OralMedCh17

Chapter 17: Women's Health Issues

Page 1: Title

• Dr. Donal Scheidel, Creighton School of Dentistry

• Focus on women's health issues in dentistry.

Page 2: Objectives

• Review dental management of pregnant patients.

• Discuss the effect of osteoporosis on oral health.

Page 3: Overview of Dental Management During Pregnancy

• Unique management circumstances for dentists.

• Primary goal: ensure safety of mother and developing fetus.

• Harmful factors to consider: drug administration, ionizing radiation, patient positioning (especially in the third trimester).

• Importance of weighing benefits versus risks.

• Consideration of postpartum breastfeeding effects on drug administration.

Page 4: Patient Evaluation and Risk Assessment

• Evaluate the trimester of pregnancy.

• Consult medical professionals if medical conditions are poorly controlled or symptoms are unclear.

• Exercise extreme caution in high-risk pregnancies.

Page 5: Physiologic Changes During Pregnancy

• Endocrine changes affecting the body.

• Increased patient fatigue, potential mild depression in the third trimester.

• Cardiovascular changes: 40-50% increase in blood volume, 30-50% increase in cardiac output, 15-20% increase in RBC volume, blood pressure variations between trimesters.

Page 6: Late Pregnancy Specifics

• Late pregnancy supine hypotensive syndrome causing abrupt BP drops, bradycardia, sweating, air hunger, nausea when in supine position.

• Gravid uterus compresses the inferior vena cava, necessitating left lateral positioning for blood flow restoration.

Page 7: Additional Physiologic Changes

• Approximately 20% of pregnant women experience anemia.

• Slight increase in coagulation factors; elevated white blood cell counts.

• Respiratory Changes: diaphragm elevation reduces lung volume, total lung capacity down by 5%, and functional residual capacity down by 20% leading to dyspnea, worsened by supine position.

Page 8: Appetite and Gastrointestinal Changes

• Increased appetite with unusual food cravings influencing weight gain and caries risk.

• Increased gag reflex and gastroesophageal reflux disease (30-70% prevalence).

• Pregnancy does not directly elevate risk of decay or periodontal disease.

• Morning sickness onset between 4 to 8 weeks, resolving by 16 weeks in 60% of cases.

Page 9: Pathologies during Pregnancy

• Preeclampsia: hypertension with proteinuria post 20 weeks, risk for seizures/coma.

• Gestational diabetes mellitus: insulin resistance, risks include larger birth weights and infections.

• Lifestyle factors affecting health: alcohol consumption, smoking, poor diet, teen pregnancies.

Page 10: Fetal Development

• First trimester: organogenesis; Second trimester: growth and maturation.

• Palate closure by 12 weeks, tooth calcification begins at 14 weeks, with subsequent crown completion over the next years.

Page 11: Miscarriage

• Influences on miscarriage include natural termination before 20 weeks occurring in 15% of pregnancies.

• Factors include chromosomal abnormalities and avoiding fetal hypoxia, teratogen exposure.

Page 12: Oral Health and Miscarriage

• Pregnancy-associated gingivitis and periodontitis increase pro-inflammatory cytokine production.

• Increased urgency for dental treatment correlated with miscarriage rates; preventive dental care can lower incidence.

Page 13: Preventative Dental Care

• Dental hygiene critical for fetal health and infant care risk reduction.

• Prophylaxis and root planing encouraged when necessary.

• CDC advises against prenatal fluoride supplements.

Page 14: Treatment Timing

• Maintain plaque and calculus control as needed.

• Urgent dental care during the first trimester; elective care preferred in the second trimester and early third trimester.

• Important to avoid supine hypotension during treatment.

Page 15: Radiographs during Pregnancy

• Safety controversies exist; FMX digital exposure equates to 2 days of background radiation.

• Use lead apron with thyroid collar during any radiograph.

• Delay FMX until after delivery unless absolutely necessary.

Page 16: Drug Administration

• Preferably avoid medication during pregnancy; 75% of women take some form of medication.

• Understand FDA Pregnancy Risk Categories A, B, C, D, and X, and prefer A and B.

• Acceptable drugs include lidocaine with epinephrine, penicillins, clindamycin, and acetaminophen.

• Caution against certain NSAIDs and others, especially in third trimester.

Page 17: Anesthesia and Drugs during Procedure

• Limit nitrous oxide to less than 30 minutes, as long-term exposure is dangerous to fetuses.

• Advise caution with antibiotics affecting birth control efficacy.

• Avoid benzodiazepines and chronic nitrous exposure, especially in pregnant employees.

• Advise nursing mothers on timing of medication relative to breastfeeding.

Page 18: Treatment Planning Modifications

• Delay complex procedures and full mouth reconstruction until after delivery.

• Manage increased gag reflex; amalgams are safe unless mishandled.

Page 19: Oral Complications and Manifestations

• Observe for pregnancy-related gingivitis, pyogenic granulomas, and periodontal disease associated with gestational diabetes.

• Risks include tooth loss, caries development, and morning sickness leading to enamel erosion.

Page 20: Summation of Potential Issues

• Consult physicians regarding antibiotic use; utilize FDA A/B classifications unless otherwise indicated.

• Acetaminophen is preferred analgesic; certain other analgesics need physician's approval.

• Local anesthetics generally considered safe (FDA B).

• Caution against anti-anxiety medications, but short-term N₂O use may be permissible.

Page 21: Ongoing Issues

• Monitor for bleeding issues and assess breathing difficulties due to supine position.

• Careful management of blood pressure and preeclampsia signs.

• Optimize chair position for comfort and access during treatment.

Page 22: Further Monitoring

• Antibiotics should be avoided or carefully selected (FDA A/B) with medical consultations.

• Limit equipment and x-ray usage to necessities, maintaining safety protocols.

• Prepare for emergencies including supine hypotension; follow-up after delivery for oral health promotion.

Page 23: Osteoporosis

• Condition characterized by calcium intake inhibition and mineral loss, affecting bone strength and increasing fracture risk.

• Triggered by aging, menopause, and specific medications.

• Estrogen is supportive of osteoblast activity in maintaining bone density.

Page 24: Medical Management of Osteoporosis

• Assess bone mineral density (2.5 SD below healthy young women implies osteoporosis).

• Treatment options include bisphosphonates (oral or IV).

• Associated conditions: Paget's disease and multiple myeloma; concerns include osteonecrosis of the jaw.

• Dental care may involve necrotic bone removal, antibiotic irrigation, and hyperbaric oxygen therapy.