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Maternal and Early Childhood Oral Health

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May 11th 2015

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Maternal and Early Childhood Oral Health

  1. 1. Maternal and Early Childhood Oral Health A 2-year project: Bring together stake holders Create tools and resources Increase awareness and understanding
  2. 2. Promoting oral health among pregnant women is a powerful window of opportunity for lifelong oral health for mothers and their children.
  3. 3. Maternal Oral Health Project • Formed sub-committee of the SK Oral Health Coalition • Focused on raising awareness that the oral health of pregnant women requires greater attention • Project strategies: Compile Evidence-Based Research Saskatchewan Consensus Document Social Marketing Campaign to ↑ Knowledge among Pregnant Women Continuing Education for Oral Care and Prenatal Care Providers
  4. 4. Maternal Oral Health Project Team Dr. Alyssa Hayes College of Dentistry, University of Saskatchewan Christine Thompson Saskatchewan Prevention Institute Janet Gray Population Health Unit, Mamawetan Churchill River Health Region, Keewatin Yatthé Health Region & Athabasca Health Authority Kellie Watson Saskatchewan Dental Hygienists’ Association Leslie Topola Saskatoon Health Region, Oral Health Program Megan Clark Saskatchewan Prevention Institute Marcella Ogenchuk College of Nursing, University of Saskatchewan
  5. 5. Saskatchewan Consensus Document Goals: Oral and prenatal care providers in Saskatchewan have an understanding of the importance and safety of oral care during pregnancy Oral care becomes part of routine prenatal care, contributing to the overall health of pregnant women and their children. Full document available at www.skprevention.ca/oral-health
  6. 6. Target Audiences Oral care providers Ministry of Health Health professional associations Prenatal care providers Primary health care managers Academics
  7. 7. Groups/Organizations Supporting the Consensus Document Oral Heath Organizations/Groups •Canadian Dental Hygienists Association •Saskatchewan Dental Assistants’ Association •Saskatchewan Dental Hygienists’ Association •Saskatchewan Dental Public Health Network •Saskatchewan Dental Therapists Association Health Organizations/Groups • Breastfeeding Committee for Saskatchewan • Medical Health Officers’ Council of Saskatchewan • Nurse Practitioners of Saskatchewan • Saskatchewan Association of Licensed Practical Nurses • Government of Saskatchewan Ministry of Health - Primary Health Services • Saskatchewan Public Health Nurse Managers Committee • Saskatchewan Registered Nurses’ Association Health Regions •Athabasca Health Authority •Cypress Health Region •Five Hills Health Region •Kelsey Trail Health Region •Prairie North Health Region •Prince Albert Parkland Health Region •Regina Qu’Appelle Health Region •Saskatoon Health Region •Sun Country Health Region
  8. 8. Public Education Materials Poster
  9. 9. Information Cards
  10. 10. Materials are available for order from: www.skprevention.ca Small counter display Large floor display (for loan)
  11. 11. Evaluation of Public Education Material • Response rate was 54% (30% were prenatal care providers) • Overall, the materials were found to be both appealing and useful • High interest in ordering more of the materials • 95% indicated they would recommend the materials to other care providers • > 80% thought the campaign was effective in increasing knowledge and awareness of oral health during pregnancy and early childhood
  12. 12. Pregnancy is a Time for Smiling… and a time to pay extra attention to your teeth and mouth Oral Health for Moms and Babies
  13. 13. Your thoughts? Do you think of these materials are useful? Will you distribute them to pregnant women and families? How would you distribute them?
