Pregnancy

By
Leslie Bebber & Marge Batterson

Clinical Seminar III

Fall 2009
 The Fun Begins
• Divided into 3 trimesters
•
• Normal pregnancy is 40 weeks
•
• Premature birth is <37 weeks
 First Trimester
• Highly susceptible to injuries and malformations
• Teratogenic effects from poor nutrition, infections
and drugs
• All organ systems formed
• By 12 weeks fetus moves and swallows
• Tooth buds develop between 5th and 6th week
• Lips form during 4th to 7th week
• Palate forms between 8th and 12th week
• Cleft lip apparent by 8th week and cleft palate by
12th week
Second and Third Trimesters
•
• Organs are fully formed
•
• Growth and maturation continue
•
• Fetal weight changes from 1oz at
3months to an average of 7.5 lbs at
birth
 The Pregnant Patient
• Have patient lie on left side with a
rolled blanket or pillow under the
right hip
• Increase frequency of recall to
3months
• Spend extra time on home care
instructions
• Ultasonics are not contraindicated
• Recommend a daily fluoride program
• Smoking cessation program if
 Health and Pregnancy
• Proteins for general tissue construction
•
• Minerals, especially calcium and
phosphorus for bone and tooth
mineralization; iron for blood corpuscles
•
• Vitamins, especially vitamin D for calcium
metabolism, folate to prevent birth
defects and vitamin A to prevent
preterm birth.
 Perio and Pregnancy

• Accounts for more than 18% of all pre-

term births
•
• This is more significant than cigarette
smoking or alcohol use
•
• Lipopolysaccharides (endotoxins) from
pathogenic periodontal plaque
bacteria cross the placental barrier
and stimulate the inflammatory
response
•
•
 “Pregnancy Tumor”
• Pyrogenic granuloma
• Smooth or lobulated
• Pedunculated
• Ranges from pink to red to purple
• Highly vascular
• 75% occur on the gingiva, however it is
important to note that they may occur on
the tongue, lips, and buccal mucosa
• Begin in 1st trimester up to the 7th month
• Related to increased levels of estrogen and
progesterone
• Most resolve after parturition
 “Mask of Pregnancy”
• Acquired, symmetrical hyperpigmentation
of the sun-exposed skin of the face and
neck
• Unknown cause
• More common is Asian and Hispanic
women
• Exposure to exogenous estrogen and
progesterone from oral contraceptives or
hormone replacement therapy may also
cause melasma
• Difficult to treat
 Tooth Mobility
•
•
• Tooth mobility may be associated with pregnancy
•
• Last few weeks before delivery
•
• Increased hydration of connective tissues
•
• With or without periodontal disease
•
•
•
• Avoid if possible
•
• Additional lead apron for the
back to prevent secondary
radiation from reaching the
abdomen
 Local Anesthetics
• Medical consult recommended
•
• Local anesthetic and vasoconstrictors
are not teratogens


• Use in moderation
 Nitrous Oxide Sedation
• Nitrous oxide is contraindicated
during the first trimester
•
•
• If used in the second or trimester it
must be minimized to 30 min with
50% oxygen
•
 Other Considerations
• Frequent urination
• Backache
• Faintness and dizziness
• Adverse reactions to strong smells and
flavors
• Exaggerated reactions to odors and
flavors of medicaments
• Nausea and vomiting
• Gagging
• Unusual food cravings (sweets)
 Dental Care
• Postpone elective treatment until the
second trimester (NOT
HYGIENE!!!!)
• Increase frequency of recare
• No temporary restorations
• Short mid-morning appointments
• Extra time spent on proper home
care
• IMPORTANT don’t forget the baby!!
Brush Your Teeth!!!