Darby Evolve Chapter 46 - Pregnancy and Oral Health

Daily oral self-care is essential during pregnancy. Research shows a link between periodontal disease and adverse effects during pregnancy.
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Daily oral self-care is essential during pregnancy. Research shows a link between periodontal disease and adverse effects during pregnancy.
The first statement is true, the second statement is false.
There is evidence to recommend personal toothbrushing. While evidence showing a cause and effect relationship is lacking between periodontal disease and adverse pregnancy outcomes, oral healthcare during pregnancy has been shown repeatedly to be safe. Thus women should not avoid oral healthcare during pregnancy or postpone it until after delivery; rather, women should seek oral healthcare and practice good oral hygiene and nutrition behaviors to ensure a healthy mouth that is free of infection. This care is not only essential for the woman's oral and systemic health, but also critical to reduce her child's risk for early childhood caries.
The incidence of gingivitis decreases during pregnancy. The decreased inflammatory response to bacterial plaque helps maintain healthy tissue.
Both statements are false.
The incidence of gingivitis increases during pregnancy. An increased inflammatory response to bacterial plaque during pregnancy causes signs of gingivitis in most women with the anterior teeth affected more than the posterior teeth. These signs are exacerbated by poor plaque control and mouth breathing. Pregnancy gingivitis typically peaks during the third trimester. Women who have gingivitis before pregnancy are more prone to exacerbation during pregnancy.
Your patient is in her last trimester of pregnancy and has a pyogenic granuloma. She is in pain. Which of the following can she take to relieve the pain?
Acetaminophen
Acetaminophen is the only analgesic that can be safely taken during the entire pregnancy. Aspirin and ibuprofen should not be used the first and third trimesters. They may be taken for a short duration (48 to 72 hours) during the second trimester. Hydrocodone, an opioid, should not be used during the pregnancy.
Case Study
Your patient is in her second trimester of pregnancy. She presents with red, inflamed gingival tissue, moderate plaque biofilm, and occlusal caries on teeth #2, 14, 15, and 19 and interproximal caries on teeth #8 and 9. She indicates she did not have inflamed tissue prior to pregnancy. She reports brushing one time a day most days. She does not floss.
Given the above scenario, which of the following should you do?

a. All are applicable.
b. Restore all carious lesions prior to delivery.
c. Educate her on proper nutrition.
d. Teach her proper oral hygiene care.
All are applicable.
Educating your patient on proper oral hygiene care and proper nutrition will benefit both her and her child. Restoring all carious lesions prior to delivery will reduce levels of Streptococcus mutans that can be transmitted vertically from mother to child and prevent the risk of early childhood caries.
Your patient should be careful not to consume any products that contain fluoride while she is pregnant. Drinking bottled water is recommended.
Both statements are false.
Personal oral healthcare during pregnancy is essentially the same as for all adults. The best weapon to prevent dental caries is drinking optimally fluoridated water. Adults and children benefit from this public health measure. Drinking tap water is especially beneficial for dental caries prevention when it is optimally fluoridated at 0.7 ppm (i.e., 0.7 mg of fluoride per liter of water). Drinking bottled water is not recommended because it is unregulated and usually contains a suboptimal amount of fluoride. An important regimen for pregnant, women is brushing teeth with fluoride containing toothpaste twice a day and flossing (or interdental cleaning) once a day.
Your patient's gingival inflammation is most likely due to hormonal changes and inadequate oral hygiene practices. The gingivitis will most likely not be reversed with thorough proper brushing and flossing in conjunction with professional dental hygiene preventive services.
The first statement is true, the second statement is false.
Women may experience pregnancy gingivitis that is most likely due to hormonal changes and inadequate oral hygiene practices; however, it can be prevented or reversed with thorough plaque control via brushing and flossing in conjunction with professional dental hygiene preventive services, if indicated. Gingivitis may be exacerbated if a woman has this condition prior to becoming pregnant.
Your recommendations to your patient should include which of the following?
Drink fluoridated tap water.
Limit sugar consumption.
All are applicable.
Eat a well-balanced diet.
All are applicable.
Advice for pregnant women should include drinking fluoridated water, eating a well-balanced diet, and limiting the amount of sugars consumed.
