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Pregnancy :pregnant_woman: (Physiology :pregnant_woman::skin-tone-2: (3rd…

- - - - Plasma volume :arrow_up:
      - Red cell volume :arrow_up:
      - Total blood volume :arrow_up: 45%
      - Platelet :arrow_down:
      - Haemoglobin :arrow_down: 15%
      - WBC/ESR: :arrow_up:
      - Factor. V,VII,VIII,IX,XII,Fibrinogen,vWF:arrow_up:
    - - Stroke volume, heart rate :arrow_up:
      - Blood pressure : non-pregnant value
      - Cardiac output: remain>50%
    - - Tidal volume, IRV :arrow_up:
      - FRC, ERV, TLC :arrow_down:
      - Diaphragm elevate
    - - GFR :arrow_down:
      - Creatinine cr :arrow_down:
      - Glycosuria, proteinuria :arrow_up:
      - Urinary frequency
    - - LOS pressure :arrow_down:
        Gastric acid secretion :arrow_down:
        Gastric emptying :arrow_down:
      - Heart burn :arrow_up:
      - GERD
    - - HCG :arrow_down:
      - Breast enlargement
      - Colostrum
    - - Calcium demand :arrow_up:
      - Insulin resistance
      - Protein systhesis :arrow_up:
    - - Separation of pubic symphysis&rectus abdominis
      - Lower back pain
      - Carpal tunnel syndrome
  - - - Plasma volume :arrow_up:
      - Total blood volume :arrow_up:30%
      - Platelet :arrow_up_down: :arrow_down:
      - Haemoglobin :arrow_down:
      - WBC/ESR :arrow_up_down: :arrow_up:
      - Factor. V,VII,VIII,IX,XII,Fibrinogen,vWF :left_right_arrow::arrow_up:
    - - Stroke volume, heart rate, cardiac output, blood volume :arrow_up:
      - Blood pressure :arrow_down: :arrow_up_down:
    - - Tidal volume :arrow_up:
    - - GERD
      - Gastric acid secretion :arrow_down:
      - LOS pressure :arrow_down:
      - Heartburn :arrow_up:
      - Gastric empty :arrow_down:
    - - Melasma
    - - Urinary frequency
    - - Lower back pain
      - Pubic pain
      - Uterus expand
      - Clamp
      - Supine hypotension syndrome
    - - Estrogen :arrow_up:
      - Progesterone :arrow_up:
      - TSH :arrow_down:, T3,T4 :arrow_up:
  - - - Blood pressure :arrow_down:
      - Stroke volume, heart rate, cardiac output, blood volume :arrow_up:
    - - Morning sickness
      - LOS pressure :arrow_down:
      - Gastric acid secretion :arrow_down:
      - Heartburn :arrow_up:
      - Gastric empty :arrow_down:
    - - Tidal volume :arrow_up:
    - - GFR,Creatinine cr :arrow_up:
    - - Plasma volume :arrow_up:
      - Red cell volume :arrow_down:
      - Total blood volume :arrow_up: 10%
      - Platelet :arrow_up_down: :arrow_down:
      - Haemoglobin :arrow_down:
      - WBC/ESR :arrow_up_down: :arrow_up:
      - Factor. V,VII,VIII,IX,XII,Fibrinogen,vWF :left_right_arrow::arrow_up:
    - - HCG :arrow_up:
      - Estrogen :arrow_up:
      - Progesterone :arrow_up:
      - TSH :arrow_down:, T3,T4 :arrow_up:
    - - Insulin :arrow_up:
      - Triglycerides, cholesterol :arrow_up:
      - Protein intake :arrow_up:
      - Water retention
- - - - Acetaminophen
        
        Category B
        
        Should not exceed >4 g/day
      - Ibuprofen
        
        Category B : 1st & 2nd trimesters
        
        Category D : 3rd trimester
    - - Category C
        
        Prilocaine
        
        Mepivacaine
      - Category B
        
        Lidocaine
    - - Category B
        
        Amoxicilin
        
        Metronidazole
        
        Clindamycin
    - - Tetracyclin
      - Warfarin
      - Alcohol :champagne:
      - Tobacco :smoking:
      - ACE inhibitor
      - Phenytoin
      - Pesticide☠️
    - - A : Safety
      - B : No fetal risk (Study on animal)
      - C : Fetal harzard (Study on animal)
      - D : Risk to the fetus but can used in exceptional cases
      - X : :forbidden:
- - - - Gingival bleeding during tooth
        brushing for about 1 month
    - - Pregnant for 3 months and morning sickness everyday
    - - General appearance
      - Extra oral Examination
        
        Head :face_with_head_bandage:
        
        Face :smiley:
        
        Eyes Ears and Nose 👂🏻👀👃🏻
        
        TMJ and masticatory muscle
      - Intraoral Examination
        
        Oral hygiene
        
        Hard Tissue examination
        
        Soft Tissue examination
  - - - Localized
      - Generalized
    - - Investigation
        
        Confirm by histopathology
      - Treatment planning
- - - - Cause
        
        Contributing factor : Hormone change
        
        Primary factor : plaque
      - Sign & symptom
        
        Bluish red
        
        Swelling
        
        Pain
        
        Gingival bleeding
    - - Cause
        
        Plaque
        
        pH :arrow_down:
        
        1st trimester
        
        Morning sickness
        
        2nd & 3rd trimester
        
        GERD
        
        Poor oral hygiene
        
        Frequently eating
        
        Nausea when brushing
    - - Cause
        
        Hormonal change
        
        Progesterone : inhibit collagenase
        
        Irritation by plaque
      - Reactive lesion
        
        Gingival margin of anterior vestibular aspect
        
        2nd & 3rd trimester
      - Clinical feature
        
        Redish mass
        
        Soft
        
        Pedunculated mass
        
        Painless
      - Pathophysiology
        
        Tumor-liked growth
        
        Cytogenic abnormalities
      - Management
        
        OHI
        
        Scalling
        
        Surgery
    - - Cause
        
        pH :arrow_down:
        
        1st trimester
        
        Morning sickness
        
        2nd & 3rd trimester
        
        GERD
      - Prevalence
        
        Lingual & palatal surface of incisor teeth
      - Management
        
        Rinse water with sodium bicarbonate
        
        1 spoon 🥄: 1 cup of water🥛
        
        Avoid brushing after vomitting 1 hr
  - - - OHI
      - Check up oral health
      - Antenatal care (ANC)
      - educate the patients about the maternal oral changes
    - - Avoid supine
        hypotensive syndrome
      - OHI
      - Dental x-ray is safe :+1:
    - - Scaling, polishing and curettage is safe
      - OHI