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Critical Issues in Dental Hygiene Improving Oral Health Outcomes from Pregnancy Through Infancy

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Critical Issues in Dental Hygiene Improving Oral Health Outcomes from Pregnancy Through Infancy Critical Issues in Dental Hygiene Improving Oral Health Outcomes from Pregnancy through Infancy Lori Rainchuso, RDH MS Introduction Abstract Oral health plays a crucial role in Purpose: The purpose of this paper is to provide an overview the overall health and well-being of of current professional guidelines regarding oral health care a pregnant woman and her newborn through pregnancy and infancy stages, and to include risks as- child.1-3 The 2000 Surgeon Gener- sociated with treatment, as well as health care providers’ beliefs al’s oral health report called for the and attitudes surrounding treatment of these specific popula- elimination of oral health disparities. tions. Although dental treatment during the second trimester is The report drew attention to the im- ideal, there is no indication that preventive or restorative dental portance of changing attitudes and treatment during any trimester of pregnancy can cause harm beliefs among health care providers, to the mother or developing fetus. Despite these recommenda- as well as in the community. In ad- tions, routine dental care is often voluntarily avoided or post- dition, the importance of oral health poned for the duration of pregnancy. Post-delivery, preventive treatment during pregnancy is high- oral care is typically postponed for a child until 3 years of age, lighted as an important strategy to years after the first tooth has erupted. While most health care potentially improve maternal and in- professionals agree on the importance of good oral health in fant health.4 every stage of life, it is not being addressed. Whether it is based on misconceptions or lack of knowledge, health care providers Pregnancy is not the time to defer are performing inadequate oral care for these patients. dental examinations and necessary Recommendations to increase health care during pregnancy treatment. Dental care can be ren- and infancy should include improved advocacy of the estab- dered safely throughout the preg- lished oral health care guidelines within each professional or- nancy, though experts agree that ganization. In addition, curriculum revision should occur at the due to first trimester morning sick- university level, to ensure future health care professionals will ness, and the third trimester level have a strong oral health foundation. Lastly, a collaborative ef- of comfort and risk of postural hy- fort needs to occur between all health care providers to better potension, the second trimester of treat the patient’s overall health, not only the specifics of one the gestational period is most ide- professional discipline. As health care professionals we are all al.3,5,6 According to a study utilizing responsible for the complete well-being of our patients, and an oral health data from the Centers for interdisciplinary approach will better ensure we accomplish this Disease Control Pregnancy Risk As- task. sessment Monitoring System, many Keywords: pregnancy, oral health, infant oral health, oral dis- women do not receive dental care ease prevention, anticipatory guidance, dental home, interdis- during their pregnancy.7 In addition, ciplinary collaboration only half of the women who report- ed actually having a dental problem This study supports the NDHRA priority area, Health Promo- during their pregnancy were seen by tion/Disease Prevention: Assess strategies for effective com- a dental professional.7 munication between the dental hygienist and client. Despite numerous research publi- cations, professional guidelines and government re- is recommended that all health care professionals ports regarding the importance of good oral health who serve pregnant women provide the following: throughout pregnancy, health care professionals an oral health risk assessment, counseling of etiol- from both the medical and dental spheres contin- ogy and transmission of cariogenic bacteria to their ue to under-treat women during pregnancy.5,6,8 It newborns, referral to an oral health provider for a 330 The Journal of Dental Hygiene Vol. 87 • No. 6 • December 2013 comprehensive examination and assistance in the they seldom asked about the pregnant patient’s establishment of a dental home for their infant.2,9 current oral health, inquired about dental visits or Early intervention and guidance during the perina- provided oral health information. In addition, over tal period from all health care providers is impera- a third of the respondents stated that they did not tive for the mother and infant.2 advise patients to see a dentist for routine dental care. The study also revealed that most do not dis- Current Health Care Perceptions cuss pre-planning methods for