<마더리스크라운드> Dental care in pregnancy 신동렬 원장 (루덴치과)

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<마더리스크라운드> Dental care in pregnancy 신동렬 원장 (루덴치과)

  1. 1. Dental care in Pregnancy DMD, PhD. Shin Dong-Ryul cons-99@hanmail.net
  2. 2. Pregnancy is a “teachable moment” whenwomen are receptive to changingbehaviors that can benefit themselves andtheir children
  3. 3. The majority of the physicians (81%)agreed that pregnancy increases thetendency to have gingival inflammation.However, 88% of doctors advised delaydental treatment until after pregnancy. Int J Dent Hyg. 2008 Aug;6(3):214-20.
  4. 4. There is no evidence relating earlyspontaneous abortion to first trimester oralhealth care or dental procedures
  5. 5. The Dentists Insurance Company (TDIC)— which isendorsed by eight U.S. state dental associations andinsures 17,000 dentists nationwide — reports only one incidence in the past 15 years or more. http://www. cdafoundation.org/library/docs/poh_policy_ 8. brief.pdf. Accessed March 2010
  6. 6. Oral change1. Hormonal change - Periodontal change2. Changes in diet and oral hygiene.Nausea and vomiting in pregnancy can causeextensive erosion.
  7. 7. periodontal disease-preterm birth, low birth weight dental caries -vertical transmission(ECC (Early Childhood Caries))
  8. 8. Periodontal disease
  9. 9. an increase in estrogen and progesterone levels Estrogen and progesterone receptors in gingival tissuesa higher vascular permeability, providing essential bacterial growthfactorsincreases in probing depth (PD) and bleeding on probing (BOP (prevalence: 35% to pregnancy gingivitis 100%) Loe H, Silness J. Acta Odontol Scand 1963; 21:533-551. Valimaa H. et al. J Endocrinol 2004;180:55-62. Miyazaki H. et al. J Clin Periodontol 1991;18:751-754. Raber-Durlacher JE. et al. J Clin Periodontol 1994;21:549-558.
  10. 10. attachment loss
  11. 11. The prevalence of periodontitis in women ofchild-bearing age and during pregnancy isnot well known. Assuming that theprevalence of periodontitis increases withage, the tendency toward an older age forpregnant women may result in a higherproportion of pregnant women havingperiodontitis.
  12. 12. Periodontal disease & Preterm low birthweight: Proposed Biological Mechanism
  13. 13. Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birthweight. J Periodontol 1996;67:1103-1113.Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection andpreterm birth: Results of a prospective study. J Am Dent Assoc 2001;132:875-880.Lo ́pez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight inwomen with periodontal disease: A randomized con- trolled trial. J Periodontol 2002;73:911-924.Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and preterm birth: Results of a pilot interven-tion study. J Periodontol 2003;74:1214-1218.Radnai M, Gorzo I, Nagy E, Urban E, Novak T, Pal A. A possible association between preterm birth andearly periodontitis. A pilot study. J Clin Periodontol 2004; 31:736-741.Do ̈rtbudak O, Eberhardt R, Ulm M, Persson GR. Peri- odontitis, a marker of risk in pregnancy for pretermbirth. J Clin Periodontol 2005;32:45-52.Jarjoura K, Devine PC, Perez-Delboy A, Herrera-Abreu M, D’Alton M, Papapanou PN. Markers ofperiodontal infection and preterm birth. Am J Obstet Gynecol 2005;192:513-519. Bosnjak A, Relja T, Vucicevi -Boras V, Plasaj H, Plancak D. Pre-term delivery andperiodontal disease: A case-control study from Croatia. J Clin Periodontol 2006;33:710-716.Offenbacher S, Boggess KA, Murtha AP, et al. Progressive periodontal disease and risk of very pretermdelivery. Obstet Gynecol 2006;107:29-36.Radnai M, Gorzo I, Urban E, Eller J, Novak T, Pal A. Possible associationbetween mother’s periodontal status and preterm delivery. J Clin Periodontol 2006; 33:791-796.Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease andpregnancy complications. J Am Dent Assoc 2006;137:7S-13S.Santos-Pereira SA, Giraldo PC, Saba-Chujfi E, et al. Chronic periodontitis and pre-term labour in Brazilianpregnant women: An association to be analysed. J Clin Periodontol 2007;34:208-213.Offenbacher S, Jared HL, O’Reilly PG, et al. Potential pathogenic mechanisms of periodontitis associatedpregnancy complications. Ann Periodontol 1998;3: 233-250.Bearfield C, Davenport ES, Sivapathasundaram V, Allaker RP. Possible association between amniotic fluidmicro-organism infection and microflora in the mouth. BJOG 2002;109:527-533.36. Boggess KA, Moss K, Madianos P, Murtha AP, Beck J, Offenbacher S. Fetal immune response to oralpath- ogens and risk of preterm birth. Am J Obstet Gynecol 2005;193:1121-1126
