Dental Management Chapter 17 Women's Health Issues

During ______ pregnancy, a phenomenon known as supine hypotensive syndrome may occur that manifests as an abrupt fall in blood pressure, bradycardia, sweating, nausea, weakness, and dyspnea when the patient is in a supine (laying) position.

Caused by impaired venous return to heart from compression of ______ _______ by gravid uterus

late, inferior vena cava

During pregnancy, anemia occurs because blood ______ increases more rapidly than RBC mass.

volume (normocytic anemia)

Normocytic, Macrocytic, and Microcytic Anemia

Normocytic: Hemodilution (more blood volume than RBC mass)

Microcytic: Most common in pregnancy: low iron storage

Macrocytic: Increased folate demand or B12 deficiency

MCV in Anemia

Decreased MCV: Macrocytic

Increased MCV: Microcytic

Why is thromboembolism so common in pregnancy?

Several blood-clotting factors such as fibrinogen, factor VII, VIII, IX, and X increased

Immune System in Pregnancy and why more susceptible to infection

WBC increase due to double neutrophils (could be due to increased estrogen)

Th1 shift to Th2 dominance (lead to immune suppression)

Why in pregnancy is Th2 dominance

Th1 (cell mediated or killer cell) Th2 (humoral antibody for mom and baby)

Avoid attacking baby

Respiratory function in pregnancy

Elevation of diaphragm which decrease volume of lung

Worsen supine position and trouble sleeping

Organogenesis occur in ______ trimester

first

Certain tetracyline in pregnancy

Can cause tooth discoloration in fetus tooth

Preclampsia in Pregnancy

Preclampsia is high blood pressure and damage to another organ system

Mostly liver and kidney

Risk factor are kidney disease and vitamin D deficiency

What is eclampsia

Caused by preclampsia very serious

Coma and seizure due to high blood pressure

What is the most common cause of spontaneous abortion

Morphologic and Chromosomal abornalities that prevent successful implantation

What is the preferred analgesic for pregnant pt

Acetaminophen

How much increase in blood pressure is sign of preeclampsia

30 for systolic

15 for diastolic

The ______ trimester is the safest period during which routine dental care can be provided.

second

1st organogenesis

3rd supine position not allowed

What should the shape of collimator be

Rectangular

The maximum permissible radiation dose for whole-body exposure of the pregnant dental care worker is 0.005Gy or 5__Sv per year.

m

Also should wear film badge and 6 feet away

Can non-pregnant operator hold receptor for pt

No it should be family or caregiver

Handheld does not need protective garment for operator

Category ABCDX of drug

A: No risk

B: No risk

C: Animal yes Human no harm

D Harm but benefit may outweight

X Harm and not enough benefit

Anesthetic in Pregnancy

Typically safe but not exceed recommended dose

Which 2 antibiotic should be avoided for pregnant pt

Tetracycline and Clarithromycin

_______ especially rifampin reduce plasma levels of circulating ____ ________

Antibiotics, oral contraceptives

Are anxiolytics allowed in pregnant pt

No especially benzodiazepines

Nitrous can be used but minimized to 30 minutes (react with B12)

Female pregnant dentist avoid for 3 hour

Drug and breastfeeding

No more than 2% usually not a problem

But can avoid by take drug just after breastfeeding and avoid nursing for 4 hr

The most common oral complication of pregnancy is pregnancy _______

gingivitis

Pregnant women and gag reflex

Hypersensitive gag reflex

Should advise pt to rinse after morning sickness

Use of what can cause osteoporosis and is very common and serious

glucocorticoids

Osteoporosis is diagnosed in individuals with a bone density of _____ SDs below the adult mean (i.e., T-score of −2.5 or less) in the total hip or femoral neck.

