DMD, PhD.Kim, Jaeseok

kjsperio@gmail.com

Importance of Maintaining Oral Health during Pregnancy

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1. Hormonal change

2. Changes in diet and oral hygiene. Nausea and vomiting in pregnancy can cause extensive erosion.

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periodontal disease-preterm birth, low birth weight

dental caries-vertical transmission

(ECC (Early Childhood Caries))

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an increase in estrogen and progesterone levels

a higher vascular permeability, providing essential bacterial growth factors (vitamin K)

Estrogen and progesterone receptors in gingival tissues

pregnancy gingivitis

increases in probing depth (PD) and bleeding on probing (BOP)

(prevalence: 35% to 100%)

Valimaa H. et al. J Endocrinol 2004;180:55-62.Miyazaki H. et al. J Clin Periodontol 1991;18:751-754.

Loe H, Silness J. Acta Odontol Scand 1963; 21:533-551.

Raber-Durlacher JE. et al. J Clin Periodontol 1994;21:549-558.

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attachment loss

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The prevalence of periodontitis in women of child-bearing age and during pregnancy is not well known. Assuming that the prevalence of periodontitis increases with age, the tendency toward an older age for pregnant women may result in a higher proportion of pregnant women having periodontitis.

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Does periodontal treatment during pregnancy reduce the rate of preterm births, low birth weight?

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Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67:1103-1113.Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: Results of a prospective study. J Am Dent Assoc 2001;132:875-880.Lo ́pez NJ, Smith PC, Gutierrez J. Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: A randomized con- trolled trial. J Periodontol 2002;73:911-924.Jeffcoat MK, Hauth JC, Geurs NC, et al. Periodontal disease and preterm birth: Results of a pilot interven- tion study. J Periodontol 2003;74:1214-1218.Radnai M, Gorzo I, Nagy E, Urban E, Novak T, Pal A. A possible association between preterm birth and early periodontitis. A pilot study. J Clin Periodontol 2004; 31:736-741.Do ̈rtbudak O, Eberhardt R, Ulm M, Persson GR. Peri- odontitis, a marker of risk in pregnancy for preterm birth. J Clin Periodontol 2005;32:45-52.Jarjoura K, Devine PC, Perez-Delboy A, Herrera-Abreu M, D’Alton M, Papapanou PN. Markers of periodontal infection and preterm birth. Am J Obstet Gynecol 2005;192:513-519. Bosnjak A, Relja T, Vucicevi -Boras V, Plasaj H, Plancak D. Pre-term delivery and periodontal disease: A case-control study from Croatia. J Clin Periodontol 2006;33:710-716.Offenbacher S, Boggess KA, Murtha AP, et al. Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol 2006;107:29-36.Radnai M, Gorzo I, Urban E, Eller J, Novak T, Pal A. Possible association between mother’s periodontal status and preterm delivery. J Clin Periodontol 2006; 33:791-796.Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc 2006;137:7S-13S.Santos-Pereira SA, Giraldo PC, Saba-Chujfi E, et al. Chronic periodontitis and pre-term labour in Brazilian pregnant women: An association to be analysed. J Clin Periodontol 2007;34:208-213.Offenbacher S, Jared HL, O’Reilly PG, et al. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol 1998;3: 233-250.Bearfield C, Davenport ES, Sivapathasundaram V, Allaker RP. Possible association between amniotic fluid micro-organism infection and microflora in the mouth. BJOG 2002;109:527-533.

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YES122010년 11월 16일 화요일

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Any PLBW and PLBW cases showed significantly greater probing depth and attachment loss, increased anaerobic bacterial counts.

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J Periodontol 2009;80:884-891.

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OIBI was significantly associated with preterm birth after adjusting for confounding factors (odds ratio [OR], 1.85; 95% confidence interval [CI]: 1.10 to 3.10; P = 0.02).

: The combined effects of multiple oral infections were significantly associated with preterm birth.

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429 reports246 PubMed

10 Cochrane Library173 Web of Science

7 eligible randomized controlled trials

411 reports excludednonradomized

news, letters, editorials, abstracts

18 reports

American Journal of Obstetrics & Gynecology MAR, 2009

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treatment with scaling and root planing reduces the rate of PTB and may reduce the rate of LBW infants.

the decline of oral cavity pathogen concentration -> the consequent reduction of transportation of organisms in the amniotic fluid and chorionic membrane.

a reduction in circulating inflammatory mediators produced in the oral crevice -> reduced exposure of genital tract tissues to these mediators.

the local inflammatory response in the crevice-> a systemic inflammatory immune response increasing the sensitivity of immune cells in the amnion to an inflammatory stimulus.

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NO212010년 11월 16일 화요일

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The rate of preterm delivery for the treatment group was

13.1% and 11.5% for the control group (P=.316)

: no stastically difference

LEVEL OF EVIDENCE—I

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no differences between the control and treatment groups in preterm birth (9.3% compared with 9.7%, odds ratio [OR] 1.05, 95% confidence interval [CI 0.7-1.58], P=.81), birth weight (3,450 compared with 3,410 g, P=.12), preeclampsia (4.1% compared with 3.4%, OR 0.82, 95% CI 0.44-1.56, P=.55), or other obstetric endpoints.