  14. 14. Continuing Education for: Oral Health Professionals Prenatal Health Professionals
  15. 15. Oral Health during Pregnancy Practice Opportunities for Oral Health Professionals Project Partners: Northern Saskatchewan Population Health Unit Saskatchewan Dental Hygienists’ Association Saskatchewan Oral Health Coalition Saskatoon Health Region, Oral Health Program University of Saskatchewan College of Dentistry University of Saskatchewan College of Nursing
  16. 16. Overview • Why oral health during pregnancy is important • Oral disease and pregnancy • Treating the pregnant patient • Barriers to oral care during pregnancy • Maternal oral health and ECC • Practice opportunities • Available guidelines on oral health during pregnancy
  17. 17. The following guidelines and documents informed the development of this presentation
  18. 18. California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  19. 19. New York State Dept. of Health (2006). Oral Care During Pregnancy & Early Childhood Practice Guidelines.
  20. 20. Maternal & Child Health Bureau, American Dental Assoc., American Congress of Obstetricians & Gynecologists (2011). Oral Health Care During Pregnancy: A National Consensus Statement. “In many cases, neither pregnant women nor health professionals understand that oral health care is an important component of a healthy pregnancy.”
  21. 21. Why Oral Health during Pregnancy is Important • Potential adverse pregnancy outcomes • Pregnant women are at higher risk of tooth erosion and periodontal disease • Untreated oral infections can further complicate pregnancy - especially for those with chronic conditions such as diabetes • Untreated maternal tooth decay increases risk for tooth decay in child - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  22. 22. Research shows a possible connection between periodontal disease and adverse birth outcomes including preterm birth and low birth weight. - Offenbacher, S. et al. (1996). Periodontal infections as a possible risk factor for preterm low birthweight. J Periodontol, 67(S10), 1103-13.
  23. 23. Pregnancy increases the risk for oral disease. This is due to hormonal changes and changes in eating patterns (such as increased snacking).
  24. 24. Oral Disease and Pregnancy • Prevalence of gingivitis during pregnancy ranges from 30% to 100% (depending on the study) • An estimated 5% to 20% of pregnant women have periodontal disease • An estimated 25% of women of childbearing age have at least one untreated cavity “A sizable number of women may enter pregnancy with active oral disease, or pregnancy may trigger the progression of the disease process”. - U.S. Department of Health and Human Services (2000). Oral Health in America: A Report of the Surgeon General.
  25. 25. Why it is Critical to Treat the Pregnant Patient • Acid erosion • Immunocompromised status • Pregnancy gingivitis • Increased risk of periodontal disease • Reduce risk of self-medication for pain management • Reduce bacterial transmission from mother to infant • Establish good oral hygiene Source: California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  26. 26. Maternal Oral Health and ECC “Vertical transmission of MS from mother to infant is well documented.” “Along with maternal salivary levels of MS, the mother’s oral hygiene, periodontal disease, snack frequency, and socio-economic status also are associated with infant colonization.” - American Academy of Pediatric Dentistry (2011). Guideline on Perinatal Oral Health Care.
  27. 27. There is well-established evidence that caregivers (primarily mothers) with high levels of mutans streptococci have a high likelihood of infecting the child before the second birthday. - Berkowitz, R. J. (2003). Acquisition and transmission of mutans streptococci. J Cal Dent Assoc, 31(2), 135-138. Early colonization in an infant’s mouth by MS is a major risk factor for early childhood caries as well as future dental caries. - California Dental Association Foundation (2010). Oral Health During Pregnancy and Early Childhood.
  28. 28. Cariogenic or decay-causing bacteria are typically transferred from the mother or caregiver to child by behaviours that directly pass saliva, such as sharing a spoon when tasting baby food or cleaning a dropped pacifier by mouth. - California Dental Association Foundation (2010). Oral Health During Pregnancy and Early Childhood. Key strategies to reduce the risk for future cavities for the child: • Minimize the MS levels in the mother in order to delay the colonization of MS in the infant as long as possible; and • Minimize the sharing of MS from mother to child. - American Academy of Pediatric Dentistry, Clinical Affairs Committee (2011). Guideline on Infant Oral Health Care.