preventing dental caries in young children (95%, 91%).11 An Oregon study revealed that general practic- ing dentists’ perceptions and perceived barriers had The study asked basic oral health knowledge the strongest direct effect on their not providing questions in which the majority (57%) acknowl- care to patients during pregnancy. Of these barri- edged they were not qualified to recognize symp- ers, the most significant were: perceived time, eco- toms of periodontal disease, and that training in nomic costs and dissatisfaction with reimbursement medical school and residency, on the screening and compensation.10 The greatest perceived barrier was assessment of oral health issues, was non-existent indicated as economic cost: 72.9% of dentists in- or inadequate. Furthermore, most respondents dicated that compensation by insurance companies stated they were not familiar with any oral health was inadequate for time spent counseling pregnant and pregnancy guideline publications.11 In addi- patients.10 tion, the study showed that a majority of OBGYN physicians recognize the importance of good oral The survey revealed that dentists in Oregon have health during pregnancy, yet they do not address a high level of incorrect knowledge about routine it. With improved advocacy and promotion of oral and emergency procedures concerning prenatal health education, OBGYNs may become more com- women. For restorative services, almost one third fortable with assessing and addressing oral health of dentists indicated they would not perform com- with their pregnant patients.11 By assimilating the posite restorations at any stage of pregnancy. Ap- current dental guidelines regarding oral care of the proximately 50% indicated they would not perform pregnant patient into an OBGYN standard of care composite restorations during a dental emergency. practice, improvement of overall health for both For nonsurgical periodontal treatment the survey mother and child could be achieved. revealed that 57% would not provide this service during the first trimester of pregnancy, 22% during Oral Health Care Guidelines the second trimester and 46% would not provide and Recommendations this service during the third trimester of pregnancy, and 69.2% would not provide this service during Pregnancy commonly creates physical effects a dental emergency involving a severe periodontal that may negatively impact routine oral self-care. abscess and infection. More than half of the dentists Women frequently experience nausea which often indicated they were reluctant to perform routine leads to avoiding oral hygiene practices like tooth services during the pregnancy, and three-quarters brushing, increasing the possibility for dental car- were reluctant to perform services to relieve pain or ies. In addition, women may be experiencing fre- swelling associated with a dental emergency. De- quent vomiting, which compounds the risk of tooth spite the established perinatal guidelines attitude erosion and dental caries.1 To counteract the acidity barriers remain, and negatively impact general of the oral cavity after vomiting, and reduce the risk dental practitioners’ current practices.10 Although of tooth erosion, it is recommended to swish with a the research focused on the state of Oregon, this is teaspoon of baking soda dissolved in a cup of water, expected to be a nationwide trend of practice. and to avoid brushing immediately after a vomiting occurrence.2 Once the acid is neutralized, the teeth Dental professionals are not the only ones re- may be brushed using a soft-bristled toothbrush sponsible for the under-treatment of oral health and fluoridated toothpaste.2 care during pregnancy. Research shows that obste- trician-gynecologists (OBGYNs) have not been ad- Furthermore, increased appetite and frequent dressing the oral health needs or conducting oral snacking of cariogenic foods may also contribute health assessments for their pregnant patients. A to caries development. Pregnancy is an ideal time national study, assessing how OBGYNs addressed for dental professionals to conduct a dietary analy- oral health during pregnancy, showed 84% out of sis. Patients should be educated on the importance the 351 respondents agreed that routine dental of eating nutrient dense foods that promote oral care during pregnancy is important.11 Those sur- health. Providers should include a discussion re- veyed also thought periodontal disease could have garding the relationship of frequent snacking on adverse effects on pregnancy outcomes, however, simple carbohydrate foods, sweetened beverages Vol. 87 • No. 6 • December 2013 The Journal of Dental Hygiene 331 (including juices) and caries development. up towel, to elevate the right hip and displace the uterus to the left. Having the patient lean to their Untreated dental caries in mothers increases the left side releases uterine pressure off the inferior
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