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Oral health, pregnancy and the first year

Johnson & Johnson is delighted to bring you this article, with the aim of supporting the ongoing 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 dentalcpd@its.jnj.com

Learning outcomes

A.C,D

Aims and objectives

The aim of this article is to explore the oral health needs of pregnant women and how to raise patient awareness in that regard, as well as looking at the first year following the birth for both mother and child.

On completing this CPD session, the reader will:

• Understand the level of oral health knowledge amongst expectant mothers

• Understand what level of dental treatment may be appropriate for those who are pregnant

• Understand the significance of beginning dental health education during pregnancy to help reduce their baby’s susceptibility to oral diseases and/or conditions

• Understand when it may be best for a baby’s first visit to the dentist and how to get parents on board

• Understand the lifelong implications of neglected deciduous teeth.

 

Oral health, pregnancy and the first year

This article explores the oral health needs of pregnant women and how to raise patient awareness in that regard, as well as looking at the first year following the birth for both mother and child.

In March 2017, a group reported on a cohort study from a London maternity unit as to the oral health of expectant mothers and their plans to provide dental care for their coming child.1

The study’s results indicated that there was a general lack of knowledge about oral health among the participants.1 One in three of the women had not received oral health advice during their pregnancy.1 In addition, most were unaware of the potential cariogenic effect of milk, dried fruits or fruit juice.1 Despite a high awareness that sugar has a detrimental effect on the teeth, only a third of the mothers knew that prolonged breastfeeding can lead to tooth decay.1

 

Expectations during pregnancy

George and colleagues (2016) consider oral health care to be essential during pregnancy, writing, ‘[…] early screening of women for oral health problems, provides an opportunity for women to learn about how to prevent decay for themselves and […] for their future or existing children.’2

They are also at pains to add, however, that concerns may go beyond that of caries, since, ‘Systematic reviews have shown a positive association between adverse pregnancy outcomes such as preterm delivery and periodontal disease although a cause and effect relationship has not been established.’2

More specifically, it has been written that changes may occur in the mouth during pregnancy that have been linked to periodontal disease, citing a connection between, ‘[…] increased plasma levels of pregnancy hormones and a decline in periodontal health status.’3

Studies have yet to produce evidence of a conclusive link between negative pregnancy outcomes and periodontal disease, and Hartnett and colleagues (2016) state that periodontal treatment may be appropriate for pregnant women, given that it, ‘[…] avoids the adverse consequences of periodontitis (e.g., pain, tooth loss) for the mother[…]’.3

This leads on to the question of the suitability of dental treatment during pregnancy, something that Hartnett and colleagues (2016) consider needs to be clarified, writing: ‘Women and their health care providers, including dentists, need more knowledge and clarification about the safety of dental treatments during pregnancy.’3

They go on to state that, ‘[…] there are appropriate guidelines for the treatment of pregnant patients […]’, and that dental appointments need not be delayed due to pregnancy.3

In terms of preventive care, this may include information about oral hygiene, such as twice-daily brushing and daily interdental cleaning.3 Alongside educating pregnant women about the usual reasons for the mechanical cleaning recommendation, they may also be told that, ‘[..] Streptococcus mutans, the bacteria associated with dental caries, can be transmitted to the child, infect the child’s teeth, and increase the risk for early childhood caries.’3

In addition, women who experience ‘morning’ sickness during their pregnancy may be advised to rinse after vomiting with a solution of baking soda (sodium bicarbonate) to help to prevent tooth surface loss.3

For any patients worried about the expense of dental care, it may be important to let them know that mothers are entitled to free dental treatment on the NHS during pregnancy and their baby’s first year.4

 

Baby steps to oral health

You may wonder when a child should first visit the dentist. According to Young (2016), ‘Opinions vary between from birth to when they have teeth to not until they are two-years-old. There is no hard-and-fast rule or even guidance it seems. However, experience has shown that children who regularly visit a dental practice from an early age develop a very positive attitude towards their own dental care and to dentistry in general. Early-age dental visits for a child helps them become accustomed to the sights, sounds and smells of a dental practice, and helps eradicate any fear they may possibly have.’5

