J Pediatr Adolesc Gynecol (2009) 22:328e329

Perspectives of the Allied Health Profession

Oral Health and Pregnancy

Margaret Tonelli, R.N., M.S.Brigham and Women’s Hospital, Boston, Massachusetts, USA

Eighteen-year-old Denise presents for her first pre-natal visit. Her medical history and physical exam areunremarkable, with the exception of poor oral health.She has extensive dental decay, missing teeth, andswollen gums. She reports she has not had dental carein many years, does not know where to go for dentalcare, and will seek care at an emergency room withtooth pain. Denise’s oral health needs are not atypicalfor our service.

Dental caries and periodontal disease are prevalentand preventable. The American Dental Associationstates the number one cause of poor oral health is non-compliance with daily oral health care. Lack of homecare, lack of access and /or barriers to regular dentalcare, and the normal hormonal changes of pregnancycan exacerbate periodontal disease in pregnancy.

The majority of young women seeking prenatal careat our service come from ethnic and minority commu-nities of Boston that continue to be disproportionatelyplagued with infant mortality and prematurity. Blackwomen in Boston continue to have almost twice the rateof prematurity of white women.1 Understanding andtrying to eliminate the racial/ethnic health disparity ofprematurity continues to challenge health providers.

Maternal oral infections may pose an infectiousand inflammatory threat during pregnancy. Recent re-search has indicated a positive correlation betweenwomen with periodontal disease having higher ratesof preterm births. Studies indicate that ‘‘periodontalinfection can lead to placental-fetal exposure andwhen coupled with a fetal inflammatory responsecan lead to preterm delivery.’’2

It is estimated that 50%-70% of women will experi-ence pregnancy gingivitis, swollen and bleeding gums.Pregnancy gingivitis enhances a woman’s susceptibilityto more severe gum and periodontal disease and is re-versible with daily home care of brushing and flossing.

Pregnancy offers an opportunity to educate womenregarding oral health and its influence on overallhealth and possibly pregnancy outcome. Myths dis-couraging dental care during pregnancy prevail, andwomen of all ages often ignore early signs of gum

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disease until tooth pain and fever bring them to theemergency room. Studies suggest periodontal treat-ment (in the second trimester) is safe for both motherand child.2

The Healthy Baby Healthy Child Program of Bos-ton Public Health has instituted an oral health promo-tion in conjunction with the Boston University Schoolof Dentistry. The program targets pregnant women inhigh-risk communities. Visiting nurses are trained insimple oral health assessment, provide oral health ed-ucation for home care, and assist with referrals foridentified dental needs.

To address this health need, our service includesa simple oral screening with the initial prenatal examand provides oral health education and dental referralsas needed. In 2006 and 2007 as part of the TeenagePrenatal Oral Health Project, the International Collegeof DentistseNew England Section provided our ser-vice with oral health kits including floss, electric toothbrushes, and education materials to provide to ournew obstetrics patients.

Education includes the importance of flossing, fol-lowed by brushing twice daily, encouraging regulardental care, and a diet limiting sweets and soda. We en-courage dental care and treatment as well as advocateand refer for a dental exam in pregnancy. Additionally,especially with a teen population, the risks associatedwith oral piercing are discussed. Though fashionablefor this population, dentists are concerned with risk ofinfection due to increase bacteria at the piercing site, re-ceding gum tissue due to oral jewelry rubbing againstgums, broken teeth, and the increase saliva oral jewelrystimulates. The use of nonsterile instruments in oralpiercing puts the teens at risk for blood-borne diseases,such as HIV and hepatitis B, C, and D.

Oral health can influence one’s lifelong generalhealth. Continued research is needed to determineassociated risks of poor oral health and adverse preg-nancy outcomes. The potential risk warrants educat-ing young pregnant women on the importance oforal health for their pregnancy, future health, and theirchildren’s health.

1083-3188/09/$36.00doi:10.1016/j.jpag.2008.07.019

329Tonelli: Oral Health and Pregnancy

Resources

YouTube Part 1 Oral Health and PregnancyThis training DVD, designed for Head Start staff,teachers, and parents, provides information about de-veloping good oral health habits. www.youtube.com/watch?v5eFamOqtH6j0.

References

1. Boston Public Health Commission: Boston Natality 2007.Available at: www.bphc.org. Accessed June 30, 2008

2. Bobetsis VA, Barros SP, Offenbacher S: Exploring the rela-tionship between periodontal disease and pregnancy com-plications. J Am Dent Assoc 2006; 137:7e13