Dental Management of the Pregnant Patient

Christos A. Skouteris, DMD, PhD, is Clinical Assistant Professor in the Department of Oral and Maxillofacial Surgery at the University of Michigan School of Dentistry and in the Department of Surgery, Section of Oral and Maxillofacial Surgery at the University of Michigan School of Medicine in Ann Arbor, Michigan, USA.

Preface xi


Acknowledgments xiii


List of Contributors xv


1 Ethical Issues in the Treatment of the Pregnant Patient 1
Christos A. Skouteris


References 3


Further Reading 3


2 Physiologic Changes and Their Sequelae in Pregnancy 5
Christos A. Skouteris


Cardiovascular 5


Respiratory 6


Hematologic 8


Gastrointestinal 10


Genitourinary 12


Endocrine 14


Immunologic 15


Dermatologic 16


Musculoskeletal 17


Psychologic and Behavioral Changes 17


References 18


Further Reading 19


3 Implications of Physiologic Changes in the Dental Management of the Pregnant Patient 25
Christos A. Skouteris


Cardiovascular Changes: Management Considerations 25


Respiratory Changes: Management Considerations 25


Hematologic Changes: Management Considerations 26


Gastrointestinal Changes: Management Considerations 27


Genitourinary Changes: Management Considerations 28


Endocrine Changes: Management Considerations 28


Immunologic Changes: Management Considerations 29


Dermatologic Changes: Management Considerations 29


Musculoskeletal Changes: Management Considerations 30


Psychologic and Behavioral Changes: Management Considerations 31


Reference 31


Further Reading 31


4 General Principles for the Comprehensive Treatment of the Pregnant Patient 33
Christos A. Skouteris


Recording of Pregnancy Status before Treatment 33


Diagnostic Imaging Modalities in Pregnancy 34


Medications, Substance Abuse, and Their Implications in the Dental


Management of the Pregnant Patient 38


Procedural Sedation (Oral, N2O, Intravenous) 57


General Anesthesia 60


References 64


Further Reading 65


5 Dental and Oral Diseases in Pregnancy 71
Christos A. Skouteris


Prenatal Counseling and Prevention 71


Further Reading 73


6 Dental, Oral, and Maxillofacial Diseases and Conditions and Their Treatment 75


Treatment of Dental Disease 75
Benjamin Craig Cornwall


Odontogenic Oral and Maxillofacial Infections in Pregnancy 85
Kyriaki C. Marti


Benign Diseases and Conditions 90
Christos A. Skouteris


Management of Oral and Maxillofacial Malignancy in Pregnancy 93
James Murphy and Brent B. Ward


Management of Oral and Maxillofacial Trauma in Pregnancy 100
Igor Makovey and Sean P. Edwards


References 106


Further Reading 106


7 Postnatal Considerations 113
Kyriaki C. Marti


Medical Contraindications to Breastfeeding 113


Breastfeeding and Infant Oral Health 113


Procedures and Medications During Breastfeeding 115


References 121


Further Reading 122


8 Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) in Pregnancy 125
Kyriaki C. Marti


Cardiac Arrest in Pregnancy 125


BLS 125


ACLS 126


Further


Reading 128


9 Obstetric ]Gynecologic Emergencies 129
Christos A. Skouteris


Hypertensive Disorders of Pregnancy 129


Abdominal Pain in Pregnancy 131


Vaginal


Bleeding in Pregnancy 134


Labor and On ]Scene Delivery 135


Further Reading 142


Appendices 143


Appendix 1 Cardiovascular Changes 145


Appendix 2 Cardiovascular Changes 146


Appendix 3 Respiratory Changes 147


Appendix 4 Hematologic Changes 148


Appendix 5 Gastrointestinal Changes 149


Appendix 6 Genitourinary Changes 150


Appendix 7 Endocrine Changes: Insulin Gestational Activity 151


Appendix 8 OB-GYN Emergencies 152


Appendix 9 OB-GYN Emergencies 153


Appendix 10 OB-GYN Emergencies 154


Appendix 11 Most Important Physiologic Changes Per Trimester of Pregnancy 155


Appendix 12 Management of Oral Squamous Cell Carcinoma in Pregnancy 156


Appendix 13 Management of Oral and Maxillofacial Trauma in Pregnancy 159


Reader s Self ]Assessment Quiz 161


Index 169