“Maternal oral health in pregnancy”
Source: Obstet Gynecol. 2008 Apr;111(4):976-86
Author By: Boggess KA
Summary of research:
Periodontal disease affects up to 40% of reproductive-aged women.
Maternal oral flora is one of the greatest predictors of child’s oral flora.
Periodontal infection is associated with adverse pregnancy outcomes.
Key take-away
Effective preventive techniques and successful treatment measures to reduce caries and periodontal disease exist within the dental profession, yet these conditions remain quite prevalent.
Reproductive-aged women or women who are pregnant provide an opportunity for education regarding their oral health and that of their unborn child.
Risk assessment, diagnosis, prognosis and treatment planning to treat both caries and periodontal disease in this group of individuals, when appropriate, is not optional.
Implementation strategies:
The clinician must understand the critical importance of meticulous oral hygiene and professional care before (for those planning a family) or during pregnancy. This is also critical after pregnancy, especially during the first 30 months of the infant’s life when transmission of pathogens from parent to child has the greatest probability.
Due to the transmissible nature of these diseases, once periodontal disease or caries infection is identified in the pregnant or reproductive-aged woman, the spouse should also be screened and treated when appropriate.
Proactive conversations with individuals who may be affected by this research should be the intention of every clinician who has opportunity to be involved in patient care. (see the following example)
Scenario One:
A male patient (Nick) comes in for his routine preventive appointment and proudly tells you that he and his wife (Katie) are expecting their first child. Previous chart notes indicate the presence of moderate bleeding upon probing and during the prophy. You have not seen his wife since she has become pregnant.
Clinician: “Nick, that’s great news, congratulations! I am so please for you and Katie. I know Dr. Williams will be happy for you too. Before I get started with your hygiene visit today, I’d like to share some research that will be of particular interest to you now that you are a father to be. We now know that periodontal disease progression during pregnancy can increase the risk for adverse outcomes like pre-term, low birth weight infants. Have you heard anything about this? We also understand that the bacteria that cause both gum disease and tooth decay are transmissible from spouse to spouse and parent to child. If the parents, especially mom, have these bacteria the child will most likely have them as well. So, today, I am going to do some very careful screenings for you to be sure you do not have any disease activity present that might be transferred to Katie. Either way, it will be very important for Katie to be screened as soon as possible as well. Do you have any questions for me before I get started?”
Nick: “What happens if I do have a problem? What do we do about it?”
Clinician: “That’s a great question. There are several ways we can treat both gum disease and tooth decay. There are also some preventive things you and Katie can do during and after her pregnancy. Let me go ahead and do your screenings and then you and I and Dr. Williams can decide how best to proceed based on your results.”
Scenario Two:
A female patient (Shirley) comes in for her routine prophy and during the health history update and risk assessment she informs you she has already undergone the preliminary steps and is beginning in-vitro fertilization in a few weeks. She comments on how stressful this whole process has been not only financially but emotionally. Her previous chart notes have no indication of periodontal disease or caries infection.
Clinician: “Well Shirley, even though you have had some stress, this is a very exciting time for you. Today, included with your hygiene visit I will be providing you with several screenings, the most important one for you, considering your upcoming in-vitro procedure, will be the periodontal screening. Are you aware of the research linking periodontal or gum disease with pre-term low birth rates in infants? The studies show that about 40% of women in child bearing years are affected. If you don’t have any questions, I’ll get started and share the results with you as I go along.“
Shirley: “I haven’t heard about this. I already have my appointments scheduled and the time off work arranged. I’m not sure I can make changes.”
Clinician: “Shirley, please don’t be concerned just yet. With your history I’m not expecting there to be any problems. Let me collect the data and then Dr. Williams will be in to do an exam and diagnosis. You’re in good hands and we’ll take great care of you.”
Scenario Three:
A young woman, mid twenties, comes into the dental office for a routine exam and checkup. There are no risk factors and no concerns where her health and family history are concerned. After the screenings it is discovered that the patient (Betty) has several areas of decay, some demineralization and bleeding gums with scattered 4mm pockets and a few isolated 5mm areas.
Clinician: “Betty, as you saw during your screenings you do have some decay and gum disease. Let me reassure you these issues are easily treated and we can help you. I do want to share some important information with you before we talk about your treatment options. Ongoing research is showing a link to premature infant births in those women who experience periodontal disease progression during pregnancy. Therefore, I need to ask, are you planning to start a family any time soon
Note: Regardless of how Betty responds, the clinician should take this opportunity to provide education and supporting data (brochures, handouts). Even if Betty is not planning a family anytime soon, she may one day. In all likelihood, she has friends or family members in a similar age group that she might share this information with.