This document discusses oral health in pregnant women, nursing mothers, and children under 5 years old. It covers common oral health issues seen such as gingivitis, dental caries, and nursing bottle caries. It emphasizes maintaining good oral hygiene during these stages through practices like brushing with fluoride toothpaste, avoiding sugary snacks, and cleaning infants' mouths and pacifiers. Regular dental checkups are also recommended to monitor oral health and treat any issues.

1. ORAL HEALTH IN
PREGNANT WOMEN,
NURSING MOTHERS
AND UNDER FIVES
SOYEBO O.A.

2. OUTLINE
 INTRODUCTION
 ORAL HEALTH IN PREGNANCY
 ORAL HEALTH IN NURSING MOTHERS
 ORAL HEALTH IN UNDER 5s
 SUMMARY
 REFERENCES

3. INTRODUCTION
 Health is a state of complete physical, mental and social well being; and not the mere
absence of illness or infirmity. -WHO
 oral health has been defined as a state of being free of mouth and facial pain, oral
infections and sores, and oral and other diseases that limit an individual's capacity in
biting, chewing, smiling, speaking, and psychosocial well-being. -WHO
 Oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch,
chew, swallow and convey a range of emotions through facial expressions with
confidence and without pain, discomfort and disease of the craniofacial complex (head,
face, and oral cavity). -FDI

4. INTRODUCTION
 Diseases of the craniofacial complex
 Orofacial pain
 Oral and throat cancer
 Oral ulcers and infections
 Cleft lip & palate
 Periodontal (Gum) diseases
 Tooth Decay
 Tooth Loss

6. ORAL HEALTH IN
PREGNANT WOMEN

7. ORAL HEALTH IN PREGNANCY
 Pregnancy is a state of physiological condition that brings about various changes in the
oral cavity along with other physiological changes taking place throughout the female
body.
 GI system
 Nausea and vomiting
 General
 Increased nutritional demands
 Changes within the oral cavity is associated with high levels of circulating estrogen and
progesterone

8. Changes during pregnancy that affect
Oral Health
 Hormonal effects
1. Saliva changes
 Decreased buffers
 Decreased minerals
 Alteration in flow
 Increased acidity
2. Increased microbial population
 Increased acidity
 Increase in decay-causing bacteria
 Increased snacking
 Increase in amount and frequency of starches/carbohydrates intake
 Reduced immune response
 Increased gingival microbes
3. Tooth mobility
-softening of lig
-altered lamina dura
4. Gum problems
-Pregnancy gingivitis
-Pregnancy epulis

10. ORAL HEALTH PROBLEMS IN
PREGNANCY
 Gum diseases
 Dental caries (tooth decay)
 Tooth erosion
 Halitosis

11. GUM DISEASES
 Pregnancy gingivitis
 Gingivae (Gum) has swollen & puffy red edges,
bleeds easily during brushing and tender
 Nearly 60 to 75% of pregnant women have
gingivitis, which when not treated may lead to
periodontitis
 Initiated by plaque
 Periodontitis
 About 30% of pregnant women suffer from
periodontal diseases.
 Elevated levels of inflammatory markers (IL6, IL8
and PGE2) have been found in the amniotic fluid of
child bearing women having periodontal
conditions, which are considered to be associated
with premature labor, low birth weight & fetal
death.
 Pregnancy gingivitis

12. Pregnancy Gingivitis

13. Periodontitis

14. DENTAL CARIES
 Prevalence of 63-99%
 Pregnant women are more prone to tooth decay
due to upturn in the acidic environment of oral
cavity leading to increased activity of carious
pathogens and increased demineralization making
teeth susceptible to caries.
 carelessness toward oral health (fatigue from
morning sickness)
 Recurrent vomiting
 increased consumption of sugary diet
 Early caries appears as white, demineralized areas
that later break down into brownish cavitation.
 Untreated carious lesions increase the incidence of
abscess and cellulitis (bacteremia)

15. -cellulitis

16. Dental caries

17. TOOTH EROSION
 Loss of enamel
 caused by acid from pregnancy induced vomiting.

18. Prevention and treatment
 It is important that women considering pregnancy
should visit their dentist for check up and receive
appropriate treatment before getting pregnant
 Good oral hygiene practices
 Brush teeth with fluoridated toothpaste 2x daily; 2-3
minutes per brushing time.
 Toothbrush should be changed every 3months or once the
bristles are frayed
 If toothpaste causes nausea, a different flavor and/or
reduced amount of toothpaste may be used.
 The toothbrush should not be shared with an infant or
anyone else.
 Flossing daily
 Rinse every night with an over-the-counter fluoridated
alcohol-free mouth rinse.
 When vomiting occurs, rinsing with a teaspoon of baking
soda and water, brush 30mins – 1hr after.

