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<마더세이프라운드> 루덴치과 김재석 원장


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Importance of maintaining oral health during pregnancy

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<마더세이프라운드> 루덴치과 김재석 원장

  1. 1. DMD, PhD. Kim, Jaeseok Importance of Maintaining Oral Health during Pregnancy 12010년 11월 16일 화요일
  2. 2. 1. Hormonal change 2. Changes in diet and oral hygiene. Nausea and vomiting in pregnancy can cause extensive erosion. 22010년 11월 16일 화요일
  3. 3. periodontal disease -preterm birth, low birth weight dental caries -vertical transmission (ECC (Early Childhood Caries)) 32010년 11월 16일 화요일
  4. 4. 42010년 11월 16일 화요일
  5. 5. 52010년 11월 16일 화요일
  6. 6. an increase in estrogen and progesterone levels a higher vascular permeability, providing essential bacterial growth factors (vitamin K) Estrogen and progesterone receptors in gingival tissues pregnancy gingivitis increases in probing depth (PD) and bleeding on probing (BOP) (prevalence: 35% to 100%) Valimaa H. et al. J Endocrinol 2004;180:55-62. Miyazaki H. et al. J Clin Periodontol 1991;18:751-754. Loe H, Silness J. Acta Odontol Scand 1963; 21:533-551. Raber-Durlacher JE. et al. J Clin Periodontol 1994;21:549-558. 62010년 11월 16일 화요일
  7. 7. attachment loss 72010년 11월 16일 화요일
  8. 8. The prevalence of periodontitis in women of child-bearing age and during pregnancy is not well known.Assuming that the prevalence of periodontitis increases with age, the tendency toward an older age for pregnant women may result in a higher proportion of pregnant women having periodontitis. 82010년 11월 16일 화요일
  9. 9. 92010년 11월 16일 화요일
  10. 10. Does periodontal treatment during pregnancy reduce the rate of preterm births, low birth weight? 102010년 11월 16일 화요일
  11. 11. Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67:1103-1113. Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm 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 in women 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 and early 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 preterm birth. J Clin Periodontol 2005;32:45-52. Jarjoura K, Devine PC, Perez-Delboy A, Herrera-Abreu M, D’Alton M, Papapanou PN. Markers of periodontal 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 and periodontal 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 preterm delivery. Obstet Gynecol 2006;107:29-36. Radnai M, Gorzo I, Urban E, Eller J, Novak T, Pal A. Possible association between 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 and pregnancy 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 Brazilian pregnant 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 associated pregnancy complications. Ann Periodontol 1998;3: 233-250. Bearfield C, Davenport ES, Sivapathasundaram V, Allaker RP. Possible association between amniotic fluid micro-organism infection and microflora in the mouth. BJOG 2002;109:527-533. 112010년 11월 16일 화요일
  12. 12. YES 122010년 11월 16일 화요일
  13. 13. 132010년 11월 16일 화요일
  14. 14. 142010년 11월 16일 화요일
  15. 15. Any PLBW and PLBW cases showed significantly greater probing depth and attachment loss, increased anaerobic bacterial counts. 152010년 11월 16일 화요일
  16. 16. J Periodontol 2009;80:884-891. 162010년 11월 16일 화요일
  17. 17. OIBI was significantly associated with preterm birth after adjusting for confounding factors (odds ratio [OR], 1.85; 95% confidence interval [CI]: 1.10 to 3.10; P = 0.02). :The combined effects of multiple oral infections were significantly associated with preterm birth. 172010년 11월 16일 화요일
  18. 18. 429 reports 246 PubMed 10 Cochrane Library 173 Web of Science 7 eligible randomized controlled trials 411 reports excluded nonradomized news, letters, editorials, abstracts 18 reports American Journal of Obstetrics & Gynecology MAR, 2009 182010년 11월 16일 화요일
  19. 19. 192010년 11월 16일 화요일
  20. 20. treatment with scaling and root planing reduces the rate of PTB and may reduce the rate of LBW infants. the decline of oral cavity pathogen concentration -> the consequent reduction of transportation of organisms in the amniotic fluid and chorionic membrane. a reduction in circulating inflammatory mediators produced in the oral crevice -> reduced exposure of genital tract tissues to these mediators. the local inflammatory response in the crevice-> a systemic inflammatory immune response increasing the sensitivity of immune cells in the amnion to an inflammatory stimulus. 202010년 11월 16일 화요일
  21. 21. NO 212010년 11월 16일 화요일
  22. 22. 222010년 11월 16일 화요일
  23. 23. 232010년 11월 16일 화요일
  24. 24. The rate of preterm delivery for the treatment group was 13.1% and 11.5% for the control group (P=.316) : no stastically difference LEVEL OF EVIDENCE—I 242010년 11월 16일 화요일
  25. 25. no differences between the control and treatment groups in preterm birth (9.3% compared with 9.7%, odds ratio [OR] 1.05, 95% confidence interval [CI 0.7-1.58], P=.81), birth weight (3,450 compared with 3,410 g, P=.12), preeclampsia (4.1% compared with 3.4%, OR 0.82, 95% CI 0.44-1.56, P=.55), or other obstetric endpoints. Periodontal treatment was not hazardous to the women or their pregnancies. 252010년 11월 16일 화요일
  26. 26. Conflicting results 262010년 11월 16일 화요일
