DEPARTMENT OF ORAL MEDICINE AND

RADIATION

MADE BY – Twinkle Singh

UNDER THE GUIDANCE OF
BDS final year
Dr. Aastha Manchanda
Roll no. - 6086092
Dr. Himani Tyagi
Dr. Anchal Goyal
•INTRODUCTION
•CHANGES IN PREGNANCY
•COMMON COMPLAINTS IN
PREGNANCY
•DENTAL MANAGEMENT
•DRUG ADMINISTRATIONS
•PREGNANCY RELATED
ORAL HEALTH PROBLEMS
•PREGNANCY AND
RADIATION
 Pregnancy, also known as gestation, is the time
during which one or more offsprings develops
inside a woman.
 Pregnancy is typically divided into three
trimesters. The first trimester is from week one
through 12 and includes conception. During
the first trimester, the possibility of miscarriage is
at its highest.
 The second trimester is from week 13 through
28. Around the middle of the second trimester,
movement of the fetus may be felt.
 The third trimester is from 29 weeks through 40
weeks.
 ANATOMIC

 Uterus weight increases from 70gm to 1 kg.

 Uterus volume increases from 10ml to
5000ml.
 Supine hypotensive syndrome
 Symptoms: sweating nausea, weakness,
low blood pressure, bradycardia, syncope
 Occurs in third trimester.
 There are 10-15% chances.
 Occurs as a result of compression of
inferior vena cava and aorta by heavy
weighted mass of uterus.
 Decreases venous return to heart
 Decreased cardiac output.

PREVENTION: LEFT LATERAL DECEITS POSITION (place a small

pillow under the right hip.
SIT UP POSITION
 CARDIOVASCULAR CHANGES
 RESPIRATORY CHANGES
 GASTROINTESTINAL SYSTEM
 RENAL SYSTEM
 HEMATOLOGICAL SYSTEM
 CARDIOVASCULAR SYSTEM

 Cardiac output increases upto 40%

 Mean arterial BP decreases.
 Total blood volume increases by 40-50%.
 Heart beat increases

RESPIRATORY SYSTEM

•Diaphragm is displaced upward upto 3-4 cm.

•Rib flare out with chest circumference of 5-7 cm
•Oxygen consumption increase upto 15-20%
•Respiratory rate increase.
 GASTROINTESTINAL SYSTEM

•Increase gastric acid production.

•Decrease gastric mobility.
•Incompetence of gastroesophageal spincter.
•Esophageal reflux.
•Excessive and unconrolled vomiting, morning appointments should
be avoided.
•Constipation

RENAL SYSTEM

•Increase renal plasma flow

•Reduced bladder capacity from uterine growth.
•Hence, increased frequency of renal flow.
•Urinary tract infection
•- It is adviced to void the bladder just prior to starting the dental
procedure.
 Hematological System

Plasma volume increase 40-70cc/kg

Red cell volume increase 25-30cc/kg
Plasma levels of factors VII, VIII, X and fibrinogen increase
Fibrinolytic activity decrease
Coagulation factors increase so pregnancy is a
hypercoaguable state that increase risk for
thromboembolism.
 First trimester Second trimester Third trimester

• Constipation • Aches and pains • Breast tenderness

• Dizziness • Shortness of • Haemorrhoids
• Frequency of breath • Heartburn
urination • Tingling and • Swelling
• Haemorrhoids itching
• Leg cramps • Weight gain
• Nausea and
vomiting
• Nosebleeds,
nasal stuffiness
• Tiredness
• Varicose veins
 GENERAL GUIDELINES

 Detailed history about the number of times

patient has been pregnant, number of
children conceived, history of abortion.
 Appointments to be kept short and the best
chair position is sitting up or left lateral
position with the head of the chair
elevated.
 Dental radiographs are best avoided. If
unvoidable then second trimester is
preferred.
 Prescription of drugs to be done with care.
 First trimester : The most critical and rapid cell division and active
organogenesis occur between the second and the eighth week of post
conception. Therefore, the greater risk of susceptibility to stress and
teratogens occurs during this time and 50% to 75% of all spontaneous
abortions occur during this period.
The recommendations are:
Educate the patient about maternal oral changes during pregnancy.
Emphasize strict oral hygiene instructions and thereby plaque control.
Limit dental treatment to periodontal prophylaxis and emergency
treatments only.

