Oral Diagnosis I Third Year

1. Pregnancy & Breast Feeding
December 04, 2005
Course Coordinator:Course Coordinator:
DR. SURESH C.S BDS, MDS, MDSc (UK)DR. SURESH C.S BDS, MDS, MDSc (UK)
Oral Diagnosis IOral Diagnosis I

2. OverviewOverview
 Pregnant patients are not considered medically
compromised patients.
 Pregnant patients poses a unique set of
management considerations for the dentist.
 Dental care must be rendered to the mother
without adversely affecting the developing
fetus.

3. Overview (Cont.)Overview (Cont.)
 Providing routine dental care to pregnant patients
is generally safe. However, the potentially harmful
elements including:
 Ionizing radiation
 Drug administration

4. Physiology & ComplicationsPhysiology & Complications
 During pregnancy, several cardiovascular changes
occur:
 Blood volume increases 40%.
 Cardiac output increases 30-40%.
 RBC volume increases only about 15-20%.
 Blood pressure falls (100/70 mm Hg).
 Heart murmur (90% of cases).

5. Physiology & ComplicationsPhysiology & Complications
Normal pregnancy lasts about 40 weeks:
 During the first trimester, formation of organs
and systems occurs (fetus most susceptible to
malformation).
 After the first trimester, the majority of
formation is complete (growth & maturation).

6. Physiology & ComplicationsPhysiology & Complications
 During late pregnancy a supine hypotension
syndrome may occur:
 Abrupt fall in blood pressure
 Bradycardia
 Sweating
 Nausea
 Weakness
 Air hunger when the patient is in supine
position

7. Physiology & ComplicationsPhysiology & Complications
 Complications of pregnancy
 More common in expectant mothers who
harbor pathogens:
 Infections
 Glucose abnormalities
 Hypertension
 Might results in perinatal abnormalities and
congenital anomalies

8. Dental ManagementDental Management
 Dentist should determine the general health of the
patient:
 Proper medical history
 Current physician
 Gestational diabetes
 Miscarriage
 Hypertension
 Morning sickness

9. Dental Management:Dental Management:
Preventive ProgramPreventive Program
 Establish a healthy oral environment and an optimum
level of oral hygiene
 Minimize the exaggerated inflammatory response
 Studies have shown that maternal periodontal disease
increases the infant risk for low birth weight
 Uses of prenatal fluoride and oral hygiene measures
benefits the mother & the newborn without risk

10. Dental Management:Dental Management:
Treatment TimingTreatment Timing
 Elective dental care is best avoided during the
first trimester
 The second trimester is the safest period which
to provide routine dental care
 After the middle of third trimester, elective
dental care is best postponed
 Prolonged time should be avoided

11. Dental Management:Dental Management:
Dental RadiographsDental Radiographs
Irradiation should be avoided especially in
the first trimester of pregnancy
If radiographs becomes necessary, the
dentist must be aware of how to proceed
safely

12. Dental Management:Dental Management:
Drug AdministrationDrug Administration
Ideally, no drug should be administered
during pregnancy, especially the first
trimester.
Counseling should be provided to make
sure that pregnant women clearly
understand the magnitude of risk associated
with drug

13. Dental Management:Dental Management:
Drug AdministrationDrug Administration
The dentist should be familiar with FDA
categorization:
A: controlled studies in humans have failed to
demonstrate a risk to the fetus.
B: animal studies have not indicated fetal risk.
C: animal studies have shown a risk.
D: positive evidence of human fetal risk exists.
E: evidence of fetal abnormalities and fetal risk
exists.

14. Dental Management:Dental Management:
Breast FeedingBreast Feeding
Careful drug selection for the nursing
mother should be made.
Authorities suggest that she takes the drug
just after breast feeding and avoid nursing
for 4 hours or more if possible.

15. Oral Complications &Oral Complications &
ManifestationsManifestations
Pregnancy gingivitis
 Exaggerated inflammatory response to local
irritants.
 The most common location of pyogenic
granuloma is the labial aspect of the interdental
papillae
 A relationship between dental caries and
physiologic process of pregnancy has not been
demonstrated

16. Pyogenic GranulomaPyogenic Granuloma