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Dental care for mother and baby

Dental care for mother and baby

Johnson & Johnson Ltd. is delighted to bring you this article, with the aim of supporting the ongoing Enhanced CPD needs of dental healthcare professionals in improving and maintaining the oral health of their patients.

This article is equivalent to one hour of Enhanced CPD.

To provide feedback on this article, please contact [email protected]

Learning Outcomes: A | C | D

Aims & Objectives

The aim of this article is to offer an evidence-based overview of the possible oral health needs of a pregnant woman and provide support on how to guide them through those first few months of motherhood in terms of their child’s oral health needs.

On completing this Enhanced CPD session, the reader will:

  1. Understand the relationship between oral health and pregnancy
  2. Understand that elevated hormone levels in pregnancy can ultimately promote gingival inflammation
  3. Understand the prevalence of morning sickness and preventive care to safeguard the dentition from acid attacks
  4. Understand what constitutes early childhood caries and how this destructive condition may be prevented
  5. Understand how the weaning process can set the scene for a baby’s future oral health status.

This article offers an evidence-based overview of the possible oral health needs of a pregnant woman and provides support on how to guide them through those first few months of motherhood in terms of their child’s oral health needs.

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Describing the relationship between oral health and pregnancy, guidelines published by the European Federation of Periodontology (EFP) and the British Society of Periodontology (BSP) state: ‘The main hormonal changes in a woman’s life take place during pregnancy – and the mouth is one of the main areas affected by such changes. Elevated hormone levels (oestrogen and progesterone) significantly increase vascular permeability in the gingival tissues and, in the presence of dental plaque, promote gingival inflammation. In the cases of women who already have periodontitis, the clinical situation will worsen.’1

Issues that may result from these changes include:1, 2

  1. Possible risk factor for gestational diabetes
  2. Possible risk factor for adverse pregnancy outcomes (for example, low birth weight, pre-term birth, pre-eclampsia, stillbirth)
  3. Halitosis
  4. Aesthetic issues
  5. Problems chewing
  6. Tooth loss.

 

To help overcome such difficulties, ‘Specific plaque removal regimens, together with professional interventions, have been shown to be safe when implemented during pregnancy and efficient both in reducing gingival inflammation and in enabling periodontal health to be maintained during pregnancy.’1

Another issue is that of morning sickness, which is experienced by 66% of pregnant women. The increase in acid on the oral cavity resulting from frequent vomiting may lead to demineralisation.3

Offering oral health support in this regard, the toolkit, ‘A little trip to the dentist’ (2019), states, ‘If you’re pregnant and suffering from morning sickness, make sure you rinse your mouth out with plain water after each episode. This helps protect your teeth from the acid in your stomach.’4

In terms of general preventive care, the Dental Health Foundation states, ‘A good oral health routine should involve brushing last thing at night and at least one other time during the day with a fluoride toothpaste, daily interdental cleaning and regular visits to the dentist....’5

As for diet, simply cutting down on sugar consumption and its frequency may be advisable, as well as switching to snacking on fresh fruit and vegetables.5

Certainly, evidence suggests that, ‘To preserve oral health during pregnancy, a healthy diet and proper oral hygiene are essential.’6

It should also be noted, as written by Kurien et al (2013), that, ‘…it is important to remember that treatment is being rendered to two patients: mother and [foetus].’7

Baby steps

Once a baby is born, oral health is immediately important, although parents may not realise this to be the case. Few consider that dentists do more than look at teeth and can examine a baby’s mouth to check all is developing normally. As an aside, an early visit to the dentist also gives a child the chance to get used to the sights, sounds and smells of the practice.8

In terms of oral health in children, according to the Global Burden of Disease from 1990-2017, there were 532 million cases of untreated caries in deciduous teeth. Although more economically developed countries fared better than those less economically developed, there is nonetheless an unmet need closer to home.9,10

For example, despite oral health improving in England, a 2017 oral health survey indicated that just under a quarter of five-year-olds have tooth decay.10

The European Association of Paediatric Dentistry defines early childhood caries (ECC) as, ‘the occurrence of any sign of dental caries on any tooth surface during the first 3 years of life’ and as ‘the presence of one or more decayed, missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.’11

Associating ECC with a mother’s education level and socioeconomic status, Correia and colleagues (2017) wrote, ‘Understandably, infants’ oral health is highly dependent on their mothers’ motivation and ability to undertake the tasks required for oral care.’11

They continued, ‘Equally determinant is the mother’s dietary habits and food choices when catering for their children.’11

With this in mind, maternal knowledge is important,11 not just for their child’s oral health but also their overall wellbeing and that of the family as a whole. After all, children who have problems with their teeth may be in pain, have an infection, and problems in terms of eating, sleeping and socialising.12

In addition, as stated by Public Health England, ‘Children who have high levels of disease in primary teeth have an increased risk of disease in their permanent teeth. If treated, these teeth will require long term maintenance throughout life.’12

Since tooth decay is, ‘…a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues’,13 the causes of such acid attacks need to be addressed, including the consumption of ‘free’ sugars.12

In this regard, for babies, Public Health England (PHE) recommends:12

  1. Breast milk is the only food or drink babies need for around the first 6 months of their life.
  2. First formula milk is the only suitable alternative to breast milk
  3. Bottle-fed babies should be introduced to drinking from a free-flow cup from the age of 6 months and bottle feeding should be discouraged from 12 months old
  4. Only breast or formula milk or cooled, boiled water should be given in bottles
  5. Only milk or water should be drunk between meals and adding sugar to foods or drinks should be avoided.

