*Elżbieta Pels1, Angelika Kobylińska2, Magdalena Kukurba-Setkowicz3, Anna Szulik4, Renata Chałas5
Dental prophylaxis and treatment in pregnant women. Opinion of the working group of the Polish Alliance for a Cavity-Free Future on dental prophylaxis in pregnant women
Profilaktyka stomatologiczna i postępowanie lecznicze u kobiet w ciąży. Stanowisko grupy roboczej ds. profilaktyki stomatologicznej u kobiet w ciąży Polskiego Oddziału Sojuszu dla Przyszłości Wolnej od Próchnicy
1Chair of Developmental Age Stomatology, Department of Developmental Age Stomatology, Medical University of Lublin
Head of Department: Professor Maria Mielnik-Błaszczak, MD, PhD
2Department of Paediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
3NZOZ Dentist, Kraków
4Dental Practice “Uśmiech” in Zabrze
5Chair and Department of Conservative Dentistry with Endodontics, Medical University of Lublin
Head of Department: Barbara Tymczyna-Borowicz, MD, PhD
Streszczenie
Wstęp. Ciąża jest szczególnym okresem w życiu kobiety, w którym powinna dbać o zdrowie swoje i przyszłego potomka. Pod pojęciem „opieka prenatalna” kryje się kompleksowa i wielospecjalistyczna opieka zdrowotna nad kobietą ciężarną, rozwijającym się płodem, a następnie noworodkiem. Profilaktyka próchnicy w okresie ciąży ma za zadanie nie tylko chronić przyszłą matkę przed powstaniem ubytków próchnicowych, ale również jest profilaktyką próchnicy zębów u nienarodzonego jeszcze dziecka.
Cel pracy. Przedstawienie zaleceń na temat stomatologicznego postępowania profilaktyczno-leczniczego u kobiet w ciąży w odniesieniu do chorób jamy ustnej występujących u matki i dziecka.
Materiał i metody. Elektroniczne wyszukanie piśmiennictwa w medycznych bazach danych (Pubmed, EMBASE, MEDLINE) oraz ręczne cytowanego piśmiennictwa dotyczącego profilaktyki pierwotnie pierwotnej choroby próchnicowej i opieki stomatologicznej w czasie ciąży.
Wyniki. Dostępne piśmiennictwo wskazuje na bezpieczeństwo prowadzenia działań profilaktyczno-leczniczych w czasie ciąży, w tym stosowania środków znieczulenia miejscowego i stomatologicznej diagnostyki radiologicznej. Leczenie stomatologiczne wymaga modyfikacji uwzględniających zmiany zachodzące w ciąży, jednak może być prowadzone z korzyścią dla zdrowia matki i dziecka.
Wnioski. Opieka stomatologiczna nad kobietą ciężarną powinna obejmować przede wszystkim edukację, działania profilaktyczne oraz lecznicze, jeśli zajdzie taka konieczność. Przyszłym matkom należy uświadomić, że już w okresie płodowym można i trzeba dbać o zdrowie jamy ustnej dziecka.
Summary
Introduction. Pregnancy is a special period in the life of a woman, when she cares not only for her own health, but also for that of her unborn child. Prenatal care is defined as comprehensive and multidisciplinary care provided to a pregnant woman, developing foetus, and then a newborn. The aim of caries prevention in pregnancy is not only to protect the future mother from caries, but also to prevent the disease in the child.
Aim. The aim of the paper was to present the recommendations on preventive and therapeutic dental management in pregnant women with regard to oral diseases in the mother and her child.
Material and methods. Electronic search for literature in medical databases (Pubmed, EMBASE, MEDLINE) and manual search for literature on primary-primary prevention of dental caries and dental care in pregnancy.
Results. The available literature indicates the safety of preventive and therapeutic activities during pregnancy, including the use of local anaesthesia and dental diagnostic radiology. Although dental treatment requires some modifications due to pregnancy-related changes, it may be safely used for the benefit of the mother’s and the child’s health.
Conclusions. Dental care in pregnancy should be primarily dedicated to education, prevention and treatment, if needed. Future mothers should be made aware that the child’s oral health can and should be taken care of already in the prenatal period.
Introduction
Many studies on oral colonisation by cariogenic bacteria in children have demonstrated that the child’s parents, mothers in particular, are the source of these pathogens. It was found that maternal caries increases the risk of early-childhood caries (1-3).
Early colonisation of poorly mineralised deciduous teeth by Streptococcus mutans increases the risk of dental caries (2).
Based on these observations, “primary-primary prevention of dental caries” also known as “pre-prevention of dental caries” was developed to define procedures and instructions for pregnant women aimed at limiting the future severity of caries intensity in the unborn child. The risk of infection in the child may be estimated by assessing maternal oral health and hygiene, especially the severity of dental caries, including the number of active carious lesions (primary and secondary caries), as well as by collecting detailed history of dietary and hygiene habits. Salivary tests to measure maternal titres of cariogenic bacteria and dental plaque staining may be also helpful (1).
