1. Dental care in Pregnancy
DMD, PhD.
Shin Dong-Ryul
cons-99@hanmail.net

2. Pregnancy is a “teachable moment” when
women are receptive to changing
behaviors that can benefit themselves and
their children

3. The majority of the physicians (81%)
agreed that pregnancy increases the
tendency to have gingival inflammation.
However, 88% of doctors advised delay
dental treatment until after pregnancy.
Int J Dent Hyg. 2008 Aug;6(3):214-20.

4. There is no evidence relating early
spontaneous abortion to first trimester oral
health care or dental procedures

5. 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

6. Oral change
1. Hormonal change - Periodontal change
2. Changes in diet and oral hygiene.
Nausea and vomiting in pregnancy can cause
extensive erosion.

7. periodontal disease
-preterm birth, low birth weight
dental caries
-vertical transmission
(ECC (Early Childhood Caries))

8. Periodontal disease

15. an increase in estrogen and progesterone levels
Estrogen and progesterone receptors in gingival tissues
a higher vascular permeability, providing essential bacterial growth
factors
increases in probing depth (PD) and bleeding on probing (BOP
(prevalence: 35% to
pregnancy gingivitis 100%)
Loe H, Silness J. Acta Odontol Scand 1963; 21:533-551.
Valimaa H. et al. J Endocrinol 2004;180:55-62.
Miyazaki H. et al. J Clin Periodontol 1991;18:751-754.
Raber-Durlacher JE. et al. J Clin Periodontol 1994;21:549-558.

16. attachment loss

17. 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.

18. Periodontal disease & Preterm low birthweight:
Proposed Biological Mechanism

19. 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.
36. Boggess KA, Moss K, Madianos P, Murtha AP, Beck J, Offenbacher S. Fetal immune response to oral
path- ogens and risk of preterm birth. Am J Obstet Gynecol 2005;193:1121-1126

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

23. Effects of periodontal therapy on rate of
preterm delivery A randomized controlled
trial
The rate of preterm delivery for the treatment
group was13.1% and 11.5% for the control group
(P=.316)
: no stastically difference
Obstet Gynecol. 2009 Sep.; 114(3): 551-559

24. Dental caries

25. Dental caries(tooth decay)
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.

26. Pregnant 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.

27. vertical transmission
Streptococcus mutans
International Journal of Paediatric Dentistry 2002; 12: 2–7

28. 60
50
40
S. mutans
30
colonization
20
10
18 months 0
36 months score 0 score 1 score 2 score 3
MS score(S. mutans)

29. DNA fingerprinting studies
genotype matches between mothers and infants in over
70 percent of cases
Caufield PW. N Y State Dent J 2005; 71(2):23-27.

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

31. Inflammation

36. Erosion

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

38. Hyperemesis gravidarum
severe form of NVP(nausea and vomiting during
pregnancy) that occurs in about 0.3-2.0% of pregnancies,
and may lead to surface enamel loss primarily through
acid-induced erosion

40. 1. Eating small amounts of nutritious yet noncariogenic
foods
2. Using a teaspoon of baking soda (sodium bicarbonate)
in a cup of water to rinse and spit after vomiting
- avoiding tooth brushing directly after vomiting as the
effect of erosion can be exacerbated by brushing an
already demineralized tooth surface

41. Safety

43. 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

44. Restorative Materials
dental amalgam, gold, composite
fillings
: class II medical devices(FDA)

45. 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.

46. Barriers to care
Barriers to care
fear of lawsuits
systems barriers Education and training
“teachable moment”
provider barriers
financial pressures
beliefs and customs
patient barriers

47. American Academy of Periodontology
Statement Regarding 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.
c

48. Thank you for your
QuickTime쥉곜
Photo - JPEG ?쫯 ?《콆겙
올 교릨역 쓲콆 욀? 쳽?쳮쪣쪦.
attention