19. Prevention and treatment
 Chew xylitol containing gums
 Smart snacking e.g. fruits & vegetables; avoid sugary foods
 Routine dental visits
 Professional prophylaxis and therapy
 scaling and polishing.
 Fluoride varnish
 fillings
 Healthy diet
 Increased calcium intake e.g. milk, cheese, nuts, almonds
 Increased vit. D intake (helps the body to utilize calcium) e.g.
eggs, bread, supplements, sun exposure
 The above practices are maintained as these help reduce
the risk of transferring cariogenic bacteria to the baby.

20. Oral Health care during pregnancy
-best time for tx
 2nd Trimester is ideal
 1st trimester: avoid using medications that may affect fetus e.g. ibuprofen,
metronidazole
 3rd trimester: may be difficult for mom to lay supine for long periods of time
(supine hypotension)
 Routine procedures (periodontal treatment, fillings) are safe and encouraged!
 Avoid radiographs; take only when necessary, but with adequate protective
gear.
 Dental emergencies always need to be addressed!
 Extractions
 Root canals

22. Oral health care during pregnancy
-Drug use

23. PREGNANCY TUMOURS
 Pyogenic granuloma, pregnancy epulis
 Occur in up to 10% of pregnant women and
often in women with pregnancy gingivitis.
 Not cancerous
 extreme inflammatory reaction to a local
irritation (such as food debris or plaque).
 Occurs mostly in 2nd trimester
 Lump on the gums usually in-between teeth;
red, raw and bleeds easily.
 These tumors usually go away on their own
after giving birth; although in rare cases they
may need to be removed surgically

24. CLEFT LIP AND PALATE

25. Cleft lip and palate
 Cleft lip and cleft palate (orofacial clefts) are birth defects that occur when
a baby's lip or mouth do not form properly during pregnancy.
 The lip and the palate form around the 4th-7th and 6th-12th weeks of
pregnancy.
 Disturbances during these stages of development result in facial clefts

26. Causes and Risk factors
 Unknown cause
 thought to be caused by a combination of genes and other factors
 Smoking
 Medications e.g. anticonvulsants, ibuprofen, carbamazepine
 Alcohol consumption
 Dietary and vitamin deficiencies
 Parental age
 History of cleft in the family
 Socioeconomic status
 Consanguineous marriage

27. Associated problems
 Affected children have a range of
functional and esthetic problems
 Feeding difficulties due to problems
with oral seal, swallowing and nasal
regurgitation.
 Hearing difficulties: fluid build up in
the middle ear
 Speech difficulties
 Dental problems: small teeth, no
teeth,

28. Prevention and management
 Diet & lifestyle modification
 Management is usually multidisciplinary
 Surgical:- lip repair, palatoplasty
 Psychological
 Social
 Others:-
 Hearing assessment
 Speech and language therapy
 Dentofacial development and treatment

29. ORAL HEALTH IN NURSING MOTHERS

30. Oral health in Nursing mothers
 It is important that the new mother maintains her practices from the prenatal period; with
good general hygiene for the benefit of both mother and child.
 Healthy diet
 Limit sugary foods to meal times only.
 Avoid/reduce in between meals.
 Never put your baby’s pacifier, feeding spoon or bottle in your mouth before feeding the
baby.
 Occasionally; check for early features of tooth decay or any other anomaly e.g. chalky
whites / brown spots on the teeth.
 Hydration is important
 Never abandon your breast / feeding bottle in the mouth of a baby; such that the baby
sleeps with them in the mouth.

31.  Oral health problems in children include:-
 Oral candidiasis
 Nursing bottle caries
 Rampant caries
 Enamel Hypoplasia
 Fluorosis
 Malocclusion

32. Oral Candidiasis
 Common in babies and children
 White or yellow velvety or red patches in the
mouth
 CAUSES
 Very low birth weight
 Maternal yeast infection
 Prolonged Antibiotic use
 Damp nursing pads or bras staying for long
periods on breast
 Frequent use of pacifier
 Poor oral hygiene
 Weak immune system

33. Oral Candidiasis
 PREVENTION AND MANAGEMENT
 Good maternal general hygiene
 Wash hands before caring for the baby
 Boil nipple or pacifiers 5-10 minutes after
each use
 Children’s mouth should be cleaned with a
white clean cloth even before teeth have
erupted
 Children’s teeth should be brushed using a
soft bristled children toothbrush as soon as
the first teeth appear in the oral cavity
 Use of antifungal gel e.g. 2% miconazole
oral gel and fluconazole for 7-10 days for
both in the mouth of the baby and breast
of the nursing mother.