Second trimester :Organogenesis is completed and therefore the risk to

the fetus is low. Some elective and emergent dentoalveolar procedures
are more safely accomplished during the second trimester.
The recommendations are:
Oral hygiene instruction, and plaque control.
Scaling, polishing, and curettage may be performed if necessary.
Control of active oral diseases, if any.
Elective dental care is safe.
Avoid routine radiographs. Use selectively and when needed
Third trimester :
Although there is no risk to the fetus during this trimester, the
pregnant mother may experience an increasing level of
discomfort. Short dental appointments should be scheduled
with appropriate positioning while in the chair to prevent
supine hypotension. It is safe to perform routine dental
treatment in the early part of the third trimester, but from the
middle of the third trimester routine dental treatment should
be avoided.
 Higher volume of drug distribution, lower maximum plasma
concentration, lower plasma half-life, higher lipid solubility,
and a higher clearance of the drugs is seen in pregnancy.
 Certain drugs are known to cause miscarriage,
teratogenicity, and low birth weight of the fetus. Most
drugs are excreted in breast milk, exposing the newborn to
the drugs. toxicity to new born depends on the chemical
properties, dose, frequency, duration of exposure to the
drugs, and amount of milk consumed.
 Several categories of drugs are known to be teratogenic,
including alcohol, tobacco, cocaine, thalidomide, methyl
mercury, anticonvulsant medications, warfarin
compounds, angiotensin-converting enzyme (ACE)
inhibitors, retinoids, and certain antimicrobial agents
DRUGS USE IN USE IN LACTATION REMARKS
PREGNANCY

ANTIBIOTICS
AMOXICILLIN YES YES
METRONIDAZOLE
ERYTHROMYCIN
PENICILLIN FETAL OTOTOXIXITY WITH
CEPHALOSPORINS GENTAMYCIN
GENTAMYCIN YES YES DICOLORATION OF
CLINDAMYCIN TEETH WITH
TETRACYCLINE
TETRACYCLINE NO NO MATERNAL TOXOCITY
CHLORAMPHENICOL FTAL DEATH WITH
CHLORAMPHENICOL

ANALGESICS
ACETAMINOPHEN YES YES
MORPHINE
MEPERIDINE
POSTPARTUM
HEMORRHAGE
ASSOCIATED WITH
ASPIRIN.
OXYCODONE WITH CAUTION WITH CAUTION RESPIRATORY
HYDROCODONE
 ANTIFUNGALS

CLOTRIMAZOLE YES YES

NYSTATIN FETAL TOXICITY WITH
FLUCANOZOLE WITH CAUTION NO KETOCONAZOLE
KETOCONAZOLE

LOCAL ANAESTHETICS
LIDOCAINE YES YES
PRILOCAINE FETAL BRADYCARDIA
ETIDOCAINE
MEPIVACAINE WITH CAUTION WITH CAUTION WITH MEPIVACAINE
BUPIVACAINE AND BUPIVACAINE

CORTICOSTEROIDS

PREDNISOLONE YES YES

SEDATIVE HYPNOTICS
NITROUS OXIDE NOT IN 1ST TRIMESTER YES SPONTANEOUS
ABORTIONS WITH
NITROUS OXIDE
BARBITURATE NO YES CLEFT LIP PALATE WITH
BENZODIAZEPINES BENZODIAZEPINES
 The capacity of a drug to cause foetal
abnormalities when administered to the
pregnant mother. The placenta does not
constitute a strict barrier, and any drug
can cross it to a greater or lesser extent.
 The embryo is one of the most dynamic
biological systems, and in contrast to
adults, drug effects on embryo are often
irreversible.
Safe Medications to Take During Pregnancy
ANTIHISTAMINES
•Diphenhydramine
•Loratidine
•Cetirizine

•Type of Remedy: Cold and Flu

•Diphenhydramine
•Dextromethorphane
•Guaifenesin
• mentholated cream
•Mentholated or non-mentholated cough drops
•(Sugar-free cough drops for gestational diabetes should not
contain blends of herbs or aspartame)
•Acetaminophen

•Type of Remedy: Diarrhea

•Safe Medications to Take During Pregnancy
•Loperamide (after 1st trimester, for 24 hours only)
•Type of Remedy: Constipation
•Methylcellulose
•Docusate
•psyllium
•polycarbophil
•polyethylene glycol
•*Occasional use only

•Type of Remedy: First Aid Ointment

•Bacitracin
•Neomycin/polymyxin B/bacitracin

•Type of Remedy: Headache

•Acetaminophen (Tylenol)

•Type of Remedy: Heartburn

•Aluminum hydroxide/magnesium carbonate
•Famotidine
•Aluminum hydroxide/magnesium hydroxide
•Calcium carbonate/magnesium carbonate
•Calcium carbonate
•Ranitidine
•*Occasional use only
•Type of Remedy: Hemorrhoids
•Phenylephrine

