Pregnancy and oral care in the time of Covid – what more should dental professionals be doing?

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  Posted by: The Probe      11th February 2021

Although plenty of women sail through pregnancy, many do not. The physical and emotional changes can alter their life dramatically and, even if it’s not their first time around, they often find out that no two pregnancies are the same, either.

If pregnancy is always a potentially challenging period, during coronavirus times, the experience could be overwhelming. Worries about bringing a child into an uncertain future, anxiety over job loss, juggling pregnancy with working from home or home schooling, loneliness if they’re not able to physically connect with their support networks… the list is endless. A pregnant woman might be more fearful about the birth itself, and whether they will be able to have their birth partner with them for the duration.

The impact of pregnancy on oral health

There are various oral health issues that can occur during, or be exacerbated by, pregnancy. When you’re engaging with pregnant patients, you’ll need to talk about these, and how to avoid and treat them, as well as address the extra pressures that could be affecting their physical and mental wellbeing at this time.

It is imperative to support pregnant women with practising good preventive behaviours not only to reduce the need for treatment, but also the risk of adverse pregnancy outcomes. Although the research is inconclusive, some studies have found evidence of a positive association between poor oral health, pre-term birth, low birth weight and pre-eclampsia; others have suggested whether “untreated dental caries may result in further inflammatory complications”.[i] It could be that periodontal bacteria is able to colonise “the foeto-placental unit through haematogenous dissemination” which then triggers the inflammatory response – these are complex biological processes, which is why more work is needed.[ii]

Gingival inflammation often increases during pregnancy, as a result of the hormonal surge, leading to swelling, gingivitis and periodontitis. Often, as with many physical problems during pregnancy, these resolve in the months following the birth. Also, oral disease is not the only factor involved in adverse pregnancy outcomes, so there is no reason for alarm if an issue is detected. The cause of pre-eclampsia still isn’t fully understood and there are a range of risk factors for both low-birth weight and pre-term birth, not all of which are preventable or predictable.

Early inception and tailored advice

What is clear, though, is that your patients who are trying to conceive, or who are already pregnant must prioritise their oral health. They need to know the warning signs to look out for, so a problem can be intercepted early, or a pre-existing condition can be treated before pregnancy.

Good preventive behaviours will also improve their all-round health. A diet that is balanced, yet varied and low in sugar is crucial, so must be discussed. Of course, you will often be talking to women who are exhausted, stressed and, particularly at this time, all out of coping mechanisms, so the temptation to reach for sweet, comforting snacks will be sky-high. Talk about sugar-free swaps and alternative ways to get an energy boost, such as a 30-minute walk outside, which is a good way to improve mood, too. Staying hydrated will also regulate energy levels and they should choose plain water where possible. Caffeine consumption must be limited during pregnancy to 200mg per day (around two mugs of tea or instant coffee) – too much is a risk factor for low birthweight. There have been claims that link caffeine intake with a failure to conceive, but these have not been substantiated by clinical evidence.

Small healthy meals, taken often, can also help with nausea. For morning (or all-day) sickness, rinsing the mouth with plain water can offer some respite, and limit the damage to the teeth from stomach acid. Your patient should try to wait an hour before brushing their teeth if they can.

Your goal is to help them avoid plaque accumulation so careful cleaning is key – if their gums are sore, they could try UltraSoft brushes from TANDEX, which are gentle yet effective. The UltraSoft range includes interdental variants; essential for removing optimal debris. Demonstrate correct brushing method and recommend they add an alcohol-free mouthrinse to their routine, such as WASH & PREVENT, also from TANDEX.

The key is to engage with pregnant women, also those who are trying to conceive, in such a meaningful way that your relationship continues post-partum, and as their family grows. The lessons for good oral health and hygiene are life-long, and quality preventive advice means that treatment interventions will be less frequent. But if they do need treatment, they should have no worries about accessing dental care at this time and be reassured that this will be delivered safely and successfully.

Even if they are feeling great, pregnant women must take extra-special care of themselves. The pandemic has demonstrated how dental professionals are an important part of their support team, helping them to have a healthy pregnancy and to stay in all-round good health and wellbeing, even after their baby is born.

 

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Author Kimberley Lloyd- Rees on behalf of Tandex

Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.

 

[i] Cho, G.J., Kim, S., Lee, H.C. et al. Association between dental caries and adverse pregnancy outcomes. Sci Rep 10, 5309 (2020). https://doi.org/10.1038/s41598-020-62306-2

[ii] British Society of Periodontology and Implant Dentistry. Oral health during pregnancy. Guidelines for oral health professionals. Link: https://www.bsperio.org.uk/professionals/oral-health-during-pregnancy (accessed November 2020).


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