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Oral Health and Pregnancy
Theory of Adverse Outcomes 2013 Review reported association between GCF inflammatory
mediator levels and adverse pregnancy outcomes Mediators enter system circulation and raise C-Reactive Pro-
tein levels Increase CRP levels induce production of PgE2 Bi-Directional Relationship Studies reveal pregnancy influenced periodontal status Pre-pregnancy periodontitis could lead to increased severity dur-
ing pregnancy Hormonal changes exacerbate gingival inflammation
Effect of Periodontal Treatment—2015 Study
Statistical reduction of CRP Greater risk of preterm birth Studies suggest treatment is safe and beneficial
Danette Ocegueda, RDH, MS
Manager, Professional Education West
Danette received her Bachelor of Science degree in
Dental Hygiene from Old Dominion University, her
Master of Science in Dental Hygiene Education for the
University of Missouri-Kansas City and is certified in
Forensic Dentistry. In addition to over twenty-five
years of clinical experience, Danette’s career also in-
cludes experience in academia, research, and public
speaking. Danette is a member of the American Dental
Education Association, California Dental Hygiene Edu-
cators’ Association, the American Dental Hygienists’
Association and the California Dental Hygienists’ Asso-
ciation.
Resources:
Offenbacher, S., Katz, V., Fertik, G., Collins, J., Boyd, D.,
Maynor, G., ... & Beck, J. (1996). Periodontal infection as a
possible risk factor for preterm low birth weight. Journal
of periodontology, 67(10s), 1103-1113.
Offenbacher, S., Jared, H. L., O'reilly, P. G., Wells, S. R., Salvi, G. E., Lawrence, H. P., ... & Beck, J. D. (1998). Poten-tial pathogenic mechanisms of periodontitis-associated pregnancy complications. Annals of periodontology, 3(1), 233-250. Offenbacher, S., Lieff, S., Boggess, K. A., Murtha, A. P., Madianos, P. N., Champagne, C. M. E., ... & Herbert, W. N. P. (2001). Maternal periodontitis and prematurity. Part I: Ob-stetric outcome of prematurity and growth re-striction. Annals of periodontology, 6(1), 164-174.
Jeffcoat, M.K., Geurs, N.C., Reddy, M.S., Cliver, S.P., Gold-enberg, R.L., Hauth, J.C. Periodontal infection and preterm birth: results of a prospective study. J Am Dent Assoc. 2001 Jul;132(7):875-80 Dörtbudak, O., Eberhardt, R., Ulm, M. and Persson, G. R. (2005), Periodontitis, a marker of risk in pregnancy for preterm birth. Journal of Clinical Periodontology, 32: 45–52. doi:10.1111/j.1600-051X.2004.00630.x López, N. J., Smith, P. C., & Gutierrez, J. (2002). Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized con-trolled trial. Journal of periodontology, 73(8), 911-924.
©2017 Philips Oral Healthcare 1
Preterm Birth < 37 weeks gestation Extremely Preterm: < 28 weeks Very Preterm: 28-<32 weeks Moderate to Late Preterm: 32-<37 weeks
Low Birth Weight <5lbs 8oz
Smoking—less oxygen for fetal development
Alcohol-No safe amount
Womb to Grow: Great Beginnings: Prenatal to Preschool
Prevention Program
Healthy Oral Environment Optimum Oral Hygiene Plaque Biofilm Control Program Coronal Scaling Limit Carbohydrate Intake Minimize Inflammatory Response Curettage 2.2 mg Fluoride Tablet Reduction in S. Mutans
Welcome Home Baby
Impact of Oral Disease Early Childhood Caries Research Updates Solutions
Impact of Oral Disease with Children Early tooth loss —-> Failure to thrive Impaired speech Low self-esteem Poor School Performance Absences from school Inability to concentrate Systemic Consequences
Progression of Early Childhood Caries High levels of S. Mutans in Mothers ——> Transfers to Baby
New Caries Pathogen in Early Childhood Caries
Scardovia Wiggsiae Associated with severe ECC Thrives in acidic conditions
Risk Assessment: Mom/sibling dental history (biggest influencer on
risk; active decay in parent/caregiver automatical-ly places as high risk)
Low health literacy of primary caregiver Low socioeconomic levels Clinically observe OH compliance issues Poor biofilm control, S. mutans and gingival
bleeding present Frequent exposure to cariogenic agents (sippy cups, bottle use, breast feed
on demand, grazing behavior)
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Resources:
Karimi, M. R., Hamissi, J. H., Naeini, S. R., & Karimi, M. (2016). The relationship between ma-ternal periodontal status of and preterm and low birth weight infants in Iran: a case control study. Global journal of health science, 8(5), 184.
