Patange, Varma, & Zope, 2017; Teshome & Yitayeh, 2016; American Dental Association 2021). It has also been proposed that periodontitis might serve as a marker for unhealthy Impact on pregnancy outcomes A number of clinical studies have suggested that gingivitis and periodontitis are risk factors for preterm birth and low birth weight (Yenen and Atacag, 2019; Daalderop, et al., 2018; Corbella, et al., 2016; Hartnett, 2016; Patton and Glick, 2016). Both gingivitis and periodontal disease during pregnancy exacerbate inflammatory reactions though mediators through mediators such as cytokines, lipopolysaccharides and prostaglandins all of which can reach the placenta and reach a critical threshold level which can induce premature labor (Patton and Glick, 2016; Lee and Hoerler, 2019). Conflicting results have also been published as some studies have not found conclusive evidence that there was a link between periodontal disease during pregnancy and adverse pregnancy outcomes (American Dental Association, 2021; Hartnett, et al., 2016). However, most of the evidence supports a link between periodontal disease and pregnancy outcomes. A systematic review concluded that despite some contradictory findings and methodological limitations, the majority of clinical studies show a positive correlation between preterm birth and periodontal disease (Daalderop, et al., 2018). An evaluation of 23 systematic reviews completed through 2016 concluded that there was an existing association between periodontal disease Transmitting cariogenic bacteria Women at risk for dental caries have the potential to pass the disease to their newborns. In addition, the caries status of the mother has implications for her child because the mother is the most common donor of cariogenic bacteria. DNA fingerprinting studies show that, in most cases, the genotype of cariogenic
behaviors or immune hyperresponsiveness that might cause preterm birth (Cobb et al., 2017).
during pregnancy and pre-term births, low birthweight babies and pre-eclampsia (Daalderop, et. al., 2018). In 2015, Schwendicke and colleagues published a meta-analysis of 13 randomized clinical trials evaluating 6,283 pregnant women, in an effort to determine whether periodontal treatment could prevent preterm birth, low birth weight, and ultimately perinatal mortality. These researchers were unable to come to a definitive conclusion and pointed out the need for further trials. A critical assessment of adverse pregnancy outcomes and periodontal disease concluded that although nonsurgical mechanical periodontal treatment in the second trimester of pregnancy is safe and effective in reducing signs of maternal periodontal disease, it does not reduce the rate of preterm birth (Bobetsis, et. al., 2020). However, in 2013, Khairnar and colleagues reported that in their study of 100 pregnant women they had found evidence that nonsurgical supportive periodontal therapy could reduce the instances of preterm birth and low birth rate. Patients and healthcare providers should be educated about the biological plausibility of an association between periodontal disease and the potential risk of adverse pregnancy outcomes, even though evidence is limited concerning the usefulness of routine periodontal treatment in reducing the risk of adverse pregnancy outcomes (Komine-Aizawa, et. al., 2018). bacteria is the same in mothers and their infants (Childers et al., 2017; Xiao et al., 2016; Lee and Hoerler, 2019). These cariogenic bacteria are typically transmitted via saliva from mother to child by behaviors such as sharing a spoon when tasting baby food (Damle et al., 2016; Lee and Hoerler, 2019).
CLINICAL PRACTICE GUIDELINES REGARDING ORAL HEALTH CARE
Clinicians increasingly look toward evidence-based treatment options for guidance in the context of oral health. To many practitioners, these recommendations serve as important tools to help make informed choices about best practices to optimize
outcomes. Accordingly, professional organizations and key federal agencies have promulgated guidelines to optimize oral health during pregnancy.
Centers for Disease Control and Prevention recommendations The CDC published a series of recommendations based on expert opinion to improve preconception health and health care (CDC, 2020). Several of these recommendations were directly relevant to improving preconception oral health. The CDC recommended preventive visits that offer routine risk assessment through screening for chronic conditions, including oral disease. The recommendations also call for additional counseling and interventions for women who are at increased risk for morbidity and mortality to the mother and fetus as a result of medical conditions, including dental disease. The CDC recommendations for interconception care advocate for additional intensive interventions for women with a prior
pregnancy that ended in an adverse outcome (i.e., fetal loss, low birth weight or preterm birth, birth defects, or infant death). In this context, the CDC recommendations cite a program that was tested in Atlanta, Georgia, called the Interpregnancy Care Program of Grady Memorial Hospital . This program focused on reducing identified medical, dental, and psychosocial risks. The program enrolled women who were at risk for delivery of very low birth weight infants and provided them with 24 months of funded, comprehensive, and integrated primary healthcare services; enhanced case management; and outreach in the community setting, including dental services (County Health Rankings & Roadmaps, 2016). health professionals for the purpose of guiding treatment (New York State Department of Health, 2006).This section will highlight recommendations in the literature which follow these guidelines and where necessary provide updates on these recommendations. and early childhood which were reaffirmed in 2017. A primary concern was that delaying dental treatment could result in more complex oral and systemic problems (American Dental Association, 2021). Unlike the New York guidelines, which were provider centric, the California Dental Association Foundation guidelines (2010) focus on a patient-centered approach from a more holistic perspective. The goal is to establish a framework for collaboration among
New York State Department of Health guidelines Several professional organizations and state agencies have undertaken efforts to promote oral health during pregnancy. For example, the New York State Department of Health published guidelines that provide separate recommendations for prenatal care providers, oral health professionals, and child Other evidence-based guidelines The California Dental Association Foundation (CDA) published “ Oral health During Pregnancy and Early Childhood: Evidence- Based Guidelines for Health Professionals ” in February 2010 (California Dental Association, 2010). This publication featured evidence-based clinical practice guidelines for the provision of dental care to women before, during, and after pregnancy. In 2013, ACOG published a list of recommendations for healthcare practitioners concerning oral healthcare during pregnancy
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