International Journal of Dental and Health Sciences Review Article Volume 02,Issue 03 ORAL HEALTH STATUS AND TREATMENT NEEDS FOR PREGNANT WOMEN: A REVIEW Mamatha.B1,R. Rekha2,G. Radha3,SK Pallavi4 1.Post Graduate Student,Department Of Public Health Dentistry,V.S Dental College & Hospital,Bengaluru 2.Professor & Head ,Department Of Public Health Dentistry,V.S Dental College & Hospital,Bengaluru 3.Reader,Department Of Public Health Dentistry,V.S Dental College & Hospital,Bengaluru 4.Reader,Department Of Public Health Dentistry,V.S Dental College & Hospital,Bengaluru ABSTRACT: Pregnancy is a special state for a woman, which is associated with a myriad of emotional and physiological changes in different parts of body including oral cavity and dental health. Thus the present review was undertaken to summarize the available information regarding oral health status and treatment needs of pregnant women in various parts, across the world and to discuss possible dental treatment needs during this period. The study was a systematic review of English-language articles indexed in PUBMED and GOOGLE SCHOLAR which was published from the year 2000-2015 with Medical subject heading (MeSH) terms linked with the maternal oral health like Pregnancy and Oral health etc. Of 179 citations, 11 studies met study criteria and were reviewed. Keywords: Pregnancy, Oral health, Treatment needs. INTRODUCTION: and physical changes in a pregnant woman.[2] The main systemic changes occur Pregnancy is a special state for a woman, in the cardiovascular, hematologic, which is associated with a myriad of respiratory, renal, gastrointestinal, emotional and physiological changes in endocrine, and genitourinary systems. different parts of the body including oral cavity and dental health.[1] The progressive Pregnancy is accompanied by changes in physiological changes that occur during the oral cavity that affect the hard and soft pregnancy are essential to support and tissues of the mouth.[3] Most pregnant protect the developing fetus and also to women change their eating habits to more prepare the mother for parturition. frequently eating foods rich in Pregnancy involves complex hormonal carbohydrates and acids. This situation is interactions, which cause profound exacerbated by the decrease in salivary pH physiologic changes. The changes that associated with frequent nausea and occur are the result of increasing maternal vomiting. Pregnant women who do not and fetal requirements for the growth of comply with regular and careful oral the fetus and for the preparation of the hygiene often suffer from erosions of tooth mother for delivery. These increased enamel and develop new dental caries. hormonal secretion and fetal growth induce several systemic, as well as local physiologic *Corresponding Author Address: Dr. Mamatha.B Email: [email protected] Mamatha.B. et al, Int J Dent Health Sci 2015; 2(3):619-627 Oral tissues are also known to be affected and poorer health behaviour.[13] Though by pregnancy with the most frequent and studies were available in past literature greatest changes occurring in the gingival regarding the oral health status of tissue.[4] They may be more susceptible to pregnant women, no such review were periodontal disease since higher made. Hence the present review was concentrations of oestrogen and undertaken to summarize the available progesterone can induce hyperaemia, information regarding oral health status edema and bleeding in periodontal tissues, and treatment needs of pregnant women increasing the risk of bacterial infections. in various parts, across the world and to The incidence of periodontal disease has discuss possible dental treatment needs been positively correlated with lower during this period. educational achievement and lower socio- METHODS: economic status.[5-7] In addition to gingival changes, the other manifestations A thorough literature review was made associated with pregnancy include which engaged most of the articles chloasma (bilateral brown patches in the published in peer reviewed journals relating midface), facial telangiectasia, sialorrhea, to maternal oral health among various tooth surface loss usually related to vomit- populations across the world. The review ing when severe (hyperemesis gravidarum), itself began with the search of relevant increased mobility of teeth, changes in the Medical subject heading (MeSH) terms like severity of oral aphthae. [8] pregnancy, Oral health etc and non-MesH terms like Treatment needs in various The reasons for this likely changes are search engines including PUBMED, multi-factorial and include inadequate oral PUBMED CENTRAL & GOOGLE SCHOLAR. hygiene, limited access to oral health care, Articles published in English language only medical co-morbidities that