Periodontal treatment was not hazardous to the women or their pregnancies.

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Conflicting results

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the acquisition of infection with Streptococcus mutans

to pathogenic levels frequent and prolonged exposure to caries-promoting carbohydrates

rapid demineralization of enamel, if unchecked, leads to cavitations.

Caufield PW. et al. J Dent Res 1993; 72(1):37-45.

Dental caries(tooth decay)

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A woman’s dental caries risk may increase

1. the consumption of small, frequent, carbohydrate-rich meals

2. increased acid in the mouth from vomiting

3. a lack of attention to proper hygiene during pregnancy.

Silk H. et al. Am Fam Physician 2008;77(8):1139-1144.

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International Journal of Paediatric Dentistry 2002; 12: 2–7

vertical transmission

Streptococcus mutans

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DNA fingerprinting studies

genotype matches between mothers and infants in over 70 percentof cases

Caufield PW. N Y State Dent J 2005; 71(2):23-27.

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mothers strong need for counseling on how to avoid early transmission of cariogenic bacteria to their offspring.

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periodontal disease-preterm birth, low birth weight

dental caries-vertical transmission

(ECC (Early Childhood Caries))

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control of oral diseases improves a woman’s quality of life and has the potential to reduce the transmission of oral bacteria from mothers to children.

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safety

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the amount of radiation

18 intraoral dental radiographs(with a lead apron) - 0.0000001Gy (fetal embryonic dose)

Dental diseases in Gleichner. Principles and practice of medical therapy in pregnancy. Stanford, Conneticut: Appleton & Lange, 1998:1093-1095

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Restorative Materials

dental amalgam, gold, composite fillings : class II medical devices(FDA)

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Journal of American Dental Association 2008;139(6):685-695.

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EDT in pregnant women at 13 to 21 weeks’ gestation was not associated with an increased risk of experiencing serious medical adverse events or adverse pregnancy outcomes.

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Reality

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A survey of 249 obstetricians practicing in Ohio during 2004–2005

• 29% performed a visual mouth inspection during prenatal care.• 20% used oral health screening questions.• 6% referred clients to a dentist.

Stafford KE. et al. Journal of Maternal-Fetal and Neonatal Medicine 2008;21(1):63–71

However, most (64%) agreed that oral screening should be part of prenatal care.

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A survey of 829 general dentists practicing in Oregon during 2006–2007

Huebner CE.et al. Journal of American Dental Association, 2009; 140(2): 211–222.

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m jnnnnbh

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The Dentists Insurance Company (TDIC)— which is endorsed by eight U.S. state dental associations and insures 17,000 dentists nationwide—reports only one incidence in the past 15 years or more.

http://www. cdafoundation.org/library/docs/poh_policy_ 8. brief.pdf. Accessed March 2010

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Educating health care professionals and their patients about the safety and advantages of dental treatment during pregnancy can benefit all women,especially low-income women.

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Access to care

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a community-based intervention to provide dental services for low-income pregnant women.

J Public Health Dent. 2008 ; 68(3): 170–173.

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a community-based intervention to provide dental services for low-income pregnant women

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fear of treatment, myths about treatment, myths about pregnancy, lack of insurance, lack of money, and no provider available

we must understand women’s beliefs, attitudes, and behaviors about their oral health during this unique time.

JOURNAL OF WOMENʼS HEALTH Volume 14, Number 10, 2005

CDC Pregnancy Risk Assessment Monitoring System (PRAMS)

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a community health partnership

(local dentists, WIC program, Medicaid

families)

technical assistance(university)

program administration,the outreach coordinator

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Initial contact focused on participation.

The focus of subsequent home/WIC visits was on providing information on the mother seeing the dentist and preventing caries transmission.

A major goal was to reduce barriers to care.

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Case management focused on reducing no-shows. on eliminating reservoirs of disease with the extraction of hopeless teeth and filling of open cavities.

After delivery, xylitol chewing gum for six months Fluoridated toothpaste

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Continuing Education - doctors, dental hygienists, students

A major concern was that the medical community was unaware of the need for treatment during pregnancy and that dental care was safe.

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Result—Between February 2004 and January 2006, 503 pregnant women were identified: 421 women were contactable. Of these, 339 received home visits (339/421, 80.5%) and 235 received care (235/339, 69.3%). Overall, 55.8% of eligible women received care (235/421).

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Barriers to careBarriers to care

systems barriers

provider barriers

patient barriers

fear of lawsuitsEducation and training“teachable moment”

financial pressuresbeliefs and customs

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c

American Academy of Periodontology StatementRegarding Periodontal Management of the Pregnant Patient

Periodontal health is a component of general health. Prevention and treatment of periodontal diseases are important to maintain to maintain health.

For pregnant women, proper periodontal examination and treatment, if indicated, can have a beneficial effect on the health of their babies.

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