Dental Care in Pregnancy
35 % of US women reported they had not had a dental visit in the past year. (2007-2009 data)
40% of pregnant women have some form of periodontal disease. ( WOW !)
56 % of women did not visit the dentist in the last pregnancy.
59 % of women did not receive counseling about oral health during pregnancy.
80% of Obstetricians did not use oral health screening questions in their prenatal visits.
94 % of Obstetricians did not routinely refer patients to a dentist.
Could these things all be related ?
What is periodontal disease?
This encompasses gingivitis, an increased inflammatory response to plaque in pregnancy causing gums to swell and bleed, tooth erosion from increased gastric acid, caries (aka cavities), and periodontitis, infection in the gums and jawbones, resulting in loss of teeth or worse.
Physiologic changes in pregnancy may result in a higher incidence of the above mentioned types of periodontal disease.
What are the consequences of poor dental health?
"Oral health disorders, such as periodontitis, are associated with many disease processes, including cardiovascular disease, Alzheimer's disease, respiratory infections, as well as osteoporosis of the oral cavity." (1)
What are the consequences of poor dental health in pregnancy?
The available literature point to a connection between periodontal disease and Preterm Labor, and possibly Preeclampsia. The theory there is that bacteria and inflammatory mediators from the mouth enter the bloodstream and are transported to the placenta where they can cause problems. Further studies need to be done to clarify this.
What can we do about it?
In years gone by, pregnant women were cautioned to avoid dental care in the first trimester or dental care in pregnancy at all. However, in 2013, ACOG (The American College of Obstetrician and Gynecologists) came out with a Committee Opinion (based on research) to the following effect :
The workup and "treatment of maternal periodontal disease is not associated with any adverse maternal or birth outcomes". This includes not only cleanings, but dental XRays with shielding to the thyroid and uterus, fillings, root canals, etc.
Recommendations for patients:
1. Eliminate sugary food, refined carbohydrates, and soda pop.
2. Rinse with dilute baking soda after vomiting (neutralizes stomach acid).
3. Brush twice a day.
4. Floss once per day with a thicker waxed floss.
5. Finish at bedtime with a peroxide based fluoridated rinse such as Rembrandt.
6. Have dental visits twice per year.
7. Take care of conditions requiring immediate treatment such as extractions, root canals and restoration promptly. These can be managed at any time in the pregnancy.
Recommendations for doctors:
1. Establish a relationship with local dentists.
2. Advocate for better dental coverage for women.
3. Use oral health screening questions in their prenatal visits.
4. Counsel patients on proper routine dental care.
5. Consistently refer patients to the dentist as a part of their prenatal care.