The Importance of Perinatal Oral Health

Original Video:



Healthy babies, and we are delighted to bring this presentation to you today on the importance of perinatal oral health.  We have a fabulous panel, and we have a very packed agenda.  So, I am going to move rather quickly and let our speaker present, to let them present their fabulous information.  Before I move into our speakers, I want to offer a very big thank you to the US Department of Health and Human Services, Office on Women’s Health Region 1 who has made this possible today.  We really appreciate their support, and I hope that you all enjoy this as much as we all enjoy providing this to you.

Moving on, I just want to introduce our four speakers for you today.  Our first speaker is Dr. Mark DeFrancesco who is secretary with the American College Obstetricians and Gynecologists and is also the chief medical officer of Women’s Health Connecticut.  I will be posting the biographies online for the presentation for you all so that you will be able to read about these fabulous speakers in more detail.

Following Dr. DeFrancesco is Dr. Irene Hilton who is a past dentist at the San Francisco Department of Public Health.  She is also a board certified in dental public health and is on faculty at the University of California San Francisco School of Medicine and School of Dentistry.  Following Dr. Irene Hilton, we have Amy Galiardi who has been involved in working maternal child health for more than 20 years, working in clinical care management, research, and policy.  She is currently with the Community Health Center, Inc., which is a federally qualified health care center in Connecticut, and she’s also the Chief Operating Officer for Lily’s Kids, Inc., a non-profit organization.

Then, following Amy is Rene Andersen who is a consultant trainer and developer for recovery-focused programs focusing on recovery from addiction, trauma, and/or extreme states.   She’s currently a consultant for the Massachusetts Department of Public Health Services and Bureau of Substance Abuse Services.

As you will see, these individuals have an awful lot to present today.  So, without further ado, I’m going to turn this over to Dr. DeFrancesco.


Dr. DeFrancesco:

Great.  Thank you so much, Jennifer, for the introduction.  This is a very important topic. I think it’s also a very underappreciated topic.  So, I’m very excited to be here to talk about this to our audience today.  I think in the past, in particular, we, obstetrical providers, were, I would say, vaguely aware that in pregnancy, women had more problems with their oral health, but we tend to think of it as basically just a hyperemic gingiva, a little bit more bleeding gums.  In pregnancy, there may be some susceptibility to cavities but thought it was limited to the mouth kind of problem, and I don’t think it raised major concerns.

I don’t think it was until quite recently that we realized how important oral health is, and this could negatively impact not only the mother’s health but the baby and the progress of the pregnancy itself.  I think our method today, really, is that pregnant women need dental care.  Untreated disease can actually harm the mother and the baby, and they negatively impact the pregnancy being, in part, be responsible for premature labor as well as low birth weight.  I think there’s a lot more research that needs to be done in that area, but there sure seems to be a [4:13] there.  We certainly know there’s vertical transmission of cariogenic oral bacteria in pregnancy when good oral health is not attended to.

There are new questions that we’ve certainly heard over the past few years.  Even outside of pregnancy, there are possible links between a poor oral health and heart disease.  Another question about future premature labor also in question here and other health problems that might be mediated by inflammation.  Possibly, the inflammation in the mouth may be, in part, responsible for things.  The question, of course, is are these associated issues or are they causally related?  I think the ongoing research will hopefully answer some of those questions.

Basically, what we do know is that a good oral health helps protect a woman’s health and her quality of life.  Pregnancy is an ideal time to do oral health screening as it may be the only time some women have insurance coverage.  In pregnancy, some women may be more teachable in some respects and more reachable about the importance of oral health for themselves and or their babies, but there are many barriers to care, especially during pregnancy.

On the OB’s side, there’s a general lack of knowledge, I have to say, about the full impact of poor oral health on the mother and the pregnancy.  As you know, we often don’t think about the mouth when we do an examination, especially pregnancy related.  I think, in general, we think that is not our problem.  I think people in the obstetrics need more education about this.

On the dental, there’s often a lack of knowledge but more based on the fear of treatment.  Could we possibly hurt the pregnancy?  Clearly, there are concerns about professional liability and malpractice claims if, somehow, following treatment, the outcome of the pregnancy.  So, clearly, there is a need for good information, good education in this area also.

