Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Pregnancy & Oral Health
Similar to Pregnancy & Oral Health (20)
More from Jacey Mitchell
More from Jacey Mitchell (20)
Recently uploaded
Recently uploaded (20)
Pregnancy & Oral Health
- 1. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. PREGNANCY AND ORAL HEALTH 1
- 2. Assessment Mother, fetus/newborn, family Consider developmental stages of mother Risk of abuse Education Individual/family Referral Referral to community resources Dental Hygiene Application 2Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
- 3. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 1. Perio disease, dental caries, and gingival inflammation 2. High risk pregnancy conditions affected by certain oral bacteria 3. Nutritional concerns 4. Transmission of oral bacteria 5. Common pregnancy misconceptions about oral health 6. Importance of dental visits 7. Oral hygiene instruction Health Promotion for the Pregnant Patient 3
- 4. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Exaggerated inflammatory response Bacteria enter bloodstream Possible associations of pre-term, low birth weight babies, gestational diabetes, preeclampsia Periodontal Disease Links 4
- 5. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Pyogenic granuloma or “pregnancy tumor” – 2- 5% of pregnancies • Red colored lesion of varying size, near maxillary gingival margin • Prone to bleeding, may break and then crust over • Typically in 2nd or 3rd trimester • Etiology unknown • Often concurrent w/ pregnancy gingivitis • Typically disappear after pregnancy completion • May be surgically removed – 50% recurrence Periodontal Diseases/ Gingival Inflammation 5
- 6. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Morning sickness/nausea vomiting enamel erosion caries • After vomiting, advise rinse with 1 tsp. baking soda/cup of water – neutralizes acid • Discourage brushing teeth after vomiting – prevent further erosion • Soft TB • Alcohol-free mouth rinses & low-abrasive dentifrices w/fluoride • Demineralized enamel – prescription fluoride – 1.1% sodium fluoride @ 5000 ppm Dental caries and Erosion 6
- 7. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. • Pre-term/Low birth weight deliveries: less than 37 weeks and birth weight below 5.5 lbs Risk Factors: low SES, smoking, drug/alcohol use, diabetes, multiple pregnancies, age Effects: asthma, low IQ, cerebral palsy, poor motor skills, other functional abnormalities • Dental Connections: endotoxin from periodontal bacteria may induce inflammatory mediators that may induce labor, intrauterine exposure to oral bacteria may stunt growth, no improvement in birth outcome with treatment except for those with high risk of pre-term birth • (Kim, Lo, Pullin, Thornton-Johnson & Karimbux, 2012) (Darby and Walsh, 2010) High-Risk Pregnancy Conditions 7
- 8. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. • Gestational Diabetes: carbohydrate intolerance with onset of pregnancy Risk factors: maternal obesity, age, hypertension, family history of diabetes type 2 Effects: Increased risk of maternal and infant morbidity, preeclampsia, preterm birth, birth injury and need for cesarean section • Dental Connections: periodontal disease may be associated with increased GDM, inflammation from periodontal disease may increase insulin resistance in pregnancy and lead to GDM (Xiong, Hirsch, Vastardis, Delarosa, Pridjian & Beukens, 2009) High Risk Pregnancy cont. 8
- 9. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Preeclampsia • Pregnancy specific, multifactorial condition • 2 HBP readings 4 hours apart of 140/90 or higher • Proteinuria • Unusual swelling of the hands, feet or face. • Condition reversible after delivery Risk factors: nulliparity, primiparity, familial history, uterine abnormalities, obesity, chronic hypertension, renal disease, diabetes, multiple gestation, maternal age Preeclampsia 9
- 10. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Effects: Fetal growth restriction, preterm labor, delivery, fetal injury Dental connections: periodontal disease has been shown to have a possible association, not causal relationship, due to inflammatory factors, conflicting studies Preeclampsia cont. 10
- 11. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. • Balanced diet • Direct correlation to healthy fetal growth and development • Nutritional supplements - prenatal vitamins • Cariogenic food ingestion = risk of tooth decay, demineralization and nutritional deficiency Nutritional Concerns 11
- 12. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Folic Acid Deficiency • Lack may result in neural tube defects – spina bifida causes incomplete brain and spinal cord development • 600 micrograms total • Raspberries, oranges, broccoli, peas, asparagus, and peanuts Nutritional Concerns folic acid 12
- 13. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. • Bone and teeth development • Calcium sources Milk and dairy products Green leafy vegetables Fish containing soft bones – sardines Bread and cereal products made with enriched flour Nutritional Concerns Calcium 13
- 14. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. • Anemia – increase risk of low birth weight and infant propensity for developing iron deficiency anemia • Need 27 mg of iron/day • Enriched bread and cereal, red meat, and dark green leafy vegetables. Nutritional Concerns Iron 14
- 15. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. • Transmissible – streptococcus mutans • Discourage sharing utensils, food and beverages, cleaning pacificers by mouth • Use of sugar-free gum containing xylitol may reduce cariogenic pathogens as well as overall risk of bacterial-based oral infections Transmission of Oral Bacteria 15