34. Nursing bottle caries
-Early childhood caries
 Nursing caries, nursing bottle
syndrome, night bottle
syndrome, milk bottle
syndrome
 About 15% Infants and
toddlers develop NBC
 Mainly due to the feeding
habits seen in bottle feeding
 Deciduous teeth
 Usually, the lower anterior
teeth are spared

35. Nursing bottle caries
 RISK FACTORS
 Direct transmission:- mother to child,
between siblings.
 Improper dietary and feeding practices
 Nocturnal feeding
 Sweetened pacifiers
 Sugary diets e.g. chocolate and other sticky
foods
 Enamel hypoplasia
 Low parental socioeconomic background
 Never put a baby to bed with juice or
milk bottle

36. Rampant caries
 Characterized by sudden,
rapid and almost
uncontrollable destruction
of teeth, affecting surfaces
that are usually caries free.
 Involvement of 10 or more
teeth over a period of 1yr is
characteristic.
 Deciduous and permanent
teeth are affected

37. Rampant caries
 RISK FACTORS
 Genetic predilection
 Frequent and persistent consumption sticky sweet substances
 Radiotherapy:- results in reduced salivary flow; where the salivary glands are exposed.
 TREATMENT
 Depends on the stage and time of detection and intervention
 Removal of caries; then restoration
 Pulpotomy/pulpectomy/root canal therapy
 Extraction

38. Enamel Hypoplasia
 Deformed, weak enamel due to disruptions in tooth development
 Pitting and Yellowish-brown staining of the teeth
 Teeth are more prone to wearing down, more sensitive to heat or
cold, more susceptible to trapping plaque and bacteria; and
decay.
 CAUSES
 Maternal vit D. deficiency
 Calcium deficiency
 Preterm or low birth weight
 Maternal Infection
 TREATMENT
 Sealants
 Filling
 crowns

39. Fluorosis
 Cosmetic condition that affects the teeth
 Usually due to over exposure to fluoride during
the first 8yrs of life.
 Characterized by
 White spots
 Brown stains
 Pitting of the enamel
 PREVENTION & MANAGEMENT
 Keep fluoride containing products out of reach of
children.
 Teeth whitening (might temporarily worsen),
veneers, micro abrasion, crowns.

40. Malocclusion
 Abnormal alignment of the teeth.
 May result in:-
 Pain/discomfort while chewing or biting
 Speech problems
 Cheek biting
 CAUSES
 Genetic predisposition
 Frequent mouth breathing
 Early loss of teeth
 Cleft lip and palate
 Habits
 Thumb sucking
 Tongue thrusting
 Prolonged use of pacifiers

41. Malocclusion
-Oral Habits
 THUMB SUCKING
 Most common oral habit, with reported
prevalence to be 13%-100% in some societies
 A common behavior of under 5s
 Active & passive thumb sucking
 Persistent thumb sucking beyond the age of
eruption of permanent teeth has been proved to
be detrimental.
 Side effects
 Anterior open bite
 Increased overjet
 Lingual inclination of lower anteriors
 Deep palate
 Compensatory tongue thrust
 Speech defect

42. Malocclusion
-thumb sucking
 MANAGEMENT
 Counselling
 Reward system e.g.
positive reinforcement
 Reminder system e.g.
use of adhesive tapes
on finger
 Adjunctive therapy e.g.
orthodontic appliances
 Palatal bars or spurs
 Hay rakes

43. Malocclusion
-Tongue thrust
 Habitual thrusting of the tongue while at
rest, when swallowing or during speech.
 Interferes with the alignment of the incisors
 Corrected with the use of Palatal cribs

44. Malocclusion
-Cheek and lip biting
 sucking or biting of the lips or inner
cheeks, among which biting of the
lower lip is most common leading to
proclination of the upper teeth and
retroclination of the lower teeth.
 Upper lip sucking may cause
restriction of the maxillary
development and result in anterior
cross bite
 MANAGEMENT
 A lip bumper appliance can be used to
break this bad habit. (Keeps the lower
lip off the lower anterior teeth)

