Dental care in Pregnancy DMD, PhD. Shin Dong-Ryul cons-99@hanmail.net
Pregnancy is a teachable moment when women are receptive to changing behaviors that can benefit themselves and their children
The majority of the physicians (81%) agreed that pregnancy increases the tendency to have gingival inflammation. However, 88% of doctors advised delay dental treatment until after pregnancy. Int J Dent Hyg. 2008 Aug;6(3):214-20.
There is no evidence relating early spontaneous abortion to first trimester oral health care or dental procedures
The Dentists Insurance Company (TDIC) which is endorsed by eight U.S. state dental associations and insures 17,000 dentists nationwide reports only one incidence in the past 15 years or more. http://www. cdafoundation.org/library/docs/poh_policy_ 8. brief.pdf. Accessed March 2010
Oral change 1. Hormonal change - Periodontal change 2. Changes in diet and oral hygiene. Nausea and vomiting in pregnancy can cause extensive erosion.
periodontal disease -preterm birth, low birth weight dental caries -vertical transmission (ECC (Early Childhood Caries))
Periodontal disease
an increase in estrogen and progesterone levels Estrogen and progesterone receptors in gingival tissues a higher vascular permeability, providing essential bacterial growth factors increases in probing depth (PD) and bleeding on probing (BOP pregnancy gingivitis (prevalence: 35% to 100%) Loe H, Silness J. Acta Odontol Scand 1963; 21:533-551. Valimaa H. et al. J Endocrinol 2004;180:55-62. Miyazaki H. et al. J Clin Periodontol 1991;18:751-754. Raber-Durlacher JE. et al. J Clin Periodontol 1994;21:549-558.
attachment loss
The prevalence of periodontitis in women of child-bearing age and during pregnancy is not well known. Assuming that the prevalence of periodontitis increases with age, the tendency toward an older age for pregnant women may result in a higher proportion of pregnant women having periodontitis.
Periodontal disease & Preterm low birthweight: Proposed Biological Mechanism
Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67:1103-1113. Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: Results of a prospective study. J Am Dent Assoc 2001;132:875-880. Lo ṕez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: A randomized con- trolled trial. J Periodontol 2002;73:911-924. Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and preterm birth: Results of a pilot intervention study. J Periodontol 2003;74:1214-1218. Radnai M, Gorzo I, Nagy E, Urban E, Novak T, Pal A. A possible association between preterm birth and early periodontitis. A pilot study. J Clin Periodontol 2004; 31:736-741. Do rtbudak O, Eberhardt R, Ulm M, Persson GR. Peri- odontitis, a marker of risk in pregnancy for preterm birth. J Clin Periodontol 2005;32:45-52. Jarjoura K, Devine PC, Perez-Delboy A, Herrera-Abreu M, D Alton M, Papapanou PN. Markers of periodontal infection and preterm birth. Am J Obstet Gynecol 2005;192:513-519. Bosnjak A, Relja T, Vucicevi -Boras V, Plasaj H, Plancak D. Pre-term delivery and periodontal disease: A case-control study from Croatia. J Clin Periodontol 2006;33:710-716. Offenbacher S, Boggess KA, Murtha AP, et al. Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol 2006;107:29-36. Radnai M, Gorzo I, Urban E, Eller J, Novak T, Pal A. Possible association between mother s periodontal status and preterm delivery. J Clin Periodontol 2006; 33:791-796. Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc 2006;137:7S-13S. Santos-Pereira SA, Giraldo PC, Saba-Chujfi E, et al. Chronic periodontitis and pre-term labour in Brazilian pregnant women: An association to be analysed. J Clin Periodontol 2007;34:208-213. Offenbacher S, Jared HL, O Reilly PG, et al. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol 1998;3: 233-250. Bearfield C, Davenport ES, Sivapathasundaram V, Allaker RP. Possible association between amniotic fluid micro-organism infection and microflora in the mouth. BJOG 2002;109:527-533. 36. Boggess KA, Moss K, Madianos P, Murtha AP, Beck J, Offenbacher S. Fetal immune response to oral path- ogens and risk of preterm birth. Am J Obstet Gynecol 2005;193:1121-1126
Any PLBW and PLBW cases showed significantly greater probing depth and attachment loss, increased anaerobic bacterial counts.
Effects of periodontal therapy on rate of preterm delivery A randomized controlled trial The rate of preterm delivery for the treatment group was13.1% and 11.5% for the control group (P=.316) : no stastically difference Obstet Gynecol. 2009 Sep.; 114(3): 551-559
Dental caries
Dental caries(tooth decay) the acquisition of infection with Streptococcus mutans to pathogenic levels frequent and prolonged exposure to caries-promoting carbohydrates rapid demineralization of enamel, if unchecked, leads to cavitations. Caufield PW. et al. J Dent Res 1993; 72(1):37-45.
Pregnant woman s dental caries risk may increase 1. the consumption of small, frequent, carbohydraterich meals 2. increased acid in the mouth from vomiting 3. a lack of attention to proper hygiene during pregnancy Silk H. et al. Am Fam Physician 2008;77(8):1139-1144.
vertical transmission Streptococcus mutans International Journal of Paediatric Dentistry 2002; 12: 2 7
60 50 S. mutans colonization 40 30 20 18 months 36 months score 0 score 1 score 2 score 3 MS score(s. mutans) 10 0
DNA fingerprinting studies genotype matches between mothers and infants in over 70 percent of cases Caufield PW. N Y State Dent J 2005; 71(2):23-27.
Mothers strong need for counseling on how to avoid early transmission of cariogenic bacteria to their offspring.
Inflammation
Erosion
Changes in diet and oral hygiene. Nausea and vomiting in pregnancy can cause extensive erosion.
Hyperemesis gravidarum severe form of NVP(nausea and vomiting during pregnancy) that occurs in about 0.3-2.0% of pregnancies, and may lead to surface enamel loss primarily through acid-induced erosion
1. Eating small amounts of nutritious yet noncariogenic foods 2. Using a teaspoon of baking soda (sodium bicarbonate) in a cup of water to rinse and spit after vomiting - avoiding tooth brushing directly after vomiting as the effect of erosion can be exacerbated by brushing an already demineralized tooth surface
Safety
the amount of radiation 18 intraoral dental radiographs(with a lead apron) - 0.0000001Gy (fetal embryonic dose) Dental diseases in Gleichner. Principles and practice of medical therapy in pregnancy. Stanford, Conneticut: Appleton & Lange, 1998:1093-1095
Restorative Materials fillings dental amalgam, gold, composite : class II medical devices(fda)
EDT in pregnant women at 13 to 21 weeks gestation was not associated with an increased risk of experiencing serious medical adverse events or adverse pregnancy outcomes.
Barriers to care Barriers to care systems barriers fear of lawsuits Education and training teachable moment provider barriers financial pressures beliefs and customs patient barriers
American Academy of Periodontology Statement Regarding Periodontal Management of the Pregnant Patient Periodontal health is a component of general health. Prevention and treatment of periodontal diseases are important to maintain to maintain health. For pregnant women, proper periodontal examination and treatment, if indicated, can have a beneficial effect on the health of their babies. c
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