increase oral were included in the review. The spotlight disease risk, and limited knowledge of the of the present review will be oral health relationship between oral and general among pregnant women, and its dental health among prenatal care providers and management will be discussed. Articles their patients. [9,10] published between the years 2000 to 2015 Apart from the effects of hormonal were only reviewed. Finally of 179 citations, changes, other factors such as HIV 11 studies met study criteria and were infection, lack of dental care, poor oral reviewed. hygiene, smoking, low educational level, DISCUSSION: low employment status, increased age and ethnicity contribute to a worsened Pregnancy is a dynamic physiological state periodontal condition during which is evidenced by several transient pregnancy.[11,12] changes. These can develop as various physical signs and symptoms that can affect Pregnant women with low health literacy the patients’ health, perceptions and also have less pregnancy-related knowledge 620 Mamatha.B. et al, Int J Dent Health Sci 2015; 2(3):619-627 interactions with others in the gingiva.[27] There are two theories for the environment. The patients may not always actions of the hormones on these cells: a) understand the relevance of the Change of the effectiveness of the epithelial adaptations of their bodies to the health of barrier to bacterial insult and b) Effect on their fetuses. A gestational woman requires collagen maintenance and repair. various levels of support throughout this Estradiol can induce cellular proliferation time, such as medical monitoring or while depressing protein production in intervention, preventive care and physical cultures of human pre-menopausal gingival and emotional assistance. fibroblasts. This cellular proliferation During pregnancy, the inflammatory appears to be the result of a specific response to the dental plaque is increased, population of cells within the parent culture leading to swollen gingiva, which tend to that responds to physiologic concentrations bleed on brushing. The gingivitis which is of estradiol.[28] caused by the hormonal changes which Sex steroid hormones have also been occur in pregnancy is known as pregnancy shown to increase the rate of folate gingivitis. It is considered to be the most metabolism in oral mucosa. Since folate is common oral manifestation of pregnancy, required for tissue maintenance, increased as it has been reported to occur in up to metabolism can deplete folate stores and 100% of the pregnant women. Pregnancy inhibit tissue repair.[29] gingivitis becomes apparent in the second month of gestation and it worsens as the As an independent risk factor for adverse pregnancy progresses, before receiving a pregnancy outcomes, periodontal disease is peak in the eighth month. In the last month preventable and treatable. Controlling of the gestation, the gingivitis usually plaque by brushing, flossing and decreases and immediately postpartum, professional prophylaxis, including scaling the gingival tissues are found to be and root planning, all help to achieve good comparable to that of normal women. dental health in pregnancy.[30] Pregnant women are more susceptible to Therefore, improving periodontal status periodontal disease because of female before pregnancy in order to reduce the reproductive hormonal influences. A few occurrence of adverse pregnancy outcomes studies have demonstrated that would be of great importance for public periodontal disease may be associated with health. And understanding the adverse pregnancy outcomes, such as characteristic of periodontal status among [25-26] premature birth and low birth weight. women with childbearing age would play an important role in developing health Sex steroid hormones have been shown to strategies. directly and indirectly exert influence on cellular proliferation, differentiation and Teeth brushing, being the most important growth in target tissues, including oral health behaviour, is still prohibited keratinocytes and fibroblasts in the 621 Mamatha.B. et al, Int J Dent Health Sci 2015; 2(3):619-627 during pregnancy for some people who care professionals need to alter their hold the old Chinese superstition and normal pharmacological armamentarium to gestation reaction such as vomiting would address the patients’ needs versus the fetal make women to reduce the brushing demands. Applying the basics of preventive frequency and time. As a result, poor oral dentistry at the primary level will broaden hygiene leads to the occurrence and the scope of the prenatal care. Dentists development of periodontal disease. should encourage all the patients of the Therefore, it is essential to correct the childbearing ages to seek oral health misleading opinion and reinforce