 

Offering further explanation for this, Naidoo and Myburgh (2007) wrote: ‘… contributing factors that predispose children to ECC include prolonged and night-time bottle feeding of milk and/or sweetened juice in infants and toddlers, nocturnal breastfeeding after 12 months of age, linear hypoplasia of primary teeth associated with malnutrition and the prolonged use of a pacifier covered with honey, sugar or other sweetened foods.’14

Naidoo and Myburgh (2007) further suggest that weaning from the bottle should be encouraged by 12 to 14 months of age.14

The toolkit, ‘A little trip to the dentist’ (2019), offers the following advice for parents: ‘When weaning your baby, it can be tempting to sweeten the deal by adding sugar or honey. Babies don’t need sugar so giving it to them increases their risk of tooth decay.’15

It is further stated: ‘Where a baby might be struggling with sour or more plain flavours, parents can try mixing in sweeter fruits such as bananas to help make it more palatable.’15

Additional guidance includes, ‘If a baby sucks drinks from a bottle teat or spout, it means the drink spends more time in contact with their teeth which can lead to dental problems. Introduce free-flow cups [from six months] as soon as possible to reduce the risk of tooth decay.’15

In addition to dietary advice, parents need to understand that cleaning their child’s teeth needs to be integrated into to a daily hygiene routine. Information to impart includes:16

  1. When the first teeth start to appear, use a toothbrush designed for children with a small smear of fluoride toothpaste of at least 1000ppm (parts per million)
  2. If possible, make brushing a routine, preferably just before your child goes to bed and at least one other time during the day
  3. Remember to brush gently behind the teeth and onto the gums
  4. You may find it easier to stand or sit behind your child, cradling their chin in your hand so you can reach their top and bottom teeth more easily.

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Starting out

Offering a succinct overview of the situation facing dental professionals, Thakur and colleagues (2020) wrote: ‘…during pregnancy many complex physiologic changes occur in the women’s body, which can adversely affect oral health and in turn those oral health problems may lead to pregnancy outcomes like preterm birth or low birth weight.’3

They continued: ‘Proper oral care is of utmost importance during pregnancy to avoid these complications. Avoiding foods that may cause oral problems, proper brushing and flossing and having dental consultations on a regular basis are steps to ensure good oral health during pregnancy.’3

As for those first few months of a child’s life, the toolkit, ‘A little trip to the dentist’ (2019), suggests, ‘At the beginning, how much a baby eats is less important than getting them used to the idea of eating. Giving them a variety of foods alongside breast or formula milk, which provides most of the nutrients they’ll need, will help set them up for a lifetime of healthier eating, which will mean better general health and a reduced risk of tooth decay.’15

Questions: 

References

  1. The relationship between oral health and pregnancy. Guidelines for oral-health professionals. European Federation of Periodontology and British Society of Periodontology 2020; https://www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/Oral_Healt.... Accessed 21 January 2021

  2. Women’s oral health during pregnancy. European Federation of Periodontology, 2020. https://www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/Oral_Healt.... Accessed 21 January 2021

  3. Thakur V et al. Pregnancy and oral health and dental management in pregnant patient. Journal of Current Medical Research and Opinion 2020; 3(11): 724-731

  4. A little trip to the dentist. Toolkit 2. NHS England, NHS Improvement – Midlands and Public Health England 2019. https://www.england.nhs.uk/midlands/2019/06/20/campaign-a-little-trip-to.... Accessed 20 January 2021

  5. Oral health and pregnancy: six things every mum needs to know. Dental Health Foundation 2018. https://www.dentalhealth.org/News/oral-health-and-pregnancy-six-things-e.... Accessed 21 January 2021

  6. Rocha JS et al. Determinants of dental care attendance during pregnancy: a systematic review. Caries Res 2018; 52: 139-152

  7. Kurien S et al. Management of pregnant patient in dentistry. J Int Oral Health 2013; 5(1): 88-97

  8. Young MR. Welcoming children into your practice. BDJ Team 2016. 3: 16119. https://www.nature.com/articles/bdjteam2016119. Accessed 21 January 2021

  9. Bernabe E et al. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the Global Burden of Disease 2017 Study. Journal of Dental Research 2020; 99(4): 362-373

  10. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2017. A report on the inequalities found in prevalence and severity of dental decay. PHE 2018

  11. Correia PN et al. What do expectant mothers need to know about oral health? A cohort study from a London maternity unit. BDJ Open 2017; 3: 17004; doi:10.1038/bdjopen.2017.4

  12. Health matters: child dental health. Public Health England, 2017. https://www.gov.uk/government/publications/health-matters-child-dental-h.... Accessed 21 January 2021

  13. Pitts NB et al. Dental caries. Nature Reviews Disease Primers 2017; 3(17030): 1-16

  14. Naidoo S, Myburgh N. Nutrition, oral health and the young child. Maternal and Child Nutrition 2007; 3: 312–321

  15. A little trip to the dentist. Toolkit 4. NHS England, NHS Improvement – Midlands and Public Health England 2019. https://www.england.nhs.uk/midlands/2019/06/20/campaign-a-little-trip-to.... Accessed 20 January 2021

  16. https://www.dentalhealth.org/childrens-teeth. Accessed 21 January 2021