CHAPTER 48
THE PREGNANT PATIENT
LISA MAYO, RDH, BSDH
Pregnancy

Review Sheet CH48 #1
Prenatal care
 Supervised
preparation for childbirth that helps
the mother enjoy optimum health during
 Provides the maximum chance for the baby to be
born healthy
Fetal Development
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Review Sheet CH48 #2
Normal pregnancy = 40 wks
Premature birth = Prior to 37wks
3 trimesters
Fetal Development
Review Sheet CH48 #3
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First trimester
 Embryo highly susceptible to injuries and malformations
 Teratogenic effects
 All organ systems are forming (organogenesis)
 12 weeks = fetus moves and swallows
 Oral cavity development
 Teeth: Tooth buds 5-6wk, initial mineralization occurs 4-5mo
Second trimester
 All organs completed, growth & maturation continue
 Fetal wt: changes 1oz every 3mo
Review Sheet CH48 #4-5
Factors That Can Harm the Fetus
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Infections: rubella, rubeola, varicella, HIV, Hep B, syphilis,
gonorrhea
Perio: pre-term, low birth weight babies
Medications and other drug use (Table 48-1)
 Nearly all drugs can pass across the placenta to enter the
circulation of the developing fetus
 Many drugs have tetratogenic effects
 Cont’d next slide
Review Sheet CH48 #4-5
Factors That Can Harm the Fetus

Meds
 Tetracycline
 Intrinsic staining of teeth
 Herbal supplements: efficacy not regulated by FDA
 Therapy for HIV
 Some antiretroviral meds are NOT withheld because of
pregnancy
 Consideration by the mother can be given to withholding the
antiretroviral tx 1st 14 weeks of pregnancy
Review Sheet CH48 #6, 12
Oral Findings During Pregnancy

Gingivitis
 Clinical
appearance will vary
 Shows
characteristics of inflamed tissues
 Predisposing
factors
 Local
irritation & infection because of poor oral
hygiene
 Hormonal changes that may alter the tissue reaction
 Microbiology
↑
Prevotella intermedia (NBQ)
Oral Findings During Pregnancy

Pyogenic granuloma / Epulis gravidarum / Pregnancy Tumor /
Pregnancy granuloma
 Benign inflammatory lesion
 Isolated, discrete, soft, round enlargement near the gingival
margin usually associated with an interdental area
 Painless
 Color varies w/vascularity
 Bleeds readily
Review Sheet CH48 #6-7
Pyogenic Granuloma
DENTAL MANAGEMENT
OF
PREGNANT PATIENT
Oral Findings During Pregnancy

Enamel erosion
 Morning sickness w/ vomiting over extended periods of time
 Recommendations
 Sodium bicarb rinses
 Sugarless gum after eating (xylitol the best)
 Gentle toothbrushing – low abrasive tp
Radiography


Not done unless necessary
Protection
 Lead
apron
 Thyroid collar

Exposures
 Minimum
# of films as possible
Overall Treatment Considerations

Appointment planning
 Frequency:
monthly or 3x during 9-mo pregnancy
 Shorter appts best
 2nd trimester best for dental tx (NBQ)
 Consult w/ OBGYN prior to tx

Clinical care: Table 48-2, p.748
Overall Treatment Considerations
PATIENT POITIONING
 Supine Position:
 Weight of developing fetus in the uterus bears down
directly on the major vessels, aorta, inferior vena
cava
 Vessels are pressed between the spinal column &
uterus
Overall Treatment Considerations
PATIENT POSITIONING
Review Sheet CH48 #14
 Supine Hypertensive Syndrome
 Emergency: Patient is lying in supine position. Abrupt fall in
blood pressure
 Impaired venous return - pressure of uterus on inferior vena
cava
 Loss of consciousness
 Emergency Tx
 Roll the patient over to her left side to relieve pressure of
uterus on vena cava
Roll to left side!
Dental Hygiene Care
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Ultrasonic not contraindicated
LA used in moderation
No nitrous 1st trimester
 2nd/3rd
= great precaution, length 30min w/O2 50%
Patient Instruction
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Emphasis on general health
Anticipatory guidance for child
Dental biofilm control
Prevent perio
Smoking cessation
Dental Caries Control

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Incidence during pregnancy: rsrch says increase
risk for caries not related to pregnancy itself, but
indirectly
Contributory factors
 Previous neglect
 Diet during pregnancy
 Neglect of personal oral care
Dental Caries Control

Calcium and the mother’s teeth
 Misconception
calcium withdrawal from moms teeth
 Minerals contained in the erupted tooth enamel &
dentin are not available = no removal of minerals
can occur by way of pulp
 Minerals are removed from the external surface of
the enamel and exposed root surface in the process
of demineralization
Dental Caries Control

Fluoride program
 Topical
solution, gel, varnish after scaling and root
planing
 Fluoride dentifrice
 Pregnant adolescent = comprehensive fluoride plan
Special Problems for Referral

Domestic Violence
 Identification
 Common
sites of injury: head, face, neck
 Miscarriages, spontaneous/mult abortions, substance
abuse, depression, suicide attempts
 What to do: provide pt info about intervention
programs, ask pt if they want help, police, refer