Boggess, K. A., & Edelstein, B. L. (2006). Oral health in women during preconception and pregnancy: implications for birth outcomes and infant oral health. Maternal and child health journal, 10(1), 169-174. Wan, A. K. L., Seow, W. K., Purdie, D. M., Bird, P. S., Walsh, L. J., & Tudehope, D. I. (2003). A longi-tudinal study of Streptococcus mutans coloni-zation in infants after tooth eruption. Journal of dental research, 82(7), 504-508. Philips CARE-Online Risk Assessment www.philipscare.com Marrs, J. A., Trumbley, S., & Malik, G. (2011). Early childhood caries: determining the risk factors and assessing the prevention strate-gies for nursing intervention. Pediatric nurs-ing, 37(1), 9. Tanner, A. C. R., Mathney, J. M. J., Kent, R. L., Chalmers, N. I., Hughes, C. V., Loo, C. Y., ... & Papadopolou, E. (2011). Cultivable anaerobic mi-crobiota of severe early childhood car-ies. Journal of clinical microbiology, 49(4), 1464-1474. Tham, R., Bowatte, G., Dharmage, S. C., Tan, D. J., Lau, M. X. Z., Dai, X., ... & Lodge, C. J. (2015). Breastfeeding and the risk of dental caries: a systematic review and meta‐analysis. Acta Paediatrica, 104(S467), 62-84.
2 ©2017 Philips Oral Healthcare
“Comprehensive dental care is considered both safe and
necessary during pregnancy and can be crucial to the well-
being of pregnant women and their offspring.”
Dimensions of Dental Hygiene: February 2017
Adverse Pregnancy Outcomes
Vital Nutrition
Smoking and Alcohol
Oral Changes
Research Updates
Solutions
Image: https://www.drugabuse.gov/publications/research-reports/heroin/how-does-heroin-abuse-affect-pregnant-women
Breast Milk and Fortified Formulas
Breast milk by itself is not cariogenic Ingestion of fermentable carbohydrate substrates is cariogenic
Baby Thrush
Candida albicans Contributing factors: antibiotics, immature immune system Symptoms: drowsiness, dilated pupils, increased irritability while feed-
ing Clinical Presentation: white velvet patches on tongue, palate or buccal
mucosa that do not rub off Treatment: Nystatin gel applied on all affected areas
Ankylglossia
Loses suction while feeding Tires quickly Little or no weight gain Inability to protrude tongue beyond lips Heart-shaped or square tongue tip Painful for Mother during feeding
Guidelines for Pacifier Use
1 to 12 mos helps reduce ear infections Over 12 mos increased risk of ear infections Cease pacifier habit before 2.5-3 yrs for orthognathic reasons
Teething Options Wean from bottle by 18 mos
Bottles and Sippy Cups
Wean from bottle by 18 mos Sippy cups are transitional, not a long-term means of drinking
Partnering for Overall Health Parents Dental Professionals Physicians
Successful Engagement with Parents
Friendly atmosphere Listen Ask Open-ended questions
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Resources:
Lehr, J., Masters, A., & Pollack, B. (2012). Benzo-caine-induced methemoglobinemia in the pe-diatric population. Journal of Pediatric Nursing: Nursing Care of Children and Families, 27(5), 583-588. Rosen MM. Safe baby teething reme-dies. Parenting. www.parenting.com/gallery/baby-teething-remedies?pnid=376566 Weaning From The Bottle www.aap.org Dental Home Resource Center www.aapd.org/advocacy/dentalhome/ Isong, I. A., Luff, D., Perrin, J. M., Winickoff, J. P., & Ng, M. W. (2012). Parental perspectives of early childhood caries. clinical Pediatrics, 51(1), 77-85.
