Importance of Perinatal Oral Health · oral health or referring women to a dentist increased from...

Family Medicine and Community Health

Importance of Perinatal Oral Health

June 24, 2020Community of Care Network of Kansas

Hugh Silk MD, MPH, FAAFPProfessor

University of Massachusetts Medical School, Worcester, MA


Disclosures• I have no financial disclosures.• I will be using some slides from:

Smiles for Life (blue background)


Who am I


Agenda• Why addressing perinatal oral health (POH) matters

• The role for medical-dental integration in POH

• What each of us can do to better address POH and improve overall wellness of mom and baby

• National and local POH resources for providers and patients


Why are we really here?

• We can do better• Let’s take a minute to pause in the middle

of COVID 19 and an upsurge of reflection on racial injustice

• What have you seen?• What have you experienced yourself?


Kansas PRAMS 2018


Dental care in KS


“For young children of black and Hispanic mothers, dental care use is higher when their mothers have a regular source of dental care”

This is why it matters


This is why it matters


Why Does Perinatal Oral Health Have to be Integrated?


Why should dental address medical issues?


Addressing Oral Health Saves $ and Makes One Healthier!


Insurance barriers


• Barriers and facilitators to dental care during pregnancy: a systematic review and meta-synthesis of qualitative studies. Cad. Saúde Pública, Rio de Janeiro , 2018;34(8)


The state of prenatal oral health in education and practice

• 62% of OB-Gyn residency programs provide no prenatal oral health education

• 45% of Dental School Deans cite lack of prenatal patients as a barrier

Journal of Dental Education 2013;77(11):1461-1468

•


“Insanity: doing the same thing over and over again and expecting different results.”

Albert Einstein


Oral health care is not only safe but RECOMMENDED


No oral health!


What can you do specifically to help your patients?


ADA on POHDental Examinations for Pregnant Women and Women of Child-Bearing Age; ADA Adopted 2014

Resolved, that the ADA urge all pregnant women and women of child-bearing age to have a regular dental examination.

Dental Treatment During Pregnancy; ADA Adopted 2014

Resolved, that the ADA acknowledges that preventive, diagnostic and restorative dental treatment to promote health and eliminate disease is safe throughout pregnancy and is effective in improving and maintaining the oral health of the mother and her child.


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Other docs


PIOHQI Grants


OB Care Reminder: Trimesters

•Traditional 3 trimesters

•1st trimester: through 13wks

•2nd trimester: 14 through 27wks

•3rd trimester: 28wks through 40+wks

• 4th trimester: through 12wks postpartum

Let’s Review What we Know


Postpartum Xylitol • Günay et al., 1998: 100% of children in the

intervention group remained S. mutans free by the age of 3 vs 38.5%

• mothers in the intervention group also w/ significant improvement in plaque index

• Nakai et al., 2010: significantly more children in xylitol group S. mutans free at 9, 12, & 24 mos.

• children’s S. mutans acquisition age in the xylitol chewing group was 8.8 months later than that of the control group (mean age 20.8 vs. 12.0 mos).

» Caries Res 2019;53:411-421.


•15 RCTs (7161 participants)

•“It is not clear if periodontal treatment during pregnancy has an impact on preterm birth (low-quality evidence). There is low-quality evidence that periodontal treatment may reduce low birth weight (< 2500 g), however, our confidence in the effect estimate is limited. There is insufficient evidence to determine which periodontal treatment is better in preventing adverse obstetric outcomes. Future research should aim to report periodontal outcomes alongside obstetric outcomes.”

•NO CONCERNS RAISED ABOUT SAFETY OF DENTAL CARE IN PREGNANCY


Updates in Prenatal Dental CareSafety• Dental xrays safe throughout

pregnancy• Dental pain medications are

generally safe • Most dental antibiotics safe during

pregnancy• Cleanings, extractions, restorations

(filings), deep root scaling = safe

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https://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Dental-X-Rays-Teeth-Cleanings-Safe-During-Pregnancy


Source: www.ppe.gla.ac.uk, Radiation Safety Resources. Thanks to Lisa Simon DMD, MD for slide.

http://www.ppe.gla.ac.uk/


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Positioning•1st and 2nd trimesters – position as tolerated (ask mom!)•3rd trimester – left lateral decubitus position prevents compression of

IVC (supine hypotension syndrome)

https://www.slideshare.net/manjreshi/management-of-pregnant-patients-in-oral-surgery


In clinical settings, Get Buy in from EVERYONE

• Make your office look prenatal friendly (posters, handouts)

• Ask front staff if they know you want to see prenatal patients

• Be sure everyone is comfortable/educated


Promote Care for Prenatal Patients• Work with Obstetrical providers/learners

– Obstetricians– Midwives– Family Physicians

• Reach out to PCPs*• Educate them about guidelines/services• Promote to your patients who are of

childbearing age*• Have handouts; update web site


Power of medical providers• 66% of PCPs provided oral health

counseling to pregnant womenMaternal And Child Health J, March 2018

• 2009 - 2012, medical providers talking about oral health or referring women to a dentist increased from 36 to 42%, and 21–26%, p < 0.001

• proportion of women with a dental visit during pregnancy increased, from 38% to 42% p < 0.005

• improvements were mainly women of lower income/education levels, had Medi-Cal, Latinas

– Matern Child Health J. 2019;23(7):890-902


Massachusetts Example

Lucy Chie, MD, MPHMichelle Eng, DMD


# of prenatal patients seen in dental


Communicate!


Beyond medical providers

• Wisconsin PIOHQI


Take Advantage of Resources


Usage


Satisfaction Scores


http://www.mindmapinspiration.com/wp-content/uploads/2009/05/rak-04.jpg


Questions, Comments, Thoughts

www.smilesforlifeoralhealth.orghttps://cipcoh.hsdm.harvard.edu/

[email protected]

photo credit: healthmix.net

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