FRED WAICHEREMoi University School of Dentistry

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.

Stages of pregnancy

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?

Consideration divided into:

• Maternal concerns• Fetal concerns• Radiographic• medication

1. Maternal concerns

• This arise due to anatomic, physiologic and psychological changes in the pregnant woman

AnatomicSupine hypotensive syndrome: due to weight of

uterus compressing on inferior vena cava.

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

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.

2. Fetal concerns

First trimesterMost 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.

Fetal concerns cont’

Second trimesterOrganogenesis is completed• Safest period for providing dental treatment• Perform elective treatment• Avoid routine radiographs but use selectively when needed.

Third trimesterThere 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

Radiographic concerns

Hazards of irradiation to embryo:1. Death to embryo2. Birth of deformed child3. Increased frequency of malignancy4. Growth retardation5. Spontaneous abortion (esp in 1st trimester)6. Mental retardation of child

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.

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.

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

Medication cont’

Anaesthesia• LA are not teratogenic; may be administeed in

usual dose.• Large dose prilocaine may cause

methemoglobinemia hence maternal and fetal hypoxia

Thank you

References • www.slideshare.net/imelhakim/manag-of-pre

gnant-woman-in-dental-clinic• Textbook of General and Oral surgery , D.

Wray et al.

Respiratory diseases and Dentistry

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.

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.

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.

(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.

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.

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.

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.

(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.

THANK YOU