3 ©2017 Philips Oral Healthcare
Collaborate /Refer
Anticipatory Guidance
Establish a
Examination
Assign Risk Lev-Re-evaluation
Individualized Home
Individualized Treatment Based on
Parent Interview
Parental perception-You Care Avoid argument blaming
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Resources:
Well Baby Knee to Knee Exam www.youtube.com/watch?v=HCKyR-zS7J0 Galganny-Almeida, A., Queiroz, M. C., & Leite, Á. J. M. (2007). The effectiveness of a novel infant tooth wipe in high caries-risk babies 8 to 15 months old. Pediatric dentistry, 29(4), 337-342. Tips for Parents American Academy of Pediatric Dentistry www.mouthmonsters.mychildrensteeth.org/tips-for-parents/ Marinho, V. C., Higgins, J., & Logan, S. (2003). Fluoride toothpastes for preventing dental caries in children and adolescents. The Cochrane Library. Twetman, S. (2008). Prevention of Early Childhood Car-ies (ECC) Review of literature published 1998–2007. European Archives of Paediatric Dentistry, 9(1), 12-18. Marinho, V. C. C. (2008). Evidence-based effective-ness of topical fluorides. Advances in dental re-search, 20(1), 3-7. AAPD Guideline on Fluoride Therapy http://www.aapd.org/media/Policies_Guidelines/G_fluoridetherapy.pdf Llodra, J. C., Rodriguez, A., Ferrer, B., Menardia, V., Ramos, T., & Morato, M. (2005). Efficacy of silver dia-mine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. Journal of dental research, 84(8), 721-724. Li, R., Lo, E. C. M., Liu, B. Y., Wong, M. C. M., & Chu, C. H. (2016). Randomized clinical trial on arresting den-tal root caries through silver diamine fluoride appli-cations in community-dwelling elders. Journal of dentistry, 51, 15-20. Zhang, W., McGrath, C., Lo, E. C. M., & Li, J. Y. (2013). Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries research, 47(4), 284-290. Horst, J. A., Ellenikiotis, H., Milgrom, P. M., & UCSF Silver Caries Arrest Committee. (2016). UCSF protocol for caries arrest using silver diamine fluoride: ra-tionale, indications, and consent. Journal of the Cali-fornia Dental Association, 44(1), 16.
How to Perform a “Knee to Knee” Exam: After Parent Interview Laps become the examination area Don’t need to be in a traditional clinical area Child remains comfortable with caregiver close Lay child forward into clinician's lap Caregiver supports hands/feet Quiet, confident, comforting parent without actual interaction ”Calm assertive” Clinician uses lift the lip to observe
Tooth Brushing Requires Parental Supervision Short attention span <7 years old No concept of time Small teeth and mouth Dexterity issues
Fluoride Toothpaste <3 yrs = “Smear” or size of rice grain 3-5 yrs = 1/2 pea size amount 5+ yrs = Pea size amount
Fluoride Supplements
Silver Diamine Fluoride Antimicrobial, desensitizer liquid Off-Label use by US Dentists for caries arrest and prevention Pros: Low cost, no drill Cons: Black stains, Irritates soft tissue, silver allergy
Pediatric Sleep Disordered Breathing Snoring Mouth breathing Daytime sleepiness Bruxism Growth impairment Frequent nightmares Enuresis Behavioral challenges Irregular sleep patterns
Managing Pediatric Sleep Disordered Breathing—Interdisciplinary Approach Dental Professional Screening Refer to Medicine Diagnosis and Management
4 ©2017 Philips Oral Healthcare
www.toothtalk.org
Approved by the American Dental Association Council on Scientific Affairs
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Resources:
Warren, J. J., Bishara, S.E., Steinbock, K. L., Yonezu, T., & Nowak, A. J. (2001). Effects of oral habits' duration on dental characteristics in the primary dentition. The Journal of the Ameri-can dental association, 132(12), 1685-1693. Philips Oral Healthcare www.philipsoralhealthcare.com
Thumbsucking Most common sucking habit Increased incidence of malocclusion Time, intensity and degree of force dictates the character and degree of maloc-
clusion
Clinical Signs of Thumb/Finger Sucking Lateral Open Bite Excessive Overjet Anterior Open Bite Callouses Candida Infection
Abnormal Forces from Oral Habits Passive force of fingers between the teeth, tipping forward
Results may include: Anterior open bite Over erupted canines Narrow maxillary arch w/possible cross bites
Abnormal contraction of cheeks against arches with upward forces on teeth Results may include:
Narrowing of arches (cross-bite) Protruding upper teeth Intrusion of teeth
Pressure from thumb tip or fingers rests on lingual upper anterior teeth where hand rests on chin
Results may include: Retrusion of mandibular teeth Protruding maxillary teeth
Effects of Prolonged Pacifier Use Increased width mandibular arch Increased prevalence of posterior cross-bites Increased prevalence of anterior open-bites
5 ©2017 Philips Oral Healthcare
