Importance of maintaining oral health during pregnancy

1. DMD, PhD.
Kim, Jaeseok
kjsperio@gmail.com
Importance of Maintaining Oral Health
during Pregnancy
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2. 1. Hormonal change
2. Changes in diet and oral hygiene. Nausea and vomiting in
pregnancy can cause extensive erosion.
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3. periodontal disease
-preterm birth, low birth weight
dental caries
-vertical transmission
(ECC (Early Childhood Caries))
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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.
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7. attachment loss
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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.
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10. Does periodontal treatment during pregnancy reduce
the rate of preterm births, low birth weight?
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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.
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12. YES
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15. Any PLBW and PLBW cases showed significantly
greater probing depth and attachment loss,
increased anaerobic bacterial counts.
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16. J Periodontol 2009;80:884-891.
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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.
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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
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19. 192010년 11월 16일 화요일

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.
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21. NO
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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
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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.
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26. Conflicting results
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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)
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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.
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29. International Journal of Paediatric Dentistry 2002; 12: 2–7
vertical transmission
Streptococcus mutans
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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.
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32. mothers strong need for counseling on how to avoid
early transmission of cariogenic bacteria
to their offspring.
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33. periodontal disease
-preterm birth, low birth weight
dental caries
-vertical transmission
(ECC (Early Childhood Caries))
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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.
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35. safety
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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
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38. Restorative Materials
dental amalgam, gold, composite fillings
: class II medical devices(FDA)
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39. Journal of American Dental Association 2008;139(6):685-695.
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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.
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42. Reality
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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.
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45. A survey of 829 general dentists practicing in Oregon during
2006–2007
Huebner CE.et al. Journal of American Dental Association, 2009; 140(2): 211–222.
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46. m jnnnnbh
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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. cdafoundation.org/library/docs/poh_policy_ 8. brief.pdf. Accessed March 2010
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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.
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49. Access to care
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50. a community-based intervention to provide dental services for low-income pregnant women.
J Public Health Dent. 2008 ; 68(3): 170–173.
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51. a community-based intervention
to provide dental services
for low-income pregnant women
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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)
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53. a community health
partnership
(local dentists,WIC
program, Medicaid
families)
technical assistance
(university)
program
administration,
the outreach
coordinator
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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.
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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
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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.
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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).
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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
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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.
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