29 Questions
During which stage of pregnancy is it safest to provide dental care?
Second Trimester
What is the primary concern during the third trimester of pregnancy?
Upcoming birth process and safety of the pregnant woman
What is the effect of hormonal secretions on the body during pregnancy?
Increased cardiac output
What is a significant risk factor for thromboembolism during pregnancy?
Increased blood coagulation factors
Which of the following is NOT a consideration for high-risk pregnancy?
Elective dental care
What is the primary reason to avoid taking x-rays in the 2nd and 6th weeks of gestation?
The fetus is most susceptible to radiation during this period.
During which week of pregnancy is the risk of cleft lip and palate highest?
5-7 weeks
What is the main complication of the supine position in pregnant patients?
Supine hypotensive syndrome
What is the estimated risk of malignant disease from 1 rad of utero radiation exposure?
0.1%
What is the primary purpose of using a lead apron during dental radiography?
To reduce radiation exposure to the fetus
What is the FDA classification of antibiotics that are safe to be taken in all trimesters of pregnancy?
Class B
What is the adverse effect of tetracycline on the fetus?
Inhibition of bone growth and discoloration of teeth
What is the primary concern with the use of aspirin during pregnancy?
Risk of maternal and fetal hemorrhage
Why should NSAIDs be avoided in the last trimester of pregnancy?
Due to risk of circulatory effects and persistent pulmonary hypertension
Which of the following analgesics is rated Category D?
Diazepam
What is the concern with the use of corticosteroids during pregnancy?
They can inhibit brain growth
Why is nitrous oxide not recommended in the first trimester of pregnancy?
No specific reason mentioned in the text
What is the recommended analgesic of choice for short-term usage during pregnancy?
Paracetamol
Who is authorized to prescribe treatments for a pregnant lady?
Her treating doctor
Which of the following local anesthetics is categorized as Category B?
Lidocaine
What is the effect of a large dose of prilocaine?
Maternal and fetal hypoxia
What is the purpose of vasoconstrictors in local anesthesia?
To increase the effectiveness and duration of anesthesia
Is there a specific contraindication to the use of vasoconstrictors in pregnant patients?
No, but it is prudent to use the minimal effective dose
What is the most common emergency in a dental office?
Syncope
What is the primary concern in managing a seizure in a pregnant woman?
Control of airway
What is the mortality rate for seizures in pregnant women?
17%
What is the main risk factor for seizures in pregnant women?
All of the above
What is the recommended management for a pregnant woman experiencing morning sickness in a dental office?
Monitor and manage as needed
What is the recommended positioning for a pregnant woman to avoid supine hypotensive syndrome?
Rolling to her left side
Study Notes
Stages of Pregnancy
- First Trimester (1-12 weeks): fetal organ formation and differentiation, most susceptible to teratogens, avoid elective care but provide emergency care as needed, 50% of abortion
- Second Trimester (13-24 weeks): fetal growth and maturation, safest period to provide dental care
- Third Trimester (25-40 weeks): fetal growth and maturation continues, concern is upcoming birth process and safety of the pregnant woman
- High-risk pregnancy: extra precautions should be considered, recent cramping, light or intermittent bleeding or frank bleeding, diabetes, hypertension, multiple spontaneous abortion, ask about history of pregnancy
Physiologic Changes in Pregnancy
- Increased hormonal secretions (estrogen 10 folds and progesterone 30 folds) and fetal growth causes several systemic and physical changes
- Cardiovascular: increased blood volume (45%), decreased pulse (10-15 beats/min), increased cardiac output
- Respiratory: diaphragm rises 4 cm, decreased residual volume, upper respiratory infection
- GIT and Endocrine: heartburn/reflux, nausea and vomiting, gastric emptying delayed, insulin resistance (gestational diabetes)
- Hematological: decreased RBC, increased WBC, increased ESR
- Coagulation factors and risk of thromboembolism increased
Dental Considerations
- Patient position: elevate the right hip 10-12 cm, semi-supine or sit-up position to avoid hypotension or hypoxia
- Supine hypotensive syndrome: compression of inferior vena cava and aorta by the uterus, decrease venous return to heart, decrease uteroplacental perfusion, and fetal distress
- Symptoms of supine hypotensive syndrome: sweating, nausea, weakness, sense of air lack, bradycardia, decrease blood pressure, loss of consciousness
- Treatment: roll patient to her left side to decrease pressure on the inferior vena cava
Radiography in Pregnancy
- Avoid taking x-rays in the 2nd and 6th weeks of gestation
- Fetal dose from a single periapical radiograph is about 0.1 mrad
- High dose (over 250 rads) prior to 16 weeks: microcephaly, mental retardation, cataracts, microphthalmia, growth retardation, spontaneous abortion
- High dose after 20 weeks: hair loss, skin lesions, bone marrow suppression
- Precautions: use lead shielding, long cone, proper collimation, limited to affected tooth, extra care should be used while taking essential films to eliminate the need for repeated exposure
Medications in Pregnancy
- FDA classification system:
- Category B: penicillin, amoxicillin, clindamycin, paracetamol (short-term usage)
- Category C: chloramphenicol, ketoconazole, fluconazole, codeine (short-term usage)
- Category D: tetracycline, doxycycline, aminoglycoside, aspirin (non-teratogenic but may cause maternal and fetal hemorrhage and oral clefts)
- Analgesics: NSAIDs should be avoided in the last trimester, sedatives (eg, diazepam) are rated D and can cause clefts with prolonged exposure
- Nitrous oxide: avoid in the first trimester, use with caution in the second and third trimesters, do not use less than 50% oxygen
Emergencies in the Dental Office
- Syncope: management by rolling the patient to her left side, supine hypotensive syndrome, dehydration, anemia, hypoglycemia, and neurogenic disorder
- Morning sickness: enhanced gag reflex and delayed gastric emptying, aspiration of vomiting matter (real emergency), manage by oropharyngeal suction, recumbent position, chest compression
- Seizure: mortality rate 17%, management by controlling airway, oxygen, transfer to hospital immediately
- Bleeding and cramping: precedes miscarriage, active bleeding or painful contraction, manage by rolling the patient to her left side, oxygen, transfer to hospital
Learn about the importance of patient positioning in obstetrics, specifically elevating the right hip, and understand the risks of supine hypotensive syndrome, including symptoms and treatment.
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