Young (2016) also points out that parents may be unconvinced about the need to bring in their toothless new-born, as there is a significant lack of awareness that dentists look at more than the teeth.5 If this is the case, he suggests asking parents to bring their child in when the first tooth begins to erupt, and letting them know that it is also important for the dentist to examine other parts of the oral cavity.5

It may also be prudent to share with parents the significance of deciduous teeth, since there can be a general view that, since they fall out, they are not as important at the permanent dentition. Parents may be told that baby teeth:

• Help the child chew their food effectively

• Facilitate clear speech

• Create a pleasing smile.5

It may also be worthwhile pointing out that early loss of the deciduous teeth as a result of early childhood caries (ECC) – described as dental caries affecting children 71 months of age or younger6 – can result in crowding problems, which may require expensive and extensive remedial treatment later in life.5

Children suffering with ECC may also experience pain, sleep poorly, have altered eating habits, have low body weight and height for their age, and poor self-esteem.6 In addition, ECC have been shown to be a strong indicator for caries prevalence later in life.6

Whilst on the subject of ECC, breast milk has the potential to be cariogenic.1 Given the benefits of breast feeding, the practice should not be discouraged, however the dental team should aim to get parents motivated to perform adequate oral health care as soon as the first tooth erupts, as well as raising their awareness that prolonged feeds at night may contribute to ECC development.1

For children aged 0-3 years, ‘Delivering better oral health: an evidence-based toolkit for prevention’7 offers the following advice:

1. Breast feeding provides the best nutrition for babies

2. From six months of age infants should be introduced to drinking from a free-flow cup, and from age one year feeding from a bottle should be discouraged

3. Sugar should not be added to weaning foods or drinks

4. Parents/carers should brush or supervise toothbrushing

5. As soon as teeth erupt in the mouth brush them twice daily with a fluoridated toothpaste

6. Brush last thing at night and on one other occasion

7. Use fluoridated toothpaste containing no less than 1,000ppm fluoride

8. It is good practice to use only a smear of toothpaste

9. The frequency and amount of sugary food and drinks should be reduced

10. Sugar-free medicines should be recommended.

 

Preparing for a healthy future

Looking to the future, Hartnett (2016) wrote: ‘There is sufficient evidence that the lack of oral health care during pregnancy can have negative outcomes for both mothers and their newborns. To improve the oral-systemic health outcomes for mothers and their newborns, it is essential to increase the current and future interprofessional oral health workforce capacity.’3

She continued: ‘Meeting the oral health needs of pregnant women and their newborns will be accomplished only through collaboration among all health care professional educators and providers to promote the incorporation of oral health needs as a gold standard for educational programs and clinical practice.’3

It would seem, therefore, that appropriate dental health care and education to raise awareness of the needs of mother and child are essential during pregnancy, to meet the oral well-being needs of both.3

QUESTIONS: 

References

  1. Correia PN. What do expectant mothers need to know about oral health? A cohort study from a London maternity unit. BDJOpen 2017; 3: 17004; published online; doi:10.1038/bdjopen.2017.4. Accessed 18 September 2017

  2. George A et al. Measuring oral health during pregnancy: sensitivity and specificity of a maternal oral screening (MOS) tool. BMC Pregnancy and Childbirth 2016; 16: 347-352

  3. Hartnett E et al. Oral health in pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing 2016; 45: 565-573

  4. Good practice points for health visitors. Oral health for babies and children. Institute of Health Visiting 2015. ihv.org.uk/wp-content/uploads/2015/11/GPP_Dental-hygene_V3-WEB.pdf. Accessed 18 September 207

  5. Young MR. Welcoming children into your practice. BDJ Team 2016; published online: https://www.nature.com/articles/bdjteam2016119. Accessed 18 September 2017

  6. Leong PM et al. A systematic review of risk factors during first year of life for early childhood caries. International Journal of Paediatric Dentistry 2013; 23: 235–250

  7. Delivering better oral health: an evidence-based toolkit for prevention. Public Health England 2017