Dental Care for Pregnant Patients

Study Notes

Pregnant patients require special management considerations in dentistry to ensure the mother's health and the developing fetus's safety.
Dental care must balance benefits with minimizing exposure to potentially harmful procedures, such as ionizing radiation and drug administration.

First trimester:
- Fatigue with psychological impact
- Syncope and postural hypotension
Second trimester:
- Relatively few symptoms
Third trimester:
- Increasing fatigue and discomfort
- Mild depression
- Cardiovascular changes:
  - 40-50% increase in blood volume
  - High-flow, low-resistance circulation
  - Tachycardia and heart murmurs
  - Cardiac output increases by 30-50%
  - Blood pressure falls (usually to ≤100/70 mm Hg) during the second trimester, with a modest increase in the last month of pregnancy
  - Benign systolic ejection murmur is common, disappears after delivery

Occurs in late pregnancy when the patient is in a supine position
Causes an abrupt fall in blood pressure, bradycardia, sweating, nausea, weakness, and air hunger
Resulting from impaired venous return to the heart due to compression of the inferior vena cava by the uterus
Treatment: roll the patient over onto her left side, which lifts the uterus off the vena cava

Anemia: blood volume increases more rapidly than RBC mass (insufficient iron)
Decreased hematocrit value
Hypercoagulable state: increased coagulation factors, combined with venous stasis, leading to a risk of thromboembolism
White blood cell (WBC) count increases progressively
Immune system shifts from helper T-cell 1 (TH1) dominance to TH2 dominance, leading to immune suppression

Elevation of the diaphragm, which decreases the volume of the lungs in the resting state
Ventilatory changes: increased rate of respiration (tachypnea) and dyspnea, worsened by the supine position

Normal pregnancy lasts 40 weeks
First trimester: organs and systems are formed (organogenesis), susceptible to malformation
After the first trimester: growth and maturation, malformation diminished, with the exception of the fetal dentition