Dentistry and the Pregnant Patient

Daniel Ninan

• Publisher: Quintessence Publishing Co, Inc
• Year: 2019
• ISBN:
  9780867159134
• Topic: Medicine
• Subtopic: Dentistry

To err on the side of caution, some dentists may hesitate to perform necessary procedures on pregnant patients. However, good oral health is essential to a healthy pregnancy and can help reduce prenatal complications, including preterm delivery and fetal loss. This book serves as an easy-to-use guide to help dentists of all specialties provide safe, effective care for their patients during pregnancy. The book is broken down into chapters on general treatment guidelines, pregnancy-related conditions in each organ system that may impact care, and the safety of the use of common dental drugs, including anesthetics, during pregnancy. With over 50 quick-reference charts and tables and a breakdown of treatment recommendations by trimester, this book is a must-have for any dental office.

CHAPTER 1

Perceptions
About Dental
Treatment During
Pregnancy

Key Points

• Prenatal care providers often do not discuss oral health with their patients or provide dental referrals.¹

• Dentists do not always provide treatment during pregnancy because of poor perceptions of treatment safety.²

• Pregnant women often do not seek dental care because they believe it is unsafe.^3,4

Most women do not see a dentist during their pregnancy, but the consequence of not treating oral pathologies can be devastating.^1,5 Perceptions of the safety of dental treatment during pregnancy by patients, dental providers, and prenatal providers may all contribute to the lack of oral health care during pregnancy.^1,6

Prenatal Care Provider Perceptions

In 1992, it was reported that 91% of obstetricians did not want to be consulted before dental treatment unless the treatment might induce a bacteremia.⁷ If they believed a bacteremia might occur, 79% of the obstetricians wanted to be consulted prior to treatment.⁷ The conflict, which suggests insufficient understanding of dental treatment, is that most routine dental procedures have been well documented to induce a transient bacteremia. Examples of procedures that induce bacteremia include tooth extraction, gingivectomy, supra- and subgingival scaling, ultrasonic scaling, and subgingival irrigation.⁸

In a 2012 study, it was reported that obstetricians were well informed on the relationship between periodontal disease and pregnancy outcomes.¹ However, at the same time, many prenatal general practitioners and midwives may not understand the link between oral health and overall health.¹ The authors of the study also found that most of the time, prenatal care providers did not discuss oral health with their patients and that dental referrals were often only made when the patient self-identified an oral health problem.¹ Other researchers reported that only 26% of women were advised by their prenatal care provider to see a dentist.² While there has been an improvement in awareness of how oral health may affect pregnancy, there is still a significant lack of dental referrals.

Dental Provider Perceptions

Many dentists are reluctant, or simply refuse, to see pregnant patients.¹ In 2004, in response to the increasing evidence that periodontal disease may contribute to preterm birth and low–birth weight babies, the American Academy of Periodontology began recommending that all women who were pregnant or planning to become pregnant should undergo a periodontal examination.⁹ In 2006, the New York State Department of Health published guidelines for oral health care during pregnancy.¹⁰ Despite this, researchers in 2008 found that 90% of dentists did not provide all necessary treatment to pregnant patients.² Reasons dentists reported for withholding or delaying treatment included fear of injuring the woman or fetus and fear of litigation.²

In 2010, the California Dental Association published evidence-based guidelines for oral health care during pregnancy¹¹ (see Appendix E). There is still room for the dental profession to improve the delivery of oral health care to pregnant patients.

Patient Perceptions

In the United States, only 25% to 50% of women will receive any dental care while pregnant, including prophylaxis.¹¹ This is true even though 50% of pregnant women have dental problems.¹² Pregnant women do not seek dental care during pregnancy for a number of reasons, including the following¹³:

• They do not realize they have an oral disease.⁴

• They believe poor oral health is normal during pregnancy.^3,4

• They believe dental treatment may harm the fetus.^3,4

• They are not informed that they should seek care.⁴

Pregnancy may be the only time women in the lower socioeconomic strata are eligible for dental benefits.³ At the same time, however, these women are less likely to utilize services to receive dental care. For example, only 20% of the pregnant women enrolled in California’s Medi-Cal Program in 2007 had a dental visit during their pregnancy.¹⁴

Conclusion

As these facts suggest, the main barrier to proper dental care during pregnancy is the poor perception of patients, prenatal providers, and dental providers, all of whom contribute to the lack of proper oral health care during pregnancy.

References

1. George A, Shamim S, Johnson M, et al. How do dental and prenatal care practitioners perceive dental care during pregnancy? Current evidence and implications. Birth 2012;39:238–247.

2. Michalowicz BS, DiAngelis AJ, Novak MJ, et al. Examining the safety of dental treatment in pregnant women. J Am Dent Assoc 2008;139:685–695.

3. Stevens J, Iida H, Ingersoll G. Implementing an oral health program in a group prenatal practice. J Obstet Gynecol Neonatal Nurs 2007;36:581–591.

4. Dasanayake AP, Gennaro S, Hendricks-Muñoz KD, Chhun N. Maternal periodontal disease, pregnancy, and neonatal outcomes. MCN Am J Matern Child Nurs 2008;33:45–49.

5. Wong D, Cheng A, Kunchur R, Lam S, Sambrook PJ, Goss AN. Management of severe odontogenic infections in pregnancy. Aust Dent J 2012;57:498–503.

6. Strafford KE, Shellhaas C, Hade EM. Provider and patient perceptions about dental care during pregnancy. J Matern Fetal Neonatal Med 2008;21:63–71.

7. Shrout MK, Comer RW, Powell BJ, McCoy BP. Treating the pregnant dental patient: Four basic rules addressed. J Am Dent Assoc 1992;123:75–80.

8. Achtari MD, Georgakopoulou EA, Afentoulide N. Dental care throughout pregnancy: What a dentist must know. Oral Health Dent Manag 2012;11:169–176.

9. Task Force on Periodontal Treatment of Pregnant Women, American Academy of Periodontology. American Academy of Periodontolo...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Preface
• 1 Perceptions About Dental Treatment During Pregnancy
• 2 Considerations for Treating Pregnant Patients
• 3 Complications and the Impact on Dental Care
• 4 Procedures and Treatment Guidelines
• 5 Administration of Drugs During Pregnancy
• 6 Medications
• 7 Anesthetic Use
• Appendices
• Back Cover