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






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

    • Dental care in Pregnancy DMD, PhD. Shin Dong-Ryul cons-99@hanmail.net
    • Pregnancy is a “teachable moment” whenwomen are receptive to changingbehaviors that can benefit themselves andtheir children
    • 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.
    • There is no evidence relating earlyspontaneous abortion to first trimester oralhealth care or dental procedures
    • 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
    • Oral change1. Hormonal change - Periodontal change2. Changes in diet and oral hygiene.Nausea and vomiting in pregnancy can causeextensive erosion.
    • periodontal disease-preterm birth, low birth weight dental caries -vertical transmission(ECC (Early Childhood Caries))
    • Periodontal disease
    • 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.
    • attachment loss
    • 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.
    • Periodontal disease & Preterm low birthweight: Proposed Biological Mechanism
    • 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
    • Any PLBW and PLBW cases showedsignificantly greater probing depth andattachment loss, increased anaerobic bacterialcounts.
    • 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
    • Dental caries
    • 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.
    • 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.
    • vertical transmission Streptococcus mutans International Journal of Paediatric Dentistry 2002; 12: 2–7
    • 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)
    • 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.
    • Mothers strong need for counseling onhow to avoid early transmission ofcariogenic bacteria to their offspring.
    • Inflammation
    • Erosion
    • Changes in diet and oral hygiene.Nausea and vomiting in pregnancy cancause extensive erosion.
    • 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
    • 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
    • Safety
    • 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
    • Restorative Materials dental amalgam, gold, compositefillings : class II medical devices(FDA)
    • EDT in pregnant women at 13 to 21 weeks’gestation was not associated with anincreased risk of experiencing seriousmedical adverse events or adversepregnancy outcomes.
    • Barriers to careBarriers to care fear of lawsuitssystems barriers Education and training “teachable moment”provider barriers financial pressures beliefs and customspatient barriers
    • 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
    • Thank you for your QuickTime쥉곜 Photo - JPEG ?쫯 ?《콆겙 올 교릨역 쓲콆 욀? 쳽?쳮쪣쪦. attention