- 16. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. How you would answer these questions and statements????? • “Poor oral health during pregnancy is normal.” • “I lost a tooth for every pregnancy. My baby sucked all the calcium from my teeth.” • “Is dental treatment harmful to baby or mother?” • “Bleeding gums are normal during pregnancy.” Pregnancy Oral Health Misconceptions 16
- 17. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Dental prophylaxis is safe! • AAP: perio evaluation, prophylaxis, restorative tr. • Best time is between weeks 14-20 (2nd trimester) • Review good oral hygiene to reduce risk of periodontal diseases, dental caries, and gingival inflammation and possible high risk pregnancy conditions Importance of Dental Visits 17
- 18. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. • Demonstrate brushing and flossing technique, have patient demonstrate too • Fluoride treatment • Assess need for prescription fluoride toothpaste, fluoride mouthrinses or trays Oral Hygiene Instructions 18
- 19. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Brush twice daily with a fluoride toothpaste Floss daily Limit foods containing sugar to mealtimes only Choose water or low-fat milk as a beverage Avoid carbonated beverages Choose fruit rather than fruit juice to meet recommended daily fruit intake Obtain necessary dental treatment before delivery Chew xylitol-containing gum ( 4 pcs/day) Avoid saliva-sharing behaviors that directly pass saliva from mother or caregiver to child ADA Oral Health Recommendations for Pregnant Patient 19
Editor's Notes
- This information comes from the Dimensions of Dental Hygiene “Pregnancy and Oral Health”2011 Pregnancy is a state of increased inflammation and bacteria like tannerella and prevotella intermedia are increased because they feed off of progesterone and estrogen, Why is there an exaggerated inflammatory response during pregnancy? The inflammatory response is higher during pregnancy because of the increased hormonal and vascular changes. There is already more blood flow so it makes it easier for inflammation to happen(Darby and Walsh,2010) Journal of Periodontolgy states that pregnancy is “a stressful state with increased inflammatory activity, gingival inflammation, and insulin resistance” (2009). Bacteria may enter the blood stream in periodontal disease because the gingiva is ulcerated…meaning it has holes in it allowing bacteria to enter the blood stream (Darby and Walsh, 2010) ch. 18 The bacteria may even cross the placenta and affect the fetus. This is the relationship of certain adverse pregnancy outcomes such as pre-term birth, low birth weight, gestational diabetes, and preeclampsia. We will look specifically at how these factors play in each high risk pregnancy situations
- Progesterone inhibits collagenase(which breaks down collagen), when this is inhibited we often see the tumor-like growth of the pregnancy granuloma. High prevalence of bacterial organisms – initiate inflammation or pregnancy gingivitis. Associated with poor oral hygiene and high plasma hormone levels. P. Intermedia is bacteria found in pyogenic granuloma
- Dental caries are sometimes higher in pregnant women because of erosion from vomiting. If the patient is experiencing morning sickness advise them to rinse with 1tsp baking soda and 1 cup water to help neutralize acids. Also, ask the dentist if they would recommend a prescription fluoride toothpaste to minimize enamel erosion and tooth decay.
- Pre-term low birth weight babies can have multiple health issues such as asthma, low IQ, cerebral palsy, poor motor skills and others. The Risk factors for having a PTLB baby include low SES, smoking, drug use, diabetes, multiple pregnancies, and age
- nulliparity Condition of having borne no children. primiparity the condition of having borne one child.
- The suggested associated is that cytokines(inflammatory mediators) are induced by periodontal bacteria and may initiate preeclampsia. However, this is not shown to be a causal relationship as studies have struggled to put a clear definition on periodontal disease and control for the other risk factors of preeclampsia.
- Fetus gets most iron from mother – 3rd trimester
- Recommended to chew 4 pieces of xylitol gum from 6 months prenatal to 6 months postnatal to delay the colonization of s. mutans in child.
- Poor oral health is not normal during pregnancy. Poor oral health is usually caused by lack of brushing, increased cravings and sweet consumption and erosion of the teeth from vomiting during morning sickness. There is no evidence that shows breakdown of maternal calcium in teeth. Loss of teeth during a pregnancy is most likely due to pre-existing conditions and poor oral hygiene during pregnancy. Dental treatment is safe. The American Academy of Pediatrics recommends for mothers to seek dental care during pregnancy. Treatment is usually done during the second trimester of pregnancy because of the high risk of exposure to environmental conditions to the fetus during the first trimester. Bleeding gums are always a sign of infection. Increased hormone and blood circulation make it more likely that inflammation will be present, however, it can be reversed with brushing and flossing.
- Relate importance of good oral hygiene to a healthy pregnancy Educate patient on relationship between bacteria and inflammation and adverse pregnancy outcomes Nutritional counseling Build rapport with patient