The document discusses oral health challenges during pregnancy. It notes increased risks of gingivitis, dental caries, and pregnancy tumors due to hormonal changes. Proper oral hygiene and dental care during pregnancy is important for maternal and infant health and can help prevent complications like preterm births. The roles of obstetricians and dentists in educating pregnant women and providing treatment are discussed. Guidelines indicate dental care is safe during pregnancy with precautions.

1.  Chairperson Elect ICOG –Indian College of OB/GY
 National Corresponding Editor-Journal of OB/GY of India JOGI
 National Corresponding Secretary Association of Medical Women, India
 Founder Patron & President –ISOPARB Vidarbha Chapter 2019-21
 Chairperson-IMS Education Committee 2021-23
 President-Association of Medical Women, Nagpur AMWN 2021-24
 Nagpur Ratan Award @ hands of Union Minister Shri Nitinji Gadkari
 Received Bharat excellence Award for women’s health
 Received Mehroo Dara Hansotia Best Committee Award for her work as
Chairperson HIV/AIDS Committee, FOGSI 2007-2009
 Received appreciation letter from Maharashtra Government for her work in the
field of SAVE THE GIRL CHILD
 Senior Vice President FOGSI 2012
 President Menopause Society, Nagpur 2016-18
 President Nagpur OB/GY Society 2005-06
 Delivered 11 orations and 450 guest lectures
 Publications-Thirty National & Eleven International
 Sensitized 2 lakh boys and girls on adolescent health issues
Dr. Laxmi Shrikhande
MBBS; MD(OB/GY);
FICOG; FICMU; FICMCH
Medical Director-
Shrikhande Fertility Clinic
Nagpur, Maharashtra

2. Oral health & Pregnancy
Dr Laxmi Shrikhande
Consultant –Shrikhande Hospital & Research Centre Pvt Ltd
Nagpur

5. Depiction of changes
Pregnancy
Hormonal changes during pregnancy
morning sickness
Acidic nature of vomitus may lead to
wearing off of enamel surface
tooth sensitivity and increased risk of
dental caries
Effects
Increased deposition of plaque in the
oral cavity
Inflammation of the gums- gingivitis
inflammation of the structures
surrounding the tooth- periodontitis
(might lead to bone loss)
Gum irritation leading to pregnancy
tumor/pyogenic
granuloma/granuloma gravidarium
Complications
may cause Low birth Weight
Babies (LBW) or premature
birth of the baby (upto 18 out
of 100 premature births)
mayspontaneously resolve in
mild cases or require surgical
excision in severe cases.
may cause discomfort and
gum bleeding especially
during brushing

6. Pregnancy Gingivitis
• Some women do complaint of bleeding gums while brushing or
flossing during their pregnancy.
• Also known as, “Pregnancy gingivitis” caused by a rise in the
hormone progesterone which can contribute to an increase in the flow
of blood to gum tissues making them more sensitive, swollen and
more likely to bleed.

7. Pregnancy Gingivitis
• Although these changes can occur anytime during the pregnancy, but
they are more severe during the second trimester.
• These hormonal changes can make it easier for certain gingivitis-
causing bacteria to accumulate and can make gums more tender.
• If left untreated, gingivitis can lead to more chronic gum diseases.

8. CAVITIES
• 1/4th of women of reproductive age have dental caries, a disease in which
dietary carbohydrate is fermented by oral bacteria into acid that
demineralizes enamel.
• Pregnant women are at higher risk of tooth decay for several reasons,
including increased acidity in the oral cavity, sugary dietary cravings, and
limited attention to oral health.
• Early caries appears as white, demineralized areas that later break down
into brownish cavitations.
• Untreated dental caries can lead to oral abscess and facial cellulitis.

9. CAVITIES
• Children of mothers who have high caries levels are more likely to
get caries

10. Pregnancy periodontitis
• Periodontitis is a destructive inflammation of the
periodontium affecting approximately 30% of
women of childbearing age.
• In a recent systematic review of mainly cross-
sectional, case-control, and cohort studies
conducted between 1996 and 2006 in 12 countries
on 15000 mothers, investigators identified 24
studies demonstrating a positive relationship
between periodontitis and preterm birth, low
birth weight, or both.

