Traditionally, general dentists have been reluctant to treat pregnant patients due to uncertainty of the risks that might be imposed on both the mother and the fetus. However, preventive, emergency, and routine dental procedures are all suitable during various phases of a pregnancy, with some treatment modifications and initial planning. This article will review some of the physiologic changes and oral pathology associated with pregnancy, and how these alterations affect dental care for the patient. A brief discussion concerning the risks and benefits of radiation, certain medications, and pre-natal fluoride is also given. Additionally, an overview of possible obstetric emergencies that may arise during a general dental appointment is presented with treatment options outlined.
A 19-year-old pregnant woman presented with an enlarging lesion in the right mandible. She was examined by a general dental practice resident in the hospital outpatient clinic and subsequently managed by the resident as an inpatient. Both moral and ethical questions arose because of the discovery of the lesion early in the patient's pregnancy. Delay on the part of the patient while she contemplated termination of the pregnancy, compounded by loss of contact with her, eliminated the possibility of removal of the lesion during the second trimester. The patient elected to continue the pregnancy, and an en bloc procedure was used to remove the ameloblastoma.
Glycogen storage diseases (GSD) are metabolic disorders which impair the body's ability to store glucose and utilize it later, requiring patients to take multiple daily dietary supplementation with a high carbohydrate content. Patients undergoing this treatment modality are placed at increased risk for gross dental caries and other oral abnormalities. Additionally, GSD may prolong the patient's bleeding time, which may necessitate consultation with the treating physician. In the following case, our patient required a multidisciplinary approach to address not only her dental needs, but also to coordinate the management of both her GSD and an additional complication, von Willebrand's disease. This was best achieved in a hospital setting.
An increased level of ammonia in the bloodstream, or hyperammonemia, is a symptom associated with metabolic disorders referred to as inborn errors of metabolism. Urea cycle disorder is a congenital abnormality or absence of one of the six enzymes involved in the elimination of ammonia. Administration of certain medications, high protein diet, excessive exercise, surgical procedures, or trauma can precipitate symptoms of mental confusion, seizure-like activity, and ataxia. This paper reviews the literature with insight into current treatment and management options of the disorder and modification of treatment for the dental patient.
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