Oral Health in Pregnancy, Drug Prescribing and Dental Materials

how do we manage pt pre conception

problem list

pain first

identify risk factors

prevention - ohi diet flouride

tx plan and review

what do we do with unretained roots

extractions

why do we plan pre conception

less bacteria is better for mother and baby

reduces tx risks while pregnant

what is the first trimester

up to 12 weeks

when can we take dental radiographs in a pregnant pt

throoghout pregnancy even in the first trimester

some pts dont want to tho and maybe psotpone to second or third

what is a concern in pregnant pts

radiographs

amalgam - mercury from removing or adding as can cross placenta

be aware of plastic aerosols in polishing composite - bpa

may be on blood thinners so can affect pmpr

may up carb intake due to nausea

why is perio in pregnancy bad

bad perio means leaky pocket and spread of bacteria

means there is an inflammatory response

there is a suppressed immune system to sustain pregnancy

due to bacteria from perio there is an increased inflammatory response = risk of miscarraige and bacterua passing to placenta

which weeks is second trimester

14-27

what can we do in second trimester

extraction

avoid antibiotics - avoid metranidazole but check bnf

avoid amalgam obvs

what la do we avoid in pregnancy

articaine

what is pregnancy epulis

is endocrine/metabolic risk factor

is a pyogenic granuloma

vascular

driven by hormone progesterone - reduced thickness of keratin

less effective to barrier bacteria

when is the third trimester

weeks 28-40

what are the contraindications of third trimester

avoid articaine and prilocaine - usually avoid all

lay pt on left side to not suppress vena cava

what is the 4th trimester and what happens

postpartum period

usually breastfeeding

can be on iron tabs

less time for oral hygiene

likely irregular eating habits

epulis has shrunk and pregnancy gingivitis has resolved

what do we avoid in breastfeeding

articaine as it goes into the milk

avoid amalgams etc aswell

what is the composition of breast milk

immunoglobulins

proteins

fat

vitamins etc

how does pregnancy gingivitis occur

increase in steroid hormones causes increased vascular permeability = inflammation

gingiva is sensitised and caused inflammation to less bacteria than normal

inflammation happens in presence of bacteria

what is the direct bacterial effect on platelet

oral bactera mimix host receptors that trigger thrombus formation within platelets

can cause blockages of the placenta and can lose the pregnancy

what are the perio systemic effects

perio inflammation releases inflammatory mediatirs which causes damage yo vascular tissues and causes atherosclerosis

usuall CRP from liver that elevates systemic level of inflammation

cytokines can initiate labour so perio can increase levels by bacteraemia and induce it

what are the adverse pregnancy risks from perio

preterm low birthweught

misscarriage

preclampsia