11. Pregnancy epulis
• Occasionally during the second trimester,
some pregnant women will develop a
localized swelling on the gum, known as a
pregnancy epulis or pregnancy granuloma.
• A pregnancy epulis will often bleed easily,
and can appear red, raw-looking raspberry-
like. and inflamed appearance. They are
generally not painful.
• These are harmless tumor and do not have the potential to become cancerous.
• If left alone, the epulis will usually become smaller or disappear after childbirth.

12. Increased risk of tooth decay
• Pregnant women may be eating more
carbohydrates than usual, this can cause tooth
decay.
• Morning sickness can increase the amount of acid
oral cavity is exposed to, which can eat away at
the outer covering of tooth increasing the chances
of decay.
• Erosion of tooth enamel may be more common because of increased exposure
to gastric acid from vomiting secondary to morning sickness, hyperemesis
gravidarum, or gastric reflux during late pregnancy

13. Oral care in pregnancy -
(J Turk Ger Gynecol Assoc 2019; 20: 264-8)
Conclusion
• During pregnancy, oral and dental care requires special attention. Oral
health is a part of general health, and it is of even greater importance
during this period because it concerns both the mother and the fetus.
• It should also be kept in mind that neglecting oral and dental health during
pregnancy does not only cause problems such as tooth decay and tooth
loss, but may also lead to problems such as premature birth, low birth
weight infant, and pre-eclampsia.
• Pregnancy is a period in which the mother must obey certain rules in order
to protect her health and her baby’s’ health. In this period, mothers can
protect their oral health by taking the necessary precautions and then they
can prevent dental problems that may be irreversible.
• Peer-review: Externally peer-reviewed.

14. TITLE OF THE STUDY: Dental Phobia among Pregnant
Women: Considerations for Healthcare Professionals
Reference: Hindawi International Journal of Dentistry Volume 2020,
• Objective: To report the prevalence of dental phobia and associated factors among
pregnant women.
• Materials and Methods. Cross-sectional study included pregnant women. Modified
Dental Anxiety Scale (MDAS) was used to assess dental anxiety and phobia.
• Results.
• ✓ The study analyzed data of 825 participants with mean age of 29.08 ± 5.18 years. &
prevalence of dental phobia was 16.1%.
• Conclusions. A considerable proportion of pregnant women reported dental phobia.
• Bad dental experience was associated with increased dental phobia.
• However,reduced likelihood of dental phobia was associated with updating oral health
knowledge.
• Health care professionals may consider these factors to reduce dental phobia and
improve oral health of pregnant women.

15. Oral health knowledge and awareness among
pregnant women in India: A systematic review
CONCLUSION
• Good oral health during pregnancy can not only improve the health of the pregnant mother, but also
potentially the health of her child.
• The present review showed that pregnant women's knowledge and awareness regarding oral health was
poor as displayed from the results.
• Most of the women were unaware of the potential consequences of neglecting oral hygiene during
pregnancy.
• Pregnancy is a “teachable” moment when women are motivated to adopt healthy behavior.
• Women and families need to hear from a variety of sources about the importance and safety of dental care
during pregnancy.
• Therefore, various health promotion interventions should be carried out during pregnancy in order to
motivate and educate expectant mothers on importance of good oral health.
• Moreover, if obstetric providers could talk with their pregnant patients about oral health; there is a high
probability that patient will pay more attention to their oral health and may schedule a dental visit.
• There is a need for creative, consistent, and comprehensive public health communication strategies that
promote oral health to women in accessible and timely manners.
J Indian Soc Periodontol. 2015 Nov-Dec; 19(6): 612–617.

16. REVIEW ARTICLE-
Oral health challenges in pregnant women:
Recommendations for dental care professionals
Conclusions and recommendations
• Pregnancy should not be considered as an absolute reason to defer required dental care.
• Oral care during pregnancy is very important and involves the contribution of the patient herself,
dental professionals and physicians.
• Pregnant patients must be educated about the importance of maintaining good oral hygiene,
expected changes in the oral cavity and routine dental visits.
• Dental health professionals must be aware of updation of pregnancy related conditions and their
proper management without harming the patient and fetus.
• Considering the best level of patient’s care, referral and consultation to patient’s gynecologist’s or
physician should be considered.
• Drug therapies should be limited and carried out carefully.
• It is better to avoid radiography and elective surgery.
• Female patients of childbearing age or expecting females should be screened for caries and oral
diseases for timely management.
The Saudi Journal for Dental Research (2016) 7, 138–146

