonary hypotension.

14. Medication cont’
Sedatives
• Anxiolytics e.g diazepam (rated class D) may cause oral
clefts.
• Nitrous oxide should not be used in 1st trimester. In 2nd
and 3rd trimester use with > 50% oxygen.
Antibiotics
• Commonly used: penicillin, amoxicillin. Cephalexin,
erythromicin base, metronidazole
• Avoid : doxycycline, erythromycin (estolate form),
vancomycin, tetracycline (FDA: D), chloramphenicol

15. Medication cont’
Anaesthesia
• LA are not teratogenic; may be administeed in
usual dose.
• Large dose prilocaine may cause
methemoglobinemia hence maternal and fetal
hypoxia

16. Thank you
References
• www.slideshare.net/imelhakim/manag-of-
pregnant-woman-in-dental-clinic
• Textbook of General and Oral surgery , D.
Wray et al.

17. Respiratory diseases and Dentistry

18. Bronchial asthma
• Bronchial asthma is a syndrome consisting of
dyspnoea, cough, wheezing, that are caused
by bronchial spasms.
• It can be classified into: intrinsic and extrinsic
asthma.
Extrinsic – it is the same as allergic asthma,
mainly found in children and disappears
during adulthood.

19. Intrinsic- it is not associated with familial history
of allergy and no elevation of IgE in the blood.
The onset is usually associated with URTI.
Factors that precipitate asthmatic attack.
• Airborne substances like pollen and dust.
• Drugs e.g. anti-inflammatory and asprin.
• Respiratory tract infections.

20. Dental management of patients with
bronchial asthma.
(i) Medical consultation to verify:
• Type of asthma and precipitating factors.
• Severity and frequency of the attack.
• How the attack is usually managed.
• Medication taken.
(ii) Appointment.
• Premedication with diazepam.
• Avoid antihistamines, narcotics and asprin.

21. (iv) Local anesthesia.
• Good pain control is essential as pain may
precipitate asthma.
(v) Drug used in treatment.
• Drug used in the treatment of asthma have
major impact in the dental treatment except
for prolonged use of corticosteroids
(iv) Drugs given to the patient.
• Avoid antihistamines , narcotics, asprin and
penicillins due to their depressant action on
the respiratory system.

22. Tuberculosis
• Tb is a disease which can affect any organ in
the body, however lungs are by far the most
affected.
• It may be transmitted through airborne
droplets of mucus, digestion(secondary form
of transmission)
Signs and symptoms:- weightloss, productive
cough, night sweats, low grade fever.

24. Facial and oral manifestations.
• In the face it may involve submandibular and
cervical lymph nodes leading tuberculus
lymphadenitis. Affected Lymph nodes may be
swollen and tender.
• Tongue is the most common site affected,
followed by palate, lips, buccal mucosa and
gingiva. Lesions appear as irregular,
superficial, or deep painful ulcers.
• Bone lesions may occur in the mandible and
maxilla in advanced cases.

25. Dental management.
TB patients can be placed into for categories
regarding dental management:
(i) Patient with active tuberculosis
• Medical consultation.
• Patients above 6yrs do only emergency
treatment.
• Patients below 6yrs treat them as normal
patients.

26. (ii) Patient with past history of TB.
• Medical consultation.
• If patient is free from active disease treat as
normal but with caution.
(iii) Patient with positive tuberculin test.
• Medical consultation.
• Give isoniazid for prophylactic purposes for up to
1yr.
• If free from active disease treat as normal.
(iv) Patient with signs and symptoms of TB.
• Postpone treatment and refer to physician.
• Give only emergency treatment when necessary.

27. THANK YOU