  27. 27. 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. Dental caries(tooth decay) 272010년 11월 16일 화요일
  28. 28. A woman’s dental caries risk may increase 1. the consumption of small, frequent, carbohydrate-rich meals 2. increased acid in the mouth from vomiting 3. a lack of attention to proper hygiene during pregnancy. Silk H. et al. Am Fam Physician 2008;77(8):1139-1144. 282010년 11월 16일 화요일
  29. 29. International Journal of Paediatric Dentistry 2002; 12: 2–7 vertical transmission Streptococcus mutans 292010년 11월 16일 화요일
  30. 30. 302010년 11월 16일 화요일
  31. 31. DNA fingerprinting studies genotype matches between mothers and infants in over 70 percentof cases Caufield PW. N Y State Dent J 2005; 71(2):23-27. 312010년 11월 16일 화요일
  32. 32. mothers strong need for counseling on how to avoid early transmission of cariogenic bacteria to their offspring. 322010년 11월 16일 화요일
  33. 33. periodontal disease -preterm birth, low birth weight dental caries -vertical transmission (ECC (Early Childhood Caries)) 332010년 11월 16일 화요일
  34. 34. control of oral diseases improves a woman’s quality of life and has the potential to reduce the transmission of oral bacteria from mothers to children. 342010년 11월 16일 화요일
  35. 35. safety 352010년 11월 16일 화요일
  36. 36. 362010년 11월 16일 화요일
  37. 37. 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 372010년 11월 16일 화요일
  38. 38. Restorative Materials dental amalgam, gold, composite fillings : class II medical devices(FDA) 382010년 11월 16일 화요일
  39. 39. Journal of American Dental Association 2008;139(6):685-695. 392010년 11월 16일 화요일
  40. 40. 402010년 11월 16일 화요일
  41. 41. EDT in pregnant women at 13 to 21 weeks’ gestation was not associated with an increased risk of experiencing serious medical adverse events or adverse pregnancy outcomes. 412010년 11월 16일 화요일
  42. 42. Reality 422010년 11월 16일 화요일
  43. 43. A survey of 249 obstetricians practicing in Ohio during 2004–2005 • 29% performed a visual mouth inspection during prenatal care. • 20% used oral health screening questions. • 6% referred clients to a dentist. Stafford KE. et al. Journal of Maternal-Fetal and Neonatal Medicine 2008;21(1):63–71 However, most (64%) agreed that oral screening should be part of prenatal care. 432010년 11월 16일 화요일
  44. 44. 442010년 11월 16일 화요일
  45. 45. A survey of 829 general dentists practicing in Oregon during 2006–2007 Huebner al. Journal of American Dental Association, 2009; 140(2): 211–222. 452010년 11월 16일 화요일
  46. 46. m jnnnnbh 462010년 11월 16일 화요일
  47. 47. The Dentists Insurance Company (TDIC)— which is endorsed by eight U.S. state dental associations and insures 17,000 dentists nationwide—reports only one incidence in the past 15 years or more. http://www. 8. brief.pdf. Accessed March 2010 472010년 11월 16일 화요일
  48. 48. Educating health care professionals and their patients about the safety and advantages of dental treatment during pregnancy can benefit all women,especially low-income women. 482010년 11월 16일 화요일
  49. 49. Access to care 492010년 11월 16일 화요일
  50. 50. a community-based intervention to provide dental services for low-income pregnant women. J Public Health Dent. 2008 ; 68(3): 170–173. 502010년 11월 16일 화요일
  51. 51. a community-based intervention to provide dental services for low-income pregnant women 512010년 11월 16일 화요일
  52. 52. fear of treatment, myths about treatment, myths about pregnancy, lack of insurance, lack of money, and no provider available we must understand women’s beliefs, attitudes, and behaviors about their oral health during this unique time. JOURNAL OF WOMENʼS HEALTH Volume 14, Number 10, 2005 CDC Pregnancy Risk Assessment Monitoring System (PRAMS) 522010년 11월 16일 화요일
  53. 53. a community health partnership (local dentists,WIC program, Medicaid families) technical assistance (university) program administration, the outreach coordinator 532010년 11월 16일 화요일
  54. 54. Initial contact focused on participation. The focus of subsequent home/WIC visits was on providing information on the mother seeing the dentist and preventing caries transmission. A major goal was to reduce barriers to care. 542010년 11월 16일 화요일
  55. 55. Case management focused on reducing no-shows. on eliminating reservoirs of disease with the extraction of hopeless teeth and filling of open cavities. After delivery, xylitol chewing gum for six months Fluoridated toothpaste 552010년 11월 16일 화요일
  56. 56. Continuing Education - doctors, dental hygienists, students A major concern was that the medical community was unaware of the need for treatment during pregnancy and that dental care was safe. 562010년 11월 16일 화요일
  57. 57. Result—Between February 2004 and January 2006, 503 pregnant women were identified: 421 women were contactable. Of these, 339 received home visits (339/421, 80.5%) and 235 received care (235/339, 69.3%). Overall, 55.8% of eligible women received care (235/421). 572010년 11월 16일 화요일
  58. 58. Barriers to careBarriers to care systems barriers provider barriers patient barriers fear of lawsuits Education and training “teachable moment” financial pressures beliefs and customs 582010년 11월 16일 화요일
  59. 59. 592010년 11월 16일 화요일
  60. 60. c 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 examination and treatment, if indicated, can have a beneficial effect on the health of their babies. 602010년 11월 16일 화요일