Thursday, November 14, 2019

BMC Oral Health Report on Dental Care During Pregnancy

 


As those of us in dentistry have been preaching for quite some time now, the mouth is connected to the rest of the body and what happens in the mouth can definitely have an affect on overall systemic health.

That’s why I was interested to see a study published by BMC Oral Health titled "Dental care during pregnancy based on the pregnancy risk assessment monitoring system in Utah”.  Problems and diseases of the oral cavity have been shown to have an affect on pregnant women and also on their unborn children.  Things like periodontal disease can lead to low birth weight and premature deliveries.  Those are just two of the reasons it’s important for pregnant women to seek out dental care.  It’s good for the health of the mom and also good for the health of the child.

Here’s a little of what the study had to say:

Poor dental hygiene and gum disease can increase the risk of heart attack, stroke, and adverse pregnancy outcomes. During pregnancy, a woman’s body goes through several changes that can cause oral health problems, including hormonal changes, fluctuation in oral hygiene practices and eating patterns. A 2012 national experts’ consensus statement concluded that dental care is both safe and effective throughout pregnancy, and that women should continue receiving treatment during their pregnancy. Research supports that routine preventive, diagnostic, and restorative dental therapy, and periodontal treatment, among pregnant women does not increase the risk of adverse pregnancy outcomes. Continued dental care during pregnancy is particularly important to avoid periodontal diseases  and subsequent risk of pre-eclampsia, preterm birth, and low birth weight infants.

Few studies have reported on the level of dental care received during pregnancy. However, those studies have shown lower levels of dental care during pregnancy. For example, in a study involving 2009–11 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) in Hawaii, 50% had their teeth regularly cleaned before pregnancy compared with 33.4% during pregnancy. In a study involving 1998 data for four states from the PRAMS, 23 to 35% of pregnant women went to the dentist during pregnancy, 12 to 25% suffered from an oral health problem, and, of those with a problem, only 45 to 55% received care. The study further found that some women thought poor oral health during pregnancy was normal, believing that some types of dental care could harm their fetus. In a study involving 2004–08 data from PRAMS in Michigan, 26.0% reported that they needed dental care during their pregnancy, of which only 58.4% sought care. Low levels of care may be because of concern among patients, dentists, and obstetricians regarding the safety of dental care during pregnancy. Lack of dental insurance may also play an important role. A better understanding is needed as to how these factors contribute to the use of dental care during pregnancy, according to specific subgroups of the population.

Research shows that some dentists and obstetricians contribute to the low use of dental care among pregnant women. In one study, only 40% of pregnant women were advised by their obstetric provider to seek dental care during pregnancy, and 10% were refused care during pregnancy by their dentist. A recent survey of gynecologists found that they often mistakenly believed that dental x-rays (73%) and local anesthesia (59%) were unsafe for pregnant women.

Some healthcare workers are simply not counseling their patients about the importance of receiving dental care during pregnancy. In a study involving PRAMS data for 10 states in 2004–06, only 41% of pregnant women received oral health counseling [19]. A better understanding is needed of how such counseling impacts the use of dental care during pregnancy. Many dental and obstetrics workers may simply be unaware of the prenatal oral health guidelines, thereby causing them to not recommend dental care during pregnancy and to be less likely to talk with their patients about how to care for their teeth and gums during pregnancy. In a survey conducted in the United States of 60 dental school deans and 240 obstetrics and gynecology residency program directors 65% of deans and 45% of residencies were aware of prenatal oral health guidelines and 39% of residencies taught prenatal oral health [20]. In addition, it has been recommended that pregnant women should receive education on the importance of oral health care and safe medications during pregnancy in order to encourage home oral hygiene care.

Not having insurance coverage can limit dental care during pregnancy. Pregnant women with either private or Medicaid insurance are less likely to receive dental care during pregnancy than their non-pregnant counterparts. The type of insurance has also been associated with use of dental care during pregnancy. In a PRAMS study, pregnant women with Medicaid insurance were 24 to 53% less likely to receive dental care than those covered by private insurance . This is particularly concerning since Medicaid insurance for dental care during pregnancy, as it is available in most states, only provides coverage during their pregnancy and for 2 months postpartum, such that if dental care is delayed because of pregnancy, there may not be insurance to cover treatment later on.

Certain demographic characteristics and smoking and alcohol behaviors have been associated with failure to receive dental care during pregnancy. Research has shown that pregnant women are less likely to receive dental care during pregnancy if they are younger, a minority, not married, and have lower income and education. Women who smoke cigarettes or drink alcohol also have lower use of dental care during pregnancy.

From this previous research we can conclude that dental services are less frequently used among pregnant women, and that certain demographic groups, smokers, alcohol drinkers, and uninsured or publically insured pregnant women are least likely to use dental services. However, we know little about how knowledge of the importance of care during pregnancy and having a dental or health care worker talk with pregnant women about dental care influences whether dental care is received. In addition, we know little about the characteristics of pregnant women who are most likely to have dental insurance. The purpose of the current study is to identify the prevalence of dental services received (teeth cleaning and seeing a dentist for a dental problem) and factors related to receiving dental care (knowledge of the importance of care, having a dental or other health care worker talk with them about the importance of dental care, and insurance) among a group of women who completed the PRAMS survey in Utah. The impact of knowing the importance of receiving continued dental care during pregnancy, having a dental or other health care worker talk with them about such care, and insurance on actually receiving dental care during pregnancy will also be assessed.


To read the entire paper follow this link.

1 comment:

  1. Thanks for sharing this interesting article. I enjoyed it very much. A good read for dental health while a woman is pregnant. Have a great rest of your week.
    Dentist Northeast Philadelphia

    ReplyDelete