Teeth for Two: Oral Health During Pregnancy

This week, the OHNEP team will be traveling to National Harbor, Maryland to take part in the American College of Nurse Midwives (ACNM) 60th Annual Meeting and Exhibition, an exciting meeting that brings together midwives and other women’s healthcare providers in an open forum to discover and discuss new ways to enhance the quality of care for women. In advance of our ACNM workshop, dedicated to the same topic, we would like to devote this blog post to raising awareness for the importance of oral health during pregnancy, a significant topic that often goes ignored in women’s healthcare!

Oral health is KEY to overall health and the well-being of pregnant women and their babies; however, it is also a time that is particularly vulnerable to poor oral health outcomes. It has long been known that hormonal changes commonly lead to gingivitis (Löe, 1965) that if left untreated, may progress to periodontitis, which in turn may be associated with tooth loss (Russell, 2008), poor glucose control (Xiong, 1999) and preterm birth (Walia, 2015). Mothers with high rates of caries are also more likely to have children with high caries rates (Boggess, 2006) that may lead to pain and impact nutrition, speech development and permanent teeth eruption patterns.

Despite the overwhelming research evidence that emphasizes the importance of maintaining proper oral hygiene, access to dental care during pregnancy remains limited. Many women forego oral care due to myths about the dangers of receiving dental care during pregnancy (Ressler-Maerlender et al., 2005), dentists’ fear of liabilities (National Maternal and Child Oral Health Policy Center, 2011) , and because of access barriers, including the lack of dental insurance, transportation and inability to take time off work (ACOG 2013). These myths and fears result in some staggering findings:

  • 40% of pregnant women have some form of periodontal disease (Lieff et al., 2004)
  • 25% pregnant women have dental caries (Silk et al., 2008)
  • 75% incidence of gingivitis in pregnant women (Russell & Mayberry, 2008)
  • Only 22-34% of pregnant women visit the dentist (Silk et al., 2008)
  • Only 50% of pregnant women with dental problem visit a dentist (Gaffield et al., 2001)
  • Even among women with dental insurance, dental care declines during pregnancy

These shocking numbers underscore the huge need to educate pregnant women and their healthcare providers about the interrelation between oral and overall health so that both moms and their newborns avoid needless suffering from oral disease.

Oral health equity may be achieved during pregnancy by positioning all women’s health providers (MDs, NPs, NMs, PAs RNs) as the frontline providers of oral health care to pregnant women and their newborns. The multiple encounters throughout pregnancy provide numerous opportunities to include oral-systemic health in ante- and post-partum care, parent education and anticipatory guidance, thus preventing a number of oral health conditions that may have severe consequences for both mother and child. Because women’s health providers are equipped with a broad knowledge of health problems, they can educate patients on the interrelationship between oral and overall health, simultaneously closing the existing gaps in oral healthcare and promoting the general health of the community.

To learn more about how pregnancy can impact oral and general health, we encourage you to read the Oral Health Care during Pregnancy Consensus Statement, the result of extensive data review from an expert workgroup convened by the Health Resources and Services Administration (HRSA) in collaboration with American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA) in 2011.

You can also view our NYU panel of oral health champions as they speak about oral health during pregnancy and early childhood during the NYU Master’s Preceptor Recognition Breakfast and Development Day.

Oral Systemic Health in Midwifery Practice  by Julia Lange Kessler, DNP, CM, RN

Early Childhood Oral Health by Amr Moursi,DDS, PhD

Lift the Lip by Jill Fernandez, RDH, MPH

References

American College of Obstetricians and Gynecologists. (2013). Oral health care during pregnancy and through the lifespan. Obstet Gynecol122, 417-422.

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 journal10(1), 169-174.

Gaffield ML, Gilbert BJ, Malvitz DM, Romaguera R. (2001). Oral health during pregnancy: an analysis of information collected by the pregnancy risk assessment monitoring system. J Am Dent Assoc. 132(7):1009-1016

Lieff S, Boggess KA, Murtha AP, Jared H, Madianos PN, Moss K, et al. (2004).The oral conditions and pregnancy study: periodontal status of a cohort of pregnant women. J Periodontol.75:116–26.

Löe, H. (1965). PERIODONTAL CHANGES IN PREGNANCY. The Journal of periodontology36, 209.

National Maternal and Child Oral Health Policy Center. (2012). Improving the Oral Health of Pregnant Women and Young Children: Opportunity for Policymakers. Issue Brief.

Ressler-Maerlender, J., Krishna, R., & Robison, V. (2005). Oral health during pregnancy: current research. Journal of women’s health14(10), 880-882.

Russell, S. L., Ickovics, J. R., & Yaffee, R. A. (2008). Exploring potential pathways between parity and tooth loss among American women. American journal of public health98(7), 1263.

Russell SL & Mayberry LJ. (2008). Pregnancy and oral health: a review and recommendations to reduce gaps in practice and research. American Journal of Maternal Child Nursing 33, 32–37.

Silk, H., Douglass, A. B., Douglass, J. M., Silk, L. (2008). “Oral Health During Pregnancy.” American Family Physician.77:8.

Xiong, X., Elkind-Hirsch, K. E., Vastardis, S., Delarosa, R. L., Pridjian, G., & Buekens, P. (2009). Periodontal disease is associated with gestational diabetes mellitus: a case-control study. Journal of periodontology80(11), 1742-1749.
Walia, M., & Saini, N. (2015). Relationship between periodontal diseases and preterm birth: Recent epidemiological and biological data. International Journal of Applied and Basic Medical Research5(1), 2.

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