2.5

What is the treatment of choice in bisphosphonates

Alendronate

What is the dental problem with bisphosphonates

Osteonecrosis of jaw

What is the suffix of bisphosphates

Dronate such as alendronate

What is RANKl and RANK and bisphosphonates

RANKL are osteoclast builder by binding to RANK on osteoclast

Bisphosphonates cause osteoclast apoptosis

Why does bisphosphonate cause necrosis of jaw

Bisphosphonate suppress osteoclast and reduce resorption and turnover

No turnover mean no remodeling even after constant stress

3 condiiton of MRONJ (Medication-Related Osteonecrosis of Jaw)

Current or previous treatment of bisphosphonates

Exposed bone more than 8 weeks

No history of radiation to jaw

All 3 need to be met

27-year-old female

Chief complaint

“I'm 6months pregnant and my gums bleed.”

Background and/or patient history

Patient is a healthy pregnant young woman with symptoms of nausea and fatigue. This is her third pregnancy. She has a health 3-year-old, but miscarried the second child at 8 weeks.

Current findings

Six months pregnant.

Poor oral hygiene and generalized gingivitis.

Missing tooth #29.

1. Proper management of this patient includes all the following EXCEPT?

A. provide a regular periodontal prophylaxis, oral hygiene, and dietary instructions

B. withhold full-mouth radiographs until after the delivery

C. plan to fabricate the fixed bridge (or implant) for tooth #29

D. monitor patient's vital signs for eclampsia or preeclampsia

______________________

2. All of the following are true regarding pregnancy EXCEPT?

a. pregnancy is associated with a hypercoagulable state

b. changes in pregnancy include anemia and a decreased hematocrit value

c. platelets may show a mild decrease during pregnancy

d. WBC count decreases progressively throughout pregnancy

______________________

3. If emergency dental treatment becomes necessary, which drug would be contraindicated?

A. 2% lidocaine with 1:100,000 epinephrine

B. amoxicillin 500mg, bid for 7days

C. acetaminophen 325mg, tid for 3days

D. oxycodone 5mg, tid for 3days

______________________

1. In addition to generalized gingival inflammation, there is a focal nodular swelling of the interdental papilla between teeth #s 10 and 11. The patient has been aware of it for 1week and notes that it does not hurt, but sometimes bleeds when brushing her teeth. What is the most likely diagnosis?

A. Squamous cell carcinoma

B. Medication-related osteonecrosis of the jaw

C. Pyogenic granuloma

D. Leukemia

C, D, D, C

Pyogenic Granuloma is most common pregnancy tumor

67-year-old female

Chief complaint

“I have a tooth infection that won't heal and now it's affected my jaw.”

Background and/or patient history

Patient has symptoms of a nonhealing lesion in the mandible. She had breast cancer 3 years ago treated with surgery and chemotherapy, followed by Zometa.

Current findings

A 2-cm open lesion of necrotic alveolar bone in the mid-mandible near tooth #21, which was extracted 7months ago.

1. The most likely diagnosis in this case is:

A. osteoradionecrosis

B. medication-related osteonecrosis of the jaw

C. cancer

D. fractured mandible

______________________

2. What is the most likely cause of this condition?

A. chemotherapy

B. Zoledronic acid (Zometa)

C. preexisting periodontal disease

D. all of these

______________________

3. What is the appropriate treatment for the patient's current condition?

A. immediate radical surgical debridement

B. hyperbaric oxygen therapy

C. radiation therapy

D. antiseptic, analgesic, antibiotic, therapy

______________________

4. This patient, in addition to intraoral exposed necrotic bone, has an extraoral draining fistula. Based on these features, what is the stage of MRONJ according to the American Association of Oral and Maxillofacial Surgeons MRONJ grading system?

a. Stage 0

b. Stage 1

c. Stage 2

d. Stage 3

B, B, A, D

Regarding antibiotic use during pregnancy, all of the following statements are True except one. Which is the exception?

A. The patient should receive the only half of the regular adult dose

B. Serious infections should be treated aggressively

C. Penicillins and cephalosporins are considered safe

D. Clarithromycin should be avoided or use with caution

B

Regarding drug use during pregnancy and breastfeeding, all of the following statements are True except one. Which is the exception?

A. The analgesic of choice during pregnancy is acetaminophen

B. Antibiotic use during breastfeeding may cause altered bowel flora and, thus, diarrhea in the baby

C. Most anxiolytics (i.e., benzodiazepines) should be avoided

D. Any exposure to nitrous oxide should be avoided

D