17. Prevalence of Dental Caries and Gingivitis among
Pregnant and Non Pregnant Women-Original article
Conclusion
• Dental caries and gingivitis were more prevalent among pregnant than non
pregnant women.
• The pregnant women with a poor oral hygiene status, inadequate
knowledge of dental health care, and poor dental hygiene practice were at
more risk of developing dental diseases such as dental caries, gingivitis,
periodontitis, and other oral diseases.
• Therefore, women should be offered training in good oral hygiene habits
and community awareness programs should be conducted to increase their
awareness of the crucial importance of such habits and detailed knowledge
about the diseases and their effects on health should be explained.
http://www.journaldmims.com on Wednesday, August 11, 2021,

18. Obstetric Providers’ Role in Prenatal
Oral Health Counseling and Referral
Conclusions and Implications
• For Dentists and OBs to play a crucial role in improving the oral health
of their pregnant patients, they must receive appropriate training to
have adequate oral health literacy.
Am J Health Behav.™ 2019;43(6):1162-1170

19. Oral Health in Pregnancy
• Oral health is crucial to overall health.
• Because of normal physiologic changes, pregnancy is a time of
particular vulnerability in terms of oral health.
• Pregnant women and their providers need more knowledge about
the many changes that occur in the oral cavity during pregnancy.

20. Oral Health Practice Behavior of
Women’s Health Care Providers
• Many health professionals are aware of the importance of oral health, but often they do
not address it as part of their provision of preconception, prenatal, or well woman care
(Hashim & Akbar, 2014; Morgan et al., 2009).
• Hashim and Akbar found that 95.4% of gynecologists surveyed had knowledge about the
association between oral health and pregnancy and that 85.2% recommended dental
visits for their patients.
• However, they also found that many gynaecologists mistakenly believed that dental x-ray
imaging (73%) and local dental anesthesia (59.3%) were unsafe.
• Similarly, Morgan et al. found that 84% of obstetrician-gynaecologists were aware of the
importance of oral health in pregnancy but that 54% did not ask about oral health issues
and 69% did not provide information on oral health.

21. Oral Health Practice Behavior of
Women’s Health Care Providers
• Furthermore, only 62% recommended dental visits for
their patients.
• In a summary of its survey of pregnant patients, Cigna
Corporation (2015) reported that “only 44% of women
surveyed say their doctor talked to them about oral
health during their pregnancy visits” .
• Many dentists are unwilling to see pregnant patients
because of liability concerns, yet they may face more
liability from not treating pregnant patients than from
treating them (National Maternal and Child Oral Health
Policy Center, 2012).
• This suggests that dentists may still lack knowledge
about the oral–systemic connection.

22. Role of Obstetrician
Assess pregnant women’s oral health
status
Advise pregnant women about oral health
care
Work in collaboration with oral health
professionals
Provide support services (case
management) to pregnant women
Improve health services in the community

23. Improve Health Services in the Community
Include questions about oral heath on the
prenatal patient-intake form.
Establish partnerships with community-based
programs.
Integrate oral health topics into prenatal
classes.
Provide culturally and linguistically appropriate
care.
Role of Obstetrician

24. Advise Pregnant Women About Oral Health Care
Role of Dentist
 Reassure pregnant women that oral
health care is safe during pregnancy,
including
 Radiographs
 Pain medication
 Local anesthesia
 Encourage women to seek oral
heath care, eat healthy foods, and
attend prenatal classes.

25. Work in Collaboration with Prenatal Care Health
Professional
Establish relationships with prenatal care health
professional in the community.
Develop a formal referral process.
Share pertinent information about pregnant
women
Coordinate care.
Consult with prenatal care health professionals, as
necessary.
Role of Dentist

26. Provide emergency or acute care
at any time during pregnancy.
Discuss benefits and risks of
treatment and alternatives.
Develop and provide a
comprehensive care plan.
Role of Dentist
Provide Oral Disease Management and Treatment to
Pregnant Women

27. Role of Dentist
Provide Oral Disease Management and
Treatment to Pregnant Women
Use standard practice when placing restorative
materials.
Use rubber dam during endodontic and
restorative procedures.
Position pregnant woman comfortably when
providing care.
Follow up with pregnant women.

