December 2, 2013 Healthy Smile Happy Child

Telehealth Presentation Dr. Robert J Schroth

umschrot@cc.umanitoba.ca

Recent report of an expert working group on “Oral Health Care During Pregnancy”

October 2011 in Washington, DC at Georgetown University

Sponsored by: ◦ Health Resources & Services

Administration, Maternal & Child Health Bureau

In collaboration with: ◦ American College of Obstetricians &

Gynecologists ◦ American Dental Association

http://www.mchoralhealth.org/PDFs/Oralhealthpregnancyconsensusmeetingsummary.pdf

Pregnancy is a unique time characterized by complex physiological changes, which may adversely affect oral health

Oral health is key to overall health and well-being.

Preventive, diagnostic and restorative dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health.

Many health professionals do not provide oral health care to pregnant women.

Many pregnant women, even those with dental disease, do not seek or obtain needed dental care.

“Pregnancy is not an illness”

In many cases, neither pregnant women nor health

professionals understand that oral health care is an important component of a healthy pregnancy.

Evidence suggests that infants and young children often acquire caries-causing bacteria from their mothers

Education in regards to oral health care during pregnancy is needed as it can reduce the transmission of bacteria from mothers to their children.

For this reason it is essential for health professionals (e.g., dentists, hygienists, assistants, therapists, physicians, midwives, nurses, etc.) to provide pregnant women with appropriate and timely oral health care.

In 2006 the New York State Department of Health produced Oral Health Care During Pregnancy and Early Childhood: Practice Guidelines

Other guidelines for perinatal oral health care followed: ◦ American Academy of Pediatric Dentistry ◦ California Dental Association Foundation ◦ South Carolina Department of Health and Environmental

Control ◦ The University of Washington School of Dentistry

http://www.health.ny.gov/publications/0824.pdf

The recently published Oral Health Care During

Pregnancy: A National Consensus Statement- A Summary of an Expert Workgroup Meeting urges people to review the consensus statement and work with their health professional colleagues in medicine and dentistry to implement the guidance outlines in the document.

During the initial prenatal evaluation ◦ Take an oral health history of the patient. ◦ Questions that can be asked include the following:

Do you have swollen or bleeding gums, a toothache,

problems eating or chewing food or other problems in your mouth?

Since becoming pregnant, have you been vomiting? If so, how often?

◦ Further Questions: Do you have any questions or concerns about getting

oral health care while you are pregnant?

When was your last dental visit?

Do you need help finding a dentist?

Check the mouth for problems such as swollen or bleeding gums, untreated dental decay, mucosal lesions, signs of infection or trauma.

Document findings in patients chart

Pregnant women need reassurance that oral health care including the use of radiographs, pain medications, and local anesthesia is safe throughout pregnancy.

If the last dental visit took place > 6 months ago, or they have any oral health problems they should be advised to schedule an appointment with a dentist ASAP.

If urgent care is needed make a formal referral to a dentist who maintains a collaborative relationship with the prenatal care health professional.

Encourage women to seek oral health care, practice good oral hygiene, eat healthy foods and attend prenatal classes during pregnancy.

Establish partnerships with community based programs.

Provide a referral to a nutrition professional if counseling is needed.

Integrate oral health topics into prenatal classes.

Provide culturally and linguistically appropriate care. Take time to make sure woman understand the information being provided to them.

On the patient intake form, include questions about oral health. ◦ Examples include Name & contact information of dental

professionals, reasons for and date of last dental visit, previous dental procedures.

Establish relationships with dental professionals in the community.

Develop a formal referral process where by the dental professional agrees to see the referred individual in a timely manner and to provide subsequent care.

Share important information about pregnant woman with other oral health professionals and coordinate care with oral health care professionals as appropriate.

If the patient does not have a dental home, explain the importance of optimal oral health during pregnancy.

Take an oral health history (ask questions such as when was the last visit, how many weeks pregnant are you, any mouth pain etc?)

In addition to reviewing the dental history, review medical and dietary histories including use of tobacco, alcohol and recreational drugs.

Perform a comprehensive oral examination, which includes a risk assessment for dental caries and periodontal disease.

Take radiographs to evaluate and definitively diagnose oral diseases and conditions when clinically indicated.

Provide emergency or acute care at any time during the pregnancy as indicated by the oral condition.

Develop, discuss with women and provide a comprehensive care plan that includes prevention, treatment and maintenance throughout pregnancy.

Discuss pros/cons of treatments

Use standard practice with placing restorative materials.

Position pregnant women appropriately during care

(e.g., keep the woman's head at a higher level that her feet, place a pillow under her hip and ask for her own comfort suggestions).

Help pregnant women complete applications for insurance or other sources of coverage, social services or other needs.

On the patient intake form, record the name and contact information of the prenatal health professional.

Establish partnership with community based programs that serve pregnant women with low income.

Pharmaceutical Agent Indication, Contraindication & Special Considerations

Analgesics Acetaminophen May be used during pregnancy Acetaminophen with Codeine, hydrocodone or Oxycodone Codeine Meperidine Morphine

Pharmaceutical Agent Indication, Contraindication & Special Considerations

Analgesics

Aspirin May be used in short duration during pregnancy; 48 to 72 hours. Avoid in 1st and 3rd trimesters

Ibuprofen

Naproxen

Pharmaceutical Agent Indication, Contraindication & Special Considerations

Antibiotics

Amoxicillin May be used during pregnancy

Cephalosporins

Clindamycin

Metronidazole

Penicillin

Pharmaceutical Agent Indication, Contraindication & Special Considerations

Antibiotics

Ciprofloxacin Avoid during pregnancy

Clarithomycin

Levofloxacin

Moxifloxacin

Tetracycline Never use during pregnancy

Pharmaceutical Agent Indication, Contraindication & Special Considerations

Anaesthetics Local anaesthetics with epinephrine (e.g., Bupivicaine, lidocaine, mepivicaine)

May be used during pregnancy

Pharmaceutical Agent Indication, Contraindication & Special Considerations

Anesthetics Nitrous Oxide (30%) May be used during pregnancy

when typical or local anaesthetics are inadequate. Pregnant women require lower levels of nitrous oxide to achieve sedation; consult with prenatal care health professionals

Pharmaceutical Agent Indication, Contraindication & Special Considerations

Over the counter antimicrobials

Cetylpridinium chloride mouth rinse

May be used during pregnancy

Chlorhexide mouth rinse

Xylitol

Practice good oral health hygiene Brush your teeth with fluoridated toothpaste twice a day Replace toothbrush every 3-4 months Floss daily Rinse every night with an over the counter fluoridated alcohol free mouth

rinse. Eat Healthy Foods Each a variety of healthy foods such as fruits, vegetables, whole grain

products and dairy products. Limit sugar intake Water and milk is preferred over sugar drinks such as coke, or flavored

drinks.

Encourage dental care for pregnant women

Provide oral health care services to pregnant women

Develop relationships with those professionals already providing prenatal care and accept referrals

Target at-risk moms-to-be

Philosophy of harm reduction and non-judgmental approach to care

Thank You!