ENDOCRINE DISORDERS

-IV-
Pregnany
Dr. Ahmed AL-Baghdadi
 Hormonal changes during pregnancy
1. Estrogen
o Plays a crucial role in the development of the uterus, placenta, and mammary glands.
o It promotes blood flow to the uterus
o stimulates the growth of breast tissue in preparation for breastfeeding.

2. Progesterone
o helps maintain the pregnancy by relaxing the smooth muscles of the uterus,
o preventing contractions that could lead to premature labor.
o plays a role in preparing the breasts for milk production.

3. Human Chorionic Gonadotropin (hCG):

o produced by the placenta and is responsible for maintaining the production of estrogen and progesterone during the early stages of
pregnancy.
o It is also the hormone detected in pregnancy tests.

4. Human Placental Lactogen (hPL):

o produced by the placenta
o plays a role in regulating maternal metabolism to provide nutrients for the developing fetus.
o It promotes breast development and stimulates milk production.
 Hormonal changes during pregnancy
5. Prolactin:
o Prolactin levels increase during pregnancy to prepare the breasts for lactation.
o It stimulates milk production
o plays a role in suppressing ovulation, thereby providing a natural form of contraception during breastfeeding.

6. Oxytocin:
o Oxytocin is known as the "love hormone"
o involved in various physiological processes, including uterine contractions during labor and breastfeeding.
o It promotes bonding between the mother and the baby
o facilitates the release of milk from the breasts during nursing.

What is the important of hormonal changes

1) supporting fetal development,
2) preparing the body for childbirth,
3) initiating breastfeeding.
4) They also influence various physiological adaptations in the mother's body, including changes in the reproductive system, cardiovascular
system, metabolism, and immune system.
 Hormonal Adaptations
• Estrogen and progesterone levels rise dramatically during pregnancy.
a) Impact on oral cavity:
- Increased vascularity and edema of gingival tissues.
- Pregnancy gingivitis: increased susceptibility to gum inflammation and bleeding.
- Altered response to microbial plaque.
b) Salivary Changes
- Hormonal shifts affect salivary flow and composition.
- Some pregnant women experience excessive salivation (ptyalism).
- Others may experience decreased salivary flow, increasing the risk of dental caries.
c) Cardiovascular Adaptations
- Increased heart workload to support the growing fetus.
- Expansion of blood volume and cardiac output.
- Implications for dental treatments:
- Modifications in patient positioning.
- Considerations for patients with cardiovascular conditions.
d) Respiratory Changes
Hormonal Adaptations
- Increased oxygen demand and reduced lung capacity.
- Upward displacement of the diaphragm by the enlarging uterus.
- Considerations for patient comfort during dental procedures:
- Appropriate positioning.
- Monitoring.
e) Metabolic Adjustments
- Changes in glucose metabolism and risk of gestational diabetes.
- Impact on oral health.
- Importance of nutritional considerations for optimal development.
The most important pregnancy problems facing the
dentist
1- Blood pressure
a) Hypotension in the 2nd Trimester:
- Occurs due to hormonal changes and expansion of blood vessels.
- Can lead to dizziness and fainting during dental procedures.
- Dentists should ensure proper patient positioning, allowing for optimal blood flow and avoiding
sudden postural changes.
- Frequent breaks and maintaining a comfortable environment can help manage hypotensive episodes.

b) Supine Hypotension Syndrome:

- Compression of the vena cava when a pregnant woman lies flat on her back.
- Results in reduced blood return to the heart and decreased blood pressure.
- Can cause dizziness, shortness of breath, and even loss of consciousness.
- Dentists should position pregnant patients in a semi-reclined or left lateral tilt position to relieve
pressure on the vena cava and maintain adequate blood flow.
The most important pregnancy problems facing the dentist

2. Gestational Diabetes Mellitus (GDM):

- Develops during pregnancy due to hormonal changes and increased insulin resistance.
- Can lead to higher risk of dental caries and periodontal disease.
- Dentists should be aware of the patient's GDM status and collaborate with the patient's obstetrician for optimal management.
- Emphasize good oral hygiene, regular dental visits, and dietary control to minimize oral health complications.

3. Teratogenicity in the 1st Trimester:

- The first trimester is a critical period of fetal development.
- Exposure to certain medications, radiation, and toxins during this time can pose risks to the developing fetus.
- Dentists should obtain a thorough medical history and consult with the patient's obstetrician if any dental treatments or
medications are necessary.
- Use of diagnostic imaging techniques with minimal radiation exposure is recommended.
 Oral manifestations
1- Gingivitis bleeding gums while brushing her teeth
2- periodontitis Increased risk of preterm birth

2- Pregnancy tumor

3- High caries risk

4- Aphthous- like ulcers

(Irons, Folate deficiency anemia)

5- Teeth erosion Morning sickness

Rinse the mouth with water or mouthwash after vomiting

6- Halitosis
 Medical Considerations in Oral Management of Pregnant Women
- Safest period for dental management during pregnancy: 2nd trimester. Medications:
- Delay elective treatments until after labor. a) Safe to use:
- In cases of pregnancy-related inflammation and pain: • Topical anesthesia and local anesthesia with
• Conservative treatment approaches are recommended. epinephrine.
• Emphasize plaque control. • Paracetamol.
• Medications may be prescribed, but surgery is postponed until after labor. • Penicillins.
- X-ray usage: • Cephalosporin.
• Use only when necessary. • Metronidazole.
• Minimize radiation dose. b) Avoid:
• Prefer bitewing X-rays or peripheral lead shielding. • Aspirin.
- Assess blood pressure and pulse regularly. • NSAIDs.
- Avoid the supine position. • Corticosteroids.
- For hypotension, place the patient on her left side. • Narcotic analgesics.
• Tetracycline
 Questions
Thank you for your attention. Any questions?