  29. 29. Women with poor oral health affect their children’s oral health through the influence of their beliefs, knowledge, and skills. - Huebner, C. E. & Riedy, C. A. (2010). Behavioral determinants of brushing young children’s teeth: implications for anticipatory guidance. Pediatr Dent, 32(1), 48-55.
  30. 30. Pregnant women who may not be concerned about their own oral health are generally very receptive to information about the consequences it can have on their children. Many people do not realize that dental caries is the most common infectious disease in childhood, that it has health and developmental consequences, and that it is preventable. - Kowash, M. B., et al. (2000). Dental health education: effectiveness on oral health of a long-term health education programme for mothers with young children. British Den J, 188, 201-205.
  31. 31. Where does Saskatchewan rank among Canadian provinces/territories for day surgery rates to treat cavities among children? A. 8th highest rate B. 5th highest rate C. 3rd highest rate D. 2nd highest rate
  32. 32. “One-third of all day surgery operations for preschoolers in Canada are done to perform substantial dental work, making it the leading cause of day surgery for children this age.” “Saskatchewan has the third highest rate in Canada for day surgery operations performed to treat cavities among children aged 1-5 years, after Nunavut and NWT.” - CIHI (2013). Treatment of Preventable Dental Cavities in Preschoolers, A Focus on Day Surgery Under General Anesthesia.
  33. 33. Safety of Dental Care During Pregnancy • No evidence of early spontaneous miscarriage in 1st trimester as a result of dental procedures • Women in dental pain tend to self medicate themselves • Periodontal treatment during pregnancy • Is safe • Doesn’t increase risk for preterm or low birth weight • Dental care is not contraindicated for women with preeclampsia • Dental X-rays & anesthesia present no additional fetal & maternal risk compared to no treatment for oral diseases - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  34. 34. “Pregnancy is not a reason to defer routine dental care or treatment of dental problems”. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  35. 35. Diagnostic Radiation • Radiographic imaging of oral tissues is not contraindicated in pregnancy and should be utilized as required to complete a full examination, diagnosis and treatment plan. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  36. 36. Positioning the Pregnant Patient • Place the patient in a semi-reclining position (especially in the 3rd trimester), encouraging frequent position changes, and/or place a small pillow or folded blanket underneath one of her hips to displace the uterus. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  37. 37. Use of Nitrous Oxide • Because pregnancy is associated with decreased anesthetic requirements, lower concentrations of nitrous oxide may be adequate for sedation and patient comfort. • Prolonged dental treatments and nitrous oxide exposure should be avoided if possible. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  38. 38. Restorative Materials • Given the risks associated with untreated dental caries in pregnant women, oral health professionals should recommend prompt treatment of dental caries and, in consultation with the pregnant woman, determine the appropriate options for treatment and restorative materials. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  39. 39. Pharmacologic Considerations • Pharmacologic treatment during pregnancy is of concern as the maternal metabolism of drugs is altered by the normal physiologic changes of pregnancy, and certain medications can reach the fetus and cause harm. • The physiologic changes of pregnancy influence absorption, plasma levels, drug distribution, half-lives and elimination of drugs. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  40. 40. Pharmacological Considerations for Pregnant and Breastfeeding Women Drug FDA Classification Teratogenic Risk Evidence Quality Restrictions/Special Considerations ANALGESICS Aspirin C Minimal Good  Short duration of use  Avoid in 1st and 3rd trimester  Avoid if breastfeeding Acetaminophen B None to minimal Good  Analgesic and antipyretic of choice Ibuprofen B Minimal Fair to good  Short duration of use  Avoid in 1st and 3rd trimester  Do not use for >48-72 hours  Compatible with breastfeeding Naproxen B Minimal Fair  Short duration of use  Avoid in 1st and 3rd trimester  Do not use for >48-72 hours  Compatible with breastfeeding Codeine C Unlikely Fair to good  Compatible with breastfeeding  At high maternal doses, may cause depression/ drowsiness in breastfeeding infants Morphine B/D Unlikely Fair to good  Withdrawal symptoms in neonate may occur with prolonged or chronic use  At high maternal doses, may cause depression/ drowsiness in breastfeeding infants  Category D with prolonged use Meperidine B/D Unlikely Fair  Category D with prolonged use  Compatible with breastfeeding - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  41. 