•Type of Remedy: Yeast Infection

•Miconazole
 Pregnancy gingivitis
 Pregnancy epulis
 Increased tooth mobility
 Dental Caries
 Erosion
 Dental problems in relation to labor and
delivery
 Occurs commonly in the 2nd to
8th months.
 Most common oral
manifestation
 Tendency to bleed easily
 Caused by elevated
circulatting estrogen which
increases capillary permeability
and vascular changes.
 Treatment- scaling, root
planning, curettage, OHI
 Occurs in upto 5% of women
 Most commonly in buccal
maxillary anterior areas.
 Usually starts in an area of
gingivitis.
 Rapid growth upto 2 cm
 Single tumor like growth usually
in interdental papilla.
 Purplish to bluish in color, may
be ulcerated
 May regress spontaneously
after.
 Occurs due to saliva changes-
decreased minerals, decrease flow in 1st
and 3rd trimester, more acidic
 Uncontrolled oral hygiene
 Morning sickness
 Erosion is the loss of tooth
substance due to
exposure to chemical
material.
 Vomiting and esophageal
reflux result in acid
exposure which causes
weakening of tooth
enamel and dental
erosion.
 Prenatal Radiation Exposure The exposure of a fetus to radiation is referred to
as prenatal radiation exposure. This can occur when the mother's abdomen
is exposed to radiation from outside her body. Also, a pregnant woman who
accidentally swallows or breathes in radioactive materials may absorb that
substance into her bloodstream. From the mother's blood, radioactive
materials may pass through the umbilical cord to the baby.
 The possibility of severe health effects depends on the gestational age of
the fetus at the time of exposure and the amount of radiation it is exposed
to. Unborn babies are less sensitive during some stages of pregnancy than
others. However, fetuses are particularly sensitive to radiation during their
early development, between weeks 2 and 18 of pregnancy
 The health consequences can be severe, even at radiation doses too low to
make the mother sick. Such consequences can include stunted growth,
deformities, abnormal brain function, or cancer that may develop sometime
later in life. However, since the baby is shielded by the mother's abdomen, it
is partially protected in the womb from radioactive sources outside the
mother's body. Consequently, the radiation dose to the fetus is lower than
the dose to the mother for most radiation exposure events. Pregnant women
should consult with their physicians if they have any concern about radiation
exposure to their fetus.
•During the first 2 weeks of pregnancy, the radiation-related health effect of
greatest concern is the death of the baby.
•The fetus is made up of only a few cells during the first 2 weeks of pregnancy.
Damage to one cell can cause the death of the embryo before the mother
even knows that she is pregnant. Of the babies that survive, however, few will
have birth defects related to the exposure, regardless of how much radiation
they were exposed to.
• Large radiation doses to the fetus during the more sensitive stages of
development (between weeks 2 and 18 of pregnancy) can cause birth
defects, especially to the brain.
• Between the 18th week of pregnancy and birth, radiation-induced health
effects (besides cancer) are unlikely unless the fetus receives an extremely
large dose of radiation.
•After the 26th week of pregnancy, the radiation sensitivity of the fetus is
similar to that of a newborn. At the 26th week of pregnancy, the fetus is fully
developed though not fully grown. Unborn babies exposed to radiation in the
womb during this stage of pregnancy are no more sensitive to the effects of
radiation than are newborns. This means that birth defects are not likely to
occur, and only a slight increase in the risk of having cancer later in life is
expected.
 POTENTIAL HEALTH EFFECTS OF PRENATAL EXPOSURE
ACUTE POST 3TH - 5TH 6TH – 13TH 14TH – 23RD 24TH WEEK
RADIATION CONCEPTIO WEEKS WEEKS WEEKS
DOSE TO N (UP TO 2
THE WEEKS)
EMBRYO/FE
TUS
0.10 Gy Failure implant Growth Growth Non cancer ---
(10-15 rads) may increase restriction restriction health effect
slightly, but possible unlikely
surviving
embryos will
probably have
no significant
health effects
>0.50Gy Failure implant Probability of Probability o Probability of Miscarriage
(50 rads) the will likely be miscarriage miscarriage miscarriage and neonatal
expectant high but may increase. may increase, may increase. death may
mother may be surviving Growth depending on Growth occur
experiencing embryos will restriction. dose. Growth restriction.
acute probably have Probability of restriction. Probability of
radiation no significant malformations major
syndrome in health effects of neurological malformations
this range, and motor may increase
depending on deficiencies.