Advanced Education In General Dentistry

Patient Case: Cardiac Disease

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A.E. is a 21 year old woman 8 months pregnant referred by the Triage department for evaluation and treatment of pericoronitis associated with a partially erupted tooth #17. The patient is extremely anxious and wishes to be sedated for the extraction of her tooth.

PMHx: 8 months pregnant, complicated by mild hypertension and diabetes
PSHx: None
Medications: Pre natal vitamins
Allergies: No Known Drug Allergies

Questions For The Patient

  1. When is your anticipated day of delivery?
  2. Have you had any complications during your pregnancy?
  3. When was your last ultrasound, and was it normal?

Implications For Sedation

It is generally accepted that elective treatment should be deferred in pregnant patients, especially in the 1st and 3rd trimester. Only in cases of emergency should treatment be given and if the procedure cannot be performed under local anesthesia then strong consideration should be given to providing treatment in an operating room. This will allow for the most optimal monitoring of both the mother and the fetus. Any decision to treat the aptient should be discussed with the Ob/Gyn, and one hsould avoid midecations taht are potentially harmful to the fetus.

Summary Of Treatment

  1. Defer Elective treatment until after pregnancy or until the 2nd trimester.
  2. Discuss treatment with the Ob/Gyn.
  3. Avoid radiographs if possible.
  4. Avoid drugs with teratogenic potential.
  5. Avoid keeping the patient in the supine position for long periods of time to prevent vena cava compression.
  6. Vitals monitoring
  7. Supplemental Oxygen

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