MODULE 15: ORAL HEALTH ACROSS THE LIFESPAN Oral Health Across the Lifespan
MODULE 15: ORAL HEALTH ACROSS THE SPECTRUM Part 2: Oral Health For Pregnant Women and Their Newborns Julia Lange Kessler, CM, DNP, FACNM Assistant Professor & Program Director: Nurse Midwifery/WHNP Program Georgetown School of Nursing and Health Studies
Objectives Upon completing this module students will be able to: Discuss the importance of oral systemic health during pregnancy and post partum Describe the possible effects of poor oral health on the health of the mother/baby dyad and understand the safety of treatment. Evaluate the need for dental referrals during pregnancy. 3
Healthy People 2020 Objectives Reduce the proportion of adults with untreated dental decay Reduce the proportion of children and adolescents who have dental caries experiences in their primary or permanent teeth Reduce the proportion of adults who have ever had a permanent tooth extracted because of dental caries or periodontal disease 4
TREATABLE oral systemic health problems are common in pregnant women and have increased significance ifi for the overall health h of both mother and baby. 5
Pregnancy Facts: In the United States, almost half (47%) of women who recently gave birth have not had a dental visit in the past year. Approximately 1 out of 5 (18%) have never had their teeth cleaned-ever. Overall 86% of women do not visit a dentist during pregnancy. 40% of pregnant women have some form of periodontal disease 6
Common Oral Health Problems Gingivitis Periodontitis Tooth Decay (Caries) During Pregnancy Enamel Erosion from Vomiting or Reflux Pregnancy Granuloma 7
Gingivitis & Periodontitis Gingivitis affects 25 75% of pregnant women Periodontitis is a severe form of gum disease causing distruction of gums and bones leading to tooth loss. You don t have to lose a tooth with each pregnancy! 8
Untreated Periodontitis Bacteria from the mothers mouth can reach the systemic blood stream and consequently reach the baby. When left untreated it may be associated with: Pre Term Labor Pre Term Birth Poor glycemic control 9
Enamel Erosion & Pregnancy Granuloma EE: Caused by vomiting or reflux & can be reduced by having woman rinse with water or water with baking soda after vomiting. Granuloma: 5-10% of pregnant women are affected. Usually resolves itself after delivery. If bleeding or problems with chewing occur, refer for removal Caries: Mothers with high rates of caries are more likely to have children with high rates of caries. 10
Pregnancy may be the only time that dental care is covered by a public insurance dental benefit. Keep the pregnancy healthy by keeping the pregnant mouth healthy! Consistent and regular dental visits ii are key especially important during pregnancy. It is not only safe to see the dentist,it is the right choice for mother and baby! Get to know the dentists in your area and refer all pregnant women! 11
During the postpartum period All new Moms want to be good Moms! Good oral health habits can start on day one of life! A clean wet cloth or gauze will work well to clean the newborn s mouth after feeding. Starting this habit early will make the transition to brushing easier. If Mom has good oral health, so will her child and need not suffer from cavities that are totally PREVENTABLE! 12
ALL Health Workers Can educate pregnant women about the safety and IMPORTANCE of dental care during pregnancy for both her and HER BABY. Helping a mother to find a dentist t and to refer her is not only safe but will protect the health of the mother/baby dyad. 13
Optimal dental care during pregnancy: First dental screening visit ASAP (if no visit in the last 6 months). Dental treatments can occur during all three trimesters! Dental x-rays as needed with the use of a lead apron on abdomen and thyroid. Lidocaine & Nitrous Oxide are safe for pain relief. Fluoride, Xylitol & Cholorhexidine are safe. Commonly used antibiotics are safe: Penicillin, Amoxicillin, Erythromycin, and Clindamycin 14
What to avoid during pregnancy Limit sweet snacks or drinks between meals Third trimester: Ibuprofen, Oxycodone and Codeine Procaine 15
To summarize: A healthy mouth contributes to a healthy pregnancy! ALL pregnant woman should see a dentist and it is safe to do so! Educating a new Mom on how to care for herself and her new baby can help them to avoid much pain and suffering. The dentist is NOT the enemy but dental disease left untreated can have profound effects on both mother and baby!!! 16
References American Academy of Pediatrics Children s Oral Healthhttp://www2.aap.org/oralhealth/index.ht ml Clark M.B., Douglass A.B., Maier R., Deutchman M., Douglass J.M., Gonsalves W., Silk H., Tysinger, J.W., Wrightson, A.S., Quinonez, R. (2010). Smiles for Life: A National Oral Health Curriculum. 3rd Edition. Society of Teachers of Family Medicine. www.smilesforlifeoralhealth.com. 17
References Haber, J., Harnett, E., Hallas, D., Dorsen, C., Lange- Kessler, J., Lloyd, M., Thomas, E., & Wholihan., D. (2014). Putting the Mouth back in the head: HEENT to HEENOT. Journal of Interprofessional Care (in press). Nainggolan, L. (2013). ACOG issues new practice bulletin on gestational diabetes. Obstet Gynecol, 122: 406-416. Oral Health Care During Pregnancy: A National Consensus Statement. 2012. Washington D.C. National Maternal and Child Oral Health Resource Center. http://www.mchoralhealth.org/materials/consensus_stat ement.html Thomas, E. K., & Chitra, N. (2013). Periodontal changes pertaining to women from puberty to postmenopausal stage. International Journal of Pharma and Bio Sciences, 4(2), 766-771. 18
References Sun, W., Lei, L., Chen, L., Yu, Z. & Zhou, J. (2011). Multiple gingival pregnancy tumors with rapid growth. Journal of Dental Sciences (2013)1-5 Teeuw, W.J., Gerdes, V. E.A., & Loos, B. G. (2010). Effect of periodontal treatment on glycemic control of diabetic patients: A systematic review and metaanalysis. Diabetes Care, 33(2), 421-427. United States Department of Health and Human Services. Oral health in America. A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH). 19