Women undergo many changes during pregnancy, mainly hormonal, immune and dietary changes as well as they experience gastrointestinal disorders. All these increase the risk of oral diseases and have an impact on the mode of dental treatment (4-10). Comprehensive dental treatment before pregnancy is most beneficial for the future mother and her child. Dental care of women at childbearing age should therefore include preparation for changes that occur in the oral cavity during pregnancy by educational, preventive and therapeutic activities as well as by providing information essential for the oral health care of newborns. Dentists or dental hygienists should be responsible for providing information on the prevention against dental caries and periodontal diseases, while the implementation of these guidelines and their incorporation in everyday life will depend on the level of understanding of the problem and the conscientiousness of the patients (11-13). Factors that have an impact on the global dental attendance include regular use of dental care before pregnancy, the level of knowledge on oral health and its impact on both pregnancy and child, as well as the conviction about the safety of dental treatment in pregnancy (14-18).
Aim
The aim of the paper was to present guidelines on dental preventive and therapeutic management in pregnant women with regard to oral diseases in the mother and her child.
Material and methods
A review of literature and the recommendations of the World Health Organisation and teams of experts on dental care in pregnancy was performed. Medical databases such as Pubmed, EMBASE, MEDLINE were searched using the following keywords: “primary-primary prevention”, “dental care in pregnan”, “oral health in pregnan”, “dental treatment in pregnan”. The following filters were used: English and Polish language, original papers, review papers, recommendations, and guidelines. Based on literature analysis, recommendations for pregnant women on dental prevention and treatment were developed.
The literature review was performed by the working group of the Polish Alliance for a Cavity-Free Future on dental prophylaxis in pregnant women.
Results
Dental care in pregnancy focuses on three main aspects: preventive measures, therapeutic measures, health promotion.
Collaboration between the gynaecologist and dentist should be the leading principle of health care for pregnant women as health protection in pregnancy requires continuous dental care combined with periodic prenatal check-ups. A questionnaire conducted among 3,439 Polish women up to 5 years after childbirth has demonstrated the important role of the attending obstetrician in increasing the proportion of pregnant women using dental care; a referral from the doctor increased the probability of visiting a dentist (OR = 5.20 (4.05-6.67); p < 0.001). Even higher effectiveness was shown when a written feedback on oral health was required from the dentist (OR = 2.19 (1.3-3.66); p = 0.003) (17, 18). Health education of women, which may help change inappropriate behaviours that promote caries, periodontal and oral mucosa diseases both in women and their future offspring, is equally important. Pregnant women should be informed on this fact as soon as possible to reach an adequate level of awareness and motivation to improve oral hygiene (16, 19, 20).
If inflammatory lesions are found in the oral cavity, these should be eliminated before or during pregnancy.
The following dental aspects should be considered when planning pregnancy:
– elimination of infection foci – the teeth without vital pulp should either be subject to appropriate endodontic treatment or removed,
– elimination of active carious lesions (through the use of fluoride-releasing materials, such as glass-ionomer cements, as long-term temporary fillings for high activity),
– elimination of gingival and oral mucosa inflammatory lesions,
– professional removal of dental deposits,
– fluoride prophylaxis,
– implementation of appropriate eating and hygiene habits.
Preventive actions
Dental prophylaxis in pregnant women involves preventing dental caries, acid erosion of enamel and periodontal diseases (4, 6, 13, 21-23).
Preventive measures in pregnancy are aimed at reducing the levels of cariogenic bacteria and delaying colonisation of the child’s oral cavity with cariopathogens by:
– oral rinsing with 0.12% chlorhexidine solution for 2 weeks, 10-15 mL, twice daily for 30 seconds,
– local application of fluoride compounds (the use of 1450 ppm fluoride toothpaste twice daily, daily use of an oral rinse containing 225 ppm F (0.05% NaF)) – endogenous fluoridation is not recommended (23),
– the use of soft tooth brushes and mild cleaning agents,
– cleaning the surface of the tongue (the deposit on the tongue contains microbes and exfoliated epithelial cells, which are a reservoir for dental plaque),
– the use of xylitol chewing gum 2-3 times daily after meals (5 minutes) (24),
– promoting healthy behaviours, such as avoiding behaviours increasing the risk of transmission of cariogenic bacteria to the child’s oral cavity,
– professional procedures: removal of dental deposits, application of chlorhexidine-containing varnish or fluoride-containing compounds (foams, varnishes, gels),
– implementation of appropriate eating and hygiene habits,
– the use of alkaline oral rinses and enamel remineralisation agents to reduce the risk of acidic enamel erosion.
Dental treatment in pregnancy
At least two dental visits should take place during pregnancy followed by regular visits every 6 months after delivery in the absence of therapeutic needs. The first visit should be planned at 3-4 months of pregnancy, the second one at 8 months of pregnancy. Considering the risk of toxicity of certain medications during organogenesis and the physical state of the pregnant woman (somnolence, nausea, vomiting) in the first trimester (until 12-13 weeks), an assessment of oral health and the risk of caries along with the estimation of patient’s therapeutic needs is recommended. It is also the right time for education about changes occurring in the woman’s body, appropriate hygiene and controlling dental plaque, as well as prevention of periodontal diseases and local application of fluoride compounds.
The second trimester of pregnancy (14-27 weeks) is an optimal period for dental procedures (if needed).
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