41. ANTIBIOTICS Penicillin B None Good  No restrictions Amoxicillin B Unlikely Good  No restrictions Cephalosporins B Unlikely Fair to limited  No restrictions Clindamycin B Unlikely Limited Erythromycin B Minimal Fair  Erythromycin estolate is avoided due to potential maternal hepatotoxicity Tetracycline D Moderate for tooth staining Good  Avoid during pregnancy; use after 25 weeks may result in staining of teeth and possible effects on bone growth Fluorquinolones C Unlikely Fair  Avoid during pregnancy and lactation due to toxicity to developing cartilage in animal studies Clarithromycin Undetermined Limited  Alternative antibiotics are recommended because number of cases of pregnancy exposure is too small to conclude no risk - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  42. 42. ANESTHETICS Lidocaine (local) B None Fair  No restrictions MISCELLANEOUS Chlorhexidine mouth rinse C Unlikely Poor  Has not been evaluated for possible adverse pregnancy effects Xylitol Undetermined Unlikely Not available  No references available on possible adverse pregnancy effects - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  43. 43. Dental Care Utilization During Pregnancy “Only about one-quarter to one-half of women receive dental care during their pregnancy”. “The likelihood of low-income and uninsured women receiving such care is even lower.” - Gaffield, M.L., et al. (2001). Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system. J Amer Dent Assoc, 132(7), 1009-1016.
  44. 44. Barriers to Oral Care During Pregnancy • Women often do not seek or are not referred for oral care by their doctors • Many oral care and prenatal care providers have only a limited knowledge of the safety and benefits of oral care during pregnancy • Many oral care providers delay or withhold treatment fearing: • Potential harm to the mother or fetus • Liability - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  45. 45. Practice Opportunities for Oral Health Professionals • Ask the woman if she has any concerns/fears about getting dental care while pregnant. • Advise the pregnant woman that prevention, diagnosis and treatment of oral diseases, including needed dental X-rays and use of local anesthesia (when necessary for the care of the patient), are acceptable and can be safely undertaken. • Perform a comprehensive periodontal examination. • Plan definitive treatment based on customary oral health considerations. • Develop and discuss a comprehensive treatment plan that includes preventive, treatment, and maintenance care throughout pregnancy. Discuss the benefits, risks, and alternatives to treatments. • Provide emergency/acute care at any time during pregnancy as indicated by oral condition. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  46. 46. Practice Opportunities for Oral Health Professionals cont’d • Encourage women to learn more about oral health during pregnancy and early childhood. • Provide health education or anticipatory guidance about oral health practices for her children to prevent ECC. • Recommend strategies to decrease maternal cariogenic bacterial load (i.e., tooth brushing, flossing, treating caries, mouth rinses, fluoridated water, healthy diet, regular dental visits). • Support the development of provincial guidelines on oral care during pregnancy. • Engage in training and continuing education opportunities on oral health during pregnancy. - California Dental Association Foundation (2010). Oral Health During Pregnancy & Early Childhood Guidelines.
  47. 47. Discussion What are you already doing? What barriers or challenges do you face in providing oral care to pregnant women? What supports would be helpful to enhance your practice?
  48. 48. Dental-Medical Collaboration • Connection between oral health and systemic health • Prenatal care providers play a key role in preventing oral disease, especially among those who have limited access to dental services • Interprofessional learning and practice opportunities • Collaborative relationships for case management & dental referral network
  49. 49. Discussion Do you collaborate with prenatal health care providers? What are/might be the benefits of collaborating? What are/might be some challenges with collaborating?

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