Dental images are an important diagnostic tool for this patient. Which of the following should you do when exposing your patient to x-rays?
Use the fastest image receptor.
All are applicable.
Take the minimum number of exposures necessary.
Use a protective apron with collar.
All are applicable.
The same radiation exposure guidelines are followed for your pregnant patient as for you nonpregnant patients. Take the minimum number of exposures that are necessary, cover your patient with a protective apron with thyroid collar, and use the fastest image receptor available. You should also use proper technique to avoid the need for retakes, and use a collimator designed for the size of the receptor.
Based on the information provided above on your patient. Which of the following dental images would you not take of your patient?
Right maxillary molar
Based on the guidelines that you take the minimum number of dental images necessary, the right maxillary molar image is not essential. Bitewing images are used to detect decay. The maxillary anterior image is taken because there is visible decay. The molar and premolar bitewing images are taken to detect interproximal decay.
Tooth erosion may occur during pregnancy if a woman vomits repeatedly. Pregnant women who vomit frequently because of morning sickness should be advised to brush immediately after vomiting.
The first statement is true, the second is false.
Tooth erosion may occur if a woman vomits repeatedly from severe morning sickness. Subsequent mechanical abrasion may occur when the tongue or toothbrush moves against the teeth. Patients who are vomiting frequently should be advised to rinse with 1 teaspoon of soda in a cup of water and avoid teeth brushing for about an hour.
Your patient is in the early part of her second trimester of pregnancy. Which of the following should you do? Place her in the supine position. Schedule her appointment in the morning before she gets too tired. Place a pillow under her left hip or turn her slightly to the right to prevent hypotension. Allow for frequent position changes.Allow for frequent position changes. When providing oral healthcare to pregnant women, it is best to appoint women in the afternoon during the first trimester and early part of the second trimester. This scheduling approach may avert bouts with morning nausea. Positioning pregnant women appropriately in the dental chair to ensure comfort is essential. The woman's head should always be higher than her feet, and frequent position changes should be accommodated, as necessary. A small pillow can be placed under her right hip, or the woman can turn slightly to the left as needed to avoid dizziness or nausea resulting from hypotension.An infant's mouth should be cleaned daily with a damp baby washcloth. A smear of fluoridated toothpaste should be used to clean each tooth as it erupts.Both statements are true. Teach new mothers and other caregivers how to clean an infant's mouth using a clean, damp infant washcloth. When the first tooth erupts, begin using a tiny smear (or the size of a grain of rice) of fluoride containing toothpaste to brush the child's teeth. Equally important is to teach caregivers how to "lift the lip" of the infant to look for white spot lesions along the gum line once a month and what to do if there is discoloration of the teeth.It is important to discuss infant caries prevention with your patient prior to the birth of her child. You should discuss all of the following with your patient EXCEPT which one? a. Take the child to the dentist if white spots appear on the teeth. b. Do not give juice until the child is over a year old. c. Wean the child off the bottle before the second birthday. d. Do not put the baby to sleep with a bottle.Wean the child off the bottle before the second birthday. A child should be weaned from a bottle by 12 to 14 months. A child should never be put to bed with a bottle, should not be given juice the first year of life, and should be taken to the dentist if white spots appear on the teeth. The white spots are noncavitated carious lesions that can be healed with fluoride.Which of the following can be administered during pregnancy? a. All are applicable b. Lidocaine with epinephrine c. Nitrous oxide (30%) d. Mepivacaine with epinephrineAll are applicable All of the above may be used during pregnancy. Nitrous oxide may be used during pregnancy when topical or local anesthetics are inadequate. Pregnant women require lower levels of nitrous oxide to achieve sedation; consult with prenatal care health professional.If a pregnant woman has diabetes prior to becoming pregnant, and it is poorly controlled during her first trimester, the developing baby's organs may be affected. Low blood glucose levels can be harmful during this period and can increase the baby's risk of birth defects.The first statement is true, the second statement is false. If a pregnant woman has diabetes prior to becoming pregnant, and it is poorly controlled during her first trimester, the developing baby's organs may be affected, such as the brain, heart, kidneys, and lungs that start forming during the first 8 weeks of pregnancy. High blood glucose levels can be harmful during this period and can increase the baby's risk of birth defects, such as heart defects or defects of the brain or spine.