Helping Patients Maintain Dental Visits During Pregnancy
There are many myths regarding dental treatment of a pregnant patient, and still today some physicians might believe it is unsafe to treat a woman during pregnancy. According to a report from the American College of Obstetricians and Gynecologists, from 2007-2009, 35% of women reported that they had not visited a dentist in the past year, and 56% of mothers reported they did not visit a dentist while pregnant. A major factor contributing to these high percentages was the mixed messages to not just the consumer, but the dental and medical professions as well, regarding treatment.
In response to this confusion, the National Maternal and Child Oral Health Resource Center (NMCOHRC) released a national consensus statement in 2012 with guidelines on how to improve the standard of care for pregnant patients. Barbara J. Steinberg, DDS, Clinical Professor of Surgery at Drexel University College of Medicine and Adjunct Associate Professor of Oral Medicine at University of Pennsylvania School of Dental Medicine, has been an advocate for women’s health throughout her career, and she emphasizes the importance of these guidelines. “This is probably the greatest thing that has come about to try to encourage women who are contemplating pregnancy or who are pregnant to receive the appropriate dental care. Now, the dentist can talk to the medical professional and they will be on the same page,” Steinberg says.
The guidelines provide a range of information for health professionals, such as assessing a pregnant woman’s oral health status, advising a patient about oral healthcare, working in collaboration with oral health professionals, and (specifically for oral healthcare professionals) providing oral disease management and treatment to pregnant women. “Based on these guidelines, women can be reassured that oral healthcare—including the use of radiographs, pain medication, and local anesthesia—is safe throughout pregnancy. Further, the guidelines stress that women should continue to seek oral care with an emphasis on good hygiene and, of course, eating healthy foods,” Steinberg asserts.
Emphasizing the importance of oral health in the pregnant patient is vital in helping to prevent gingivitis, which may occur in pregnancy. “Many pregnant women will experience some degree of gingivitis at some point during their pregnancy. They should keep up with their routine dental visits and know that cleanings may be needed on a more frequent basis during pregnancy. They also need to be meticulous with their oral hygiene practices. Good oral hygiene habits will help to prevent gingivitis or decrease the severity of it should it occur in pregnancy,” Steinberg says. It is crucial for both medical and dental professionals to be cognizant of this and educate their patients, stressing that dental care, whether routine or emergency, is safe during pregnancy.
While communication between the dental and medical professional is important, dental practitioners should know when a consultation is necessary prior to treating a pregnant patient. “We don’t want members of the dental team to think that every time a pregnant patient comes into the office, that a medical consultation is warranted. We only need to consult with our prenatal care health professional as necessary. If the pregnant patient has a comorbid condition that may affect management of the oral problem, such as diabetes, hypertension, cardiovascular or pulmonary disease, or bleeding disorder, a consultation would be necessary. A consultation is also needed before using nitrous oxide, intravenous sedation, or general anesthesia when treating a pregnant patient,” Steinberg says.
Pregnant patients should also be informed that if they experience vomiting during pregnancy, they need to practice good oral hygiene immediately after the vomiting episode by rinsing their mouth with a teaspoon of baking soda in a cup of water. This will help to prevent the acid from attacking the enamel, Steinberg advises. “For some women, sickness lasts all day long—throughout the whole pregnancy. So we need to really educate our patients in taking these extra steps to practice good oral hygiene.”
The NMCOHRC emphasizes how critical it is to provide this education for the sake of both the mother and her children, as infants and young children can acquire caries-causing bacteria from their mothers. With proper counseling, women can develop good oral health behaviors that can reduce this transmission of bacteria, resulting in the delay or prevention of dental caries in their children. Steinberg concludes, “What must be conveyed to all healthcare professionals is that pregnant women need to receive treatment. It is safe, and they should not shy away from going to the dentist because they are pregnant.”
The NMCOHRC Consensus Statement can be found at the following link: https://www.mchoralhealth.org/PDFs/OralHealthPregnancyConsensus.pdf