45. ORAL HEALTH IN CHILDREN UNDER
3YRS
 The new mom should continue brushing with
fluoride toothpaste twice daily and flossing daily as
this is still a critical time for optimal oral health.
 Good Oral hygiene practices before teeth erupt, will
help prevent bacteria from colonizing early in the
mouth.
 This will help reduce the risk of dental decay
developing once the teeth erupt.
 Wiping a baby’s mouth out daily helps to get baby
and parent used to cleansing the oral cavity.
 In addition to routine cleaning, cleaning should also
be done after each feeding.
 Also, pacifiers should be cleaned properly

46. Cont’d
 Minimize saliva sharing activities between mother
and child or with other siblings via:-
 Kissing
 Sharing of utensils
 Sharing of tooth brushes
 Commence brushing as soon as the first teeth
appear in the mouth
 Brush the teeth, gums and tongue with a soft
bristled children’s tooth brush and a fluoridated
toothpaste (rice size) 2x daily; first thing in the
morning and last thing at night.
 Always inspect the mouth for chalky white/brown
spots on the teeth or any other anomaly
 Dental visit at 1st birthday; then biannual
appointments or as stated by the dentist.

47. ORAL HEALTH IN CHILDREN AGED
3-5 YRS
 Avoid sugary foods and drinks
 Healthy diet; balanced diet, including fruits and vegetables,
and food rich in minerals
 Calcium:- Teeth and jaws are made mostly of calcium, and
they need lots of it to stay healthy. If children don’t eat or drink
enough calcium, they risk developing gum disease and tooth
decay. E.g. yogurt and cheese, beans .
 Iron:- It helps prevent tongue inflammation and sores that
may form inside the mouth. E.g. red meat , beans and iron-
fortified, low-sugar cereal.
 Vitamin C:- essential for children’s gums; deficiency of vitamin
C causes delays in oral wounds healing and bleeding gums
 Brushing for and supervised brushing when manual
dexterity is adequate; with children soft bristled toothbrush
and pea sized fluoridated tooth paste.

48. Cont’d
 Avoid kids swallowing toothpaste
 Flossing daily.
 Always inspect the mouth for chalky white/brown
spots on the teeth or any other anomaly
 Try to control oral habits
 Drinking of fluoridated water is recommended as
a safe, effective and economical means of
preventing dental caries in all age groups.
Although fluoridated mouth rinses are not
recommended in this age.
 Recommendations include:
 Optimal level of fluoride is 0.7mg/litre
 Daily intake of not exceeding 0.05-0.07mg / kg
body weight
 Biannual dental appointments

49. IMPORTANCE OF ORAL HEALTH CARE
 To prevent oral health problems; the likes of tooth decay and gum
diseases.
 Children’s teeth and gums can have a direct impact on their overall health.
 Poor oral care result in gum diseases, tooth decay, tooth loss, poor
nutrition and sleep problems for children.
 Oral health problems can affect self-esteem leading to social exclusion e.g.
bad breath
 Oral health problems can also lead to low school grades and overall
performance.

50. SUMMARY
 Oral health care is important for
expectant mothers; and it’s SAFE.
 Good nutrition is important for
oral health and overall health.
 Oral habits can cause harm and
need to be monitored and possibly
modified.
 Good oral health care for pregnant
women, nursing mothers and
children under 5 years is
important for good Oral Health
and overall health
 PREVENTION IS KEY

51. REFERENCES
 American Dental Association Council on Access, Prevention, and
Interprofessional Relations, 2006.
 Elizabeth Garcia-Gomez et al. Role of Sex Steroid Hormones in Bacterial-Host
Interactions, 2012.
 Mustafa Naseem et al. Oral health challenges in pregnant women:
Recommendations for dental care professionals, The Saudi Journal for Dental
Research, 7(2016) pp138-146.
 Agbenorku, Pius. (2013). Orofacial Clefts: A Worldwide Review of the Problem.
ISRN Plastic Surgery. 2013. 7 pages. 10.5402/2013/348465.
 Sujata Tungare & Aragati G.P. Baby bottle syndrome. NCBI, 2020.
 Aasim, Farooq & Batra, Manu & C B, Sudeep & Gupta, Mudit &
Kadambariambildhok, & Kumar, Rishikesh. (2014). Oral habits and their
implications. journal of dental herald. 1. 179-186.
 Google images

52. THANK YOU