Pregnancy Oral Health Guide

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
PREGNANCY AND
ORAL HEALTH
1

Perio disease, dental caries, and gingival inflammation
High risk pregnancy conditions affected by certain oral bacteria
Nutritional concerns
Transmission of oral bacteria
Common pregnancy misconceptions about oral health
Importance of dental visits
Oral hygiene instruction
Health Promotion for the Pregnant
Patient
2

Exaggerated
inflammatory
response
Bacteria enter
bloodstream
Possible associations
of pre-term, low birth
weight babies,
gestational diabetes,
preeclampsia
Periodontal Disease Links
3

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
4

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
5

• 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
6

• 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.
7

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
8

 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.
9

• 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
10

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
folic acid
11

• 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
Calcium
12

• 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.
Iron
13

• 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
14

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
15

• Demonstrate brushing and flossing technique, have patient
demonstrate too
• Fluoride treatment
• Assess need for prescription fluoride toothpaste, fluoride
mouthrinses or trays
Oral Hygiene Instructions
16

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
17

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Editor's Notes