Out in California, in the past several years, the California Dental Association partnered with District IX of the American College of Obstetricians and Gynecologists in a really excellent piece of work entitled Perinatal Oral Health Practice Guidelines.  This is easily found on the ACOG website and probably just Google.  Basically, there were two fundamental findings that came out from this piece of work.  First, the benefits of oral health outweigh the risk of oral health care.  This is not only because it can reduce the transmission of oral bacteria, but treatment appears not to have increased miscarriage risk associated with it.  Those are two very important things, especially the second.  Again, first, do no harm.  Nobody wants to do harm in treating patients.  Secondly, more globally related to that, of course, is to prevent.  Diagnosis and prevention of oral diseases are highly beneficial to the patient and can be undertaken during pregnancy.  These are two key findings of the study by the American College and by the California Dental Association.

In addition to that, most of the slides I’m going to be presenting in my brief talk really come from that report.  Particularly, we’re focusing on the role of obstetrical providers, and these are various talking points in discussing this with our OB providers that we should be really assuming some responsibility to educate patients about the importance of oral health.  We should try to be encouraging dental referrals.  If the patient is resistant to a dental referral, we should certainly ask because many times we find that patients are concerned about the safety of treatment during pregnancy, and we should be able to reassure them.  So, always find out if the patient doesn’t want to follow-up with the problem like that what the root of that is.  Certainly, advise the patient that dental care is safe, and it’s good for her and her children and the baby.

We should also document if the patient is under the care of an oral health professional.  So, in general, just like when we ask patients when they come to us as new patients who their primary care provider is, we should also know who provides them their oral health.  If we find that a referral is needed, we should not only make the referral but also document that we made it.  We should also develop a referral form that’s pretty simple and straight forward to reassure to the dental provider that hopefully it’s acceptable to treat the patient because many times, we often do hear from dentists who may call us and say, “We have so and so here.  She’s pregnant.  Is it okay if I give her this or give her this or give her that drug?”  Again, working collaboratively with the oral health care provider is good, and sometimes you can make that simpler and streamline the process by having a little form to refer a patient, and you should maintain a list of local resources because, as you may know, it’s not unusual to find that the patients are not connected in the dental health world.  They should know who they can see in the area.

As a part of our routine initial examination, actually, before there’s a problem, we should conduct and document an oral health exam, and we don’t have to be dentists to provide this kind of exam.  I think we know enough about an inflammation and about lesions and about [9:40] that we can certainly inspect the mouth, look at the teeth, the gums, the palate, the mucosa and look for any sign of destruction, lesion, or anything that we’re not sure about.  We should share appropriate information with the dental health provider if we are going to make a referral for any question, and we should, as always, encourage the quality advice of their oral health provider.

Behaviors.  We can certainly remind patients about things that we should all be doing.  In any event, brushing twice a day at least.  Use a fluoridated product and floss daily.  Take prenatal vitamins and pay attention to nutrition and the right foods, folic acid, of course.  Chewing xylitol gum four or five times daily after eating, that could be cleansing and reduce caries and inflammation and things of that nature.  So, it’s a good thing that patients can be advised to do and encouraged to do during pregnancy.

In addition to that, remind them not to delay any necessary treatment, and this is good for pregnant and non-pregnant people and for people like us, too.  Limit foods with sugars or simple carbohydrates.  Limit our drinking of juice and soda, including diet sodas, in between meals.  So, this is the second thing that we can also get people to do things that are right, nutritionally, for themselves, and that’s a good thing we should work on.

As far as protecting the baby, we can recommend certain behaviors that will help once the baby comes, including wiping the infant’s gums or teeth with soft cloth, brushing the child’s teeth after there are some teeth to brush.  Fluoride is okay after two years of age.  Avoid putting the baby to bed with a bottle or sippy cup with anything but water in it, and avoid saliva-sharing behaviors.  Again, we’re looking there to decrease the vertical transmission of cariogenic bacteria.

Remember, ultimately, that good oral health is part of good health, in general, especially in pregnancy.  For many women, we’re the only regular connection with the health care system and obstetrics, and if we don’t check on them, no one else will.

I think the rest of our talk this afternoon will be discussing the status of oral health during pregnancy, the importance of oral health screening and care in the perinatal period, barriers to providing good oral health care during pregnancy, and also a little bit about trauma-informed care.

We’re going to discuss, in much more detail, our panel of experts of group of people will be talking in more detail about oral health issues.  I will offer suggestions on how to improve oral health screening in the prenatal office also and discuss the barriers that we’ve touched upon already and share some practices surrounding trauma-informed care.  Basically, I’m looking forward to a great and timely discussion of a very important issue.  I commend you all for tuning in to this.  I think it’s great for you to take some of this to your practice, and now, I’m going to turn it over to Dr. Hilton.

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