28. Summary-
Women and their health care providers, including dentists, need more knowledge
and clarification about the safety of dental treatments during pregnancy.
Dental care during pregnancy is safe, and there are appropriate guidelines for the
treatment of pregnant patients (Oral Health Care During Pregnancy Expert
Workgroup, 2012).
Dental visits can take place during any trimester and, if urgent, should never be
delayed (Silk, Douglass, Douglass, & Silk, 2008).
The risk of radiation exposure is extremely low when lead aprons are used during
dental x-ray imaging (Kurien et al., 2013).
The most common medications and anesthetics prescribed by dentists are in U.S.
Food and Drug Administration Category B, and these drugs have not been found
to be a risk to the fetus (Oral Health Care During Pregnancy Expert Workgroup,
2012; Silk, Douglass, & Douglass, 2012).

29. Summary
The perinatal period offers a teachable moment for oral health care
and can potentially have an effect on maternal and infant health
(American College of Obstetricians and Gynecologists Women’s
Health Care Physicians, Committee on Health Care for Underserved
Women, 2013; California Dental Association Foundation & American
College of Obstetricians and Gynecologists, District IX, 2010).
The 2013 Committee Opinion from the American College of
Obstetricians and Gynecologists recommends that all health care
providers assess oral health at the first prenatal visit (American
College of Obstetricians and Gynecologists Women’s Health Care
Physicians, Committee on Health Care for Underserved Women,
2013).

30. Summary
Although many health care providers may voice concern over the amount
of time involved, an oral examination typically takes 1 minute to perform.
During the physical examination, the provider examines the lips, mucous
membranes, teeth, gums, and tongue.
A plan of care, which includes education for prevention of oral health
problems, maintenance of good oral health, and referral for any oral health
problems is integral to the provision of whole-person care.
Prevention includes information about oral hygiene, such as regular
brushing twice a day and flossing daily.
Women who experience vomiting should be instructed to rinse afterward
with a solution of baking soda to prevent erosion of tooth enamel (Silk et
al., 2008).

31. Summary
Mothers need to know that Streptococcus mutans, the bacteria associated with dental
caries, can be transmitted to the child, infect the child’s teeth, and increase the risk for
early childhood caries (Berkowitz, 2006; California Dental Association Foundation &
American College of Obstetricians and Gynecologists, District IX, 2010).
In a population-based study, Weintraub, Prakash, Shain, Laccabue, and Gansky (2010)
showed that the odds of children having untreated caries almost doubled when the
mother had untreated caries.
To reduce the transmission of bacteria from mother to child, it is important for women’s
health care providers to educate mothers about good oral hygiene practices and minimal
“saliva-sharing activities” (American Academy of Pediatric Dentistry, 2015, p. 51).
Good maternal oral health practices have the potential to influence the child’s lifelong
oral health. Documentation of all oral health assessment findings and interventions is
essential.
 The development of a network of community dentists for collaboration and referral is
invaluable to offer patients for oral health maintenance.

32. Summary
Primary prevention requires more workforce capacity than the dental
community alone can provide.
The development of an inter professional oral health primary care
workforce capacity is integral to increasing access to oral health care
for pregnant women.
Heightened awareness of oral–systemic health must be included in
women’s health care provider education for clinicians to translate the
information into practice.

33. Conclusion
There is sufficient evidence that the lack of oral health care during
pregnancy can have negative outcomes for both mothers and their
newborns.
To improve the oral–systemic health outcomes for mothers and their
newborns, it is essential to increase the current and future inter
professional oral health workforce capacity.
Meeting the oral health needs of pregnant women and their
newborns will be accomplished only through collaboration among all
health care professional educators and providers to promote the
incorporation of oral health needs as a gold standard for educational
programs and clinical practice.

35. Dr. Laxmi Shrikhande
Shrikhande Fertility Clinic
Ph-8805577600 / 8805677600
shrikhandedrlaxmi@gmail.com

37. The Art of Living
Anything that helps
you to become
unconditionally happy
and loving is what is
called spirituality.
H. H. Sri Sri Ravishakar