DMD, PhD.

Shin Dong-Ryul

cons-99@hanmail.net

Dental care in Pregnancy

Pregnancy is a “teachable moment” when

women are receptive to changing

behaviors that can benefit themselves and

their children

The majority of the physicians (81%)

agreed that pregnancy increases the

tendency to have gingival inflammation.

However, 88% of doctors advised delay

dental treatment until after pregnancy.

Int J Dent Hyg. 2008 Aug;6(3):214-20.

There is no evidence relating early

spontaneous abortion to first trimester oral

health care or dental procedures

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. cdafoundation.org/library/docs/poh_policy_ 8. brief.pdf.

Accessed March 2010

1. Hormonal change - Periodontal change

2. Changes in diet and oral hygiene.

Nausea and vomiting in pregnancy can cause

extensive erosion.

Oral change

periodontal disease-preterm birth, low birth weight

dental caries-vertical transmission

(ECC (Early Childhood Caries))

Periodontal disease

an increase in estrogen and progesterone levels

a higher vascular permeability, providing essential bacterial growth

factors

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.

attachment loss

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.

Periodontal disease & Preterm low birthweight:

Proposed Biological Mechanism

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.

36. Boggess KA, Moss K, Madianos P, Murtha AP, Beck J, Offenbacher S. Fetal immune response to oral

path- ogens and risk of preterm birth. Am J Obstet Gynecol 2005;193:1121-1126

Any PLBW and PLBW cases showed

significantly greater probing depth and

attachment loss, increased anaerobic bacterial

counts.

The rate of preterm delivery for the treatment

group was13.1% and 11.5% for the control group

(P=.316)

: no stastically difference

Effects of periodontal therapy on rate of

preterm delivery A randomized controlled

trial

Obstet Gynecol. 2009 Sep.; 114(3): 551-559

Dental caries

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)

Pregnant 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.

International Journal of Paediatric Dentistry 2002; 12: 2–7

vertical transmission

Streptococcus mutans

0

10

20

30

40

50

60

score 0 score 1 score 2 score 3

18 months

36 months

S. mutans

colonization

MS score(S. mutans)

DNA fingerprinting studies

genotype matches between mothers and infants in over

70 percent of cases

Caufield PW. N Y State Dent J 2005; 71(2):23-27.

Mothers strong need for counseling on

how to avoid early transmission of

cariogenic bacteria to their offspring.

Inflammation

Erosion

Changes in diet and oral hygiene.

Nausea and vomiting in pregnancy can

cause extensive erosion.

Hyperemesis gravidarum

severe form of NVP(nausea and vomiting during

pregnancy) that occurs in about 0.3-2.0% of pregnancies,

and may lead to surface enamel loss primarily through

acid-induced erosion

1. Eating small amounts of nutritious yet noncariogenic

foods

2. Using a teaspoon of baking soda (sodium bicarbonate)

in a cup of water to rinse and spit after vomiting

- avoiding tooth brushing directly after vomiting as the

effect of erosion can be exacerbated by brushing an

already demineralized tooth surface

Safety

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

Restorative Materials

dental amalgam, gold, composite

fillings

: class II medical devices(FDA)

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.

Barriers to careBarriers to care

systems barriers

provider barriers

patient barriers

fear of lawsuits

Education and training

“teachable moment”

financial pressures

beliefs and customs

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.

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