  14. 14. Any PLBW and PLBW cases showedsignificantly greater probing depth andattachment loss, increased anaerobic bacterialcounts.
  15. 15. Effects of periodontal therapy on rate of preterm delivery A randomized controlled trialThe rate of preterm delivery for the treatmentgroup was13.1% and 11.5% for the control group(P=.316): no stastically difference Obstet Gynecol. 2009 Sep.; 114(3): 551-559
  16. 16. Dental caries
  17. 17. Dental caries(tooth decay) the acquisition of infection with Streptococcus mutans to pathogenic levels frequent and prolonged exposure to caries-promoting carbohydrates rapid demineralization of enamel, if unchecked, leads to cavitations. Caufield PW. et al. J Dent Res 1993; 72(1):37-45.
  18. 18. Pregnant woman’s dental caries risk mayincrease1. the consumption of small, frequent, carbohydrate-rich meals2. increased acid in the mouth from vomiting3. a lack of attention to proper hygiene duringpregnancy Silk H. et al. Am Fam Physician 2008;77(8):1139-1144.
  19. 19. vertical transmission Streptococcus mutans International Journal of Paediatric Dentistry 2002; 12: 2–7
  20. 20. 60 50 40 S. mutans 30colonization 20 10 18 months 0 36 months score 0 score 1 score 2 score 3 MS score(S. mutans)
  21. 21. DNA fingerprinting studiesgenotype matches between mothers and infants in over70 percent of cases Caufield PW. N Y State Dent J 2005; 71(2):23-27.
  22. 22. Mothers strong need for counseling onhow to avoid early transmission ofcariogenic bacteria to their offspring.
  23. 23. Inflammation
  24. 24. Erosion
  25. 25. Changes in diet and oral hygiene.Nausea and vomiting in pregnancy cancause extensive erosion.
  26. 26. Hyperemesis gravidarumsevere form of NVP(nausea and vomiting duringpregnancy) that occurs in about 0.3-2.0% of pregnancies,and may lead to surface enamel loss primarily throughacid-induced erosion
  27. 27. 1. Eating small amounts of nutritious yet noncariogenicfoods2. Using a teaspoon of baking soda (sodium bicarbonate)in a cup of water to rinse and spit after vomiting- avoiding tooth brushing directly after vomiting as theeffect of erosion can be exacerbated by brushing analready demineralized tooth surface
  28. 28. Safety
  29. 29. the amount of radiation 18 intraoral dental radiographs(with a lead apron) - 0.0000001Gy (fetal embryonic dose)Dental diseases in Gleichner. Principles and practice of medical therapy in pregnancy. Stanford, Conneticut: Appleton & Lange, 1998:1093-1095
  30. 30. Restorative Materials dental amalgam, gold, compositefillings : class II medical devices(FDA)
  31. 31. EDT in pregnant women at 13 to 21 weeks’gestation was not associated with anincreased risk of experiencing seriousmedical adverse events or adversepregnancy outcomes.
  32. 32. Barriers to careBarriers to care fear of lawsuitssystems barriers Education and training “teachable moment”provider barriers financial pressures beliefs and customspatient barriers
  33. 33. American Academy of Periodontology Statement Regarding Periodontal Management of the Pregnant Patient Periodontal health is a component of general health. Prevention and treatment of periodontal diseases are important to maintain to maintain health. For pregnant women, proper periodontal examinationand treatment, if indicated, can have a beneficial effect on the health of their babies. c
  34. 34. Thank you for your QuickTime쥉곜 Photo - JPEG ?쫯 ?《콆겙 올 교릨역 쓲콆 욀? 쳽?쳮쪣쪦. attention

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