because oral-systemic health connections begin in the womb

The effects of a mother’s oral health on her unborn and growing child

Evidence continues to emerge on the relationship between a mother’s oral health and her unborn child, with more recent meta-analyses confirming adverse birth outcomes for both mother and child when gum disease is untreated. Preeclampsia, preterm birth, and low birth weight are among the most severe outcomes. Simply put, poor maternal oral health affects the overall health of the mother and therefore her child.1 Here are two examples:

Gingivitis is inflammation of the gums or gums and is common in pregnant women. It is easily preventable. Porphyromonas gingivalisbacteria associated with periodontal disease and other bacteria present in the subgingival plaque of pregnant women have been found to be more prevalent in women with preterm labor, for example, than in women with recent labor.1 More than two-thirds of pregnant women have gingivitis during pregnancy.2

In addition, pregnant women may be more susceptible to tooth decay due to hormonal changes and changes in eating habits. They can then pass large numbers of cavity-causing bacteria in their mouths to their babies’ mouths. Mothers with high levels of untreated tooth decay were three times more likely to have children with tooth decay than mothers with good oral health.2

In addition, professional medical organizations recommend oral care during pregnancy; for example, the American College of Obstetricians and Gynecologists recommends oral care during pregnancy for the benefit of both the mother and her unborn babies.3 This was confirmed in 2019, following initial guidelines in 2011.

Also, since 2000, the American Academy of Pediatrics (AAP) guidelines suggest that infants receive an oral exam by 6 months of age. Because there are not enough oral health professionals to provide care for young children, pediatricians and pediatric nurse practitioners fill this gap.4 So how can we fill this gap? One word – teledentistry.

Teledentistry can connect families with a dental home

Teledentistry, like telehealth, is now available to ensure that more children can easily access oral care from pediatricians and provide a link to oral health professionals and the dental home. With teledentistry, mothers and babies can access dental care with the mother holding the baby on her lap with no downtime for transportation or additional time off work and no risk of contracting the latest variant of COVID-19. They can have face-to-face contact with a dental professional to meet their needs.

The AAP recommends that providers perform an oral health risk assessment at all 6-, 9-, and 12-month visits.4 These can be done teledentistically or when giving routine childhood vaccinations during baby well-being check-ups.5,6

There is no doubt that oral health affects the overall quality of life. A healthy, disease-free mouth ensures the ability to swallow, smile, eat and feel confident, and improves major quality of life issues. Also, like a healthy body, oral disease prevention begins in prenatal care and is especially important in early pediatric care.

What’s more, studies have found that parents are often unable to accurately detect their children’s oral health problems because they perceive them mainly based on assumptions. Therefore, teledental consultations are of paramount importance in catching and treating problems before they become serious.7

Teledentistry connects pregnant patients and newborns with pediatricians and pediatricians with oral health professionals

While some areas may lack oral health professionals to treat infants and young children, teledentistry can easily connect oral health professionals and the regional pediatric practice schedule. According to a recent report, oral health should be integrated into primary care.8 In fact, teledentistry is the only proven technology that can bridge the gap between prenatal and pediatric care.

Teledental visits can take place simultaneously while the patient is seeing another healthcare professional or, if necessary, be pre-booked for a later appointment. Teledentistry can also connect pediatric patients to a dental home by age 1, as recommended by the AAP.

Below are some guidelines for a standard teledental virtual consultation with a mother holding a baby on her lap:

Medical history: including history of gestational diabetes, preeclampsia, gestational hypertension, preterm birth, and any other problems.

A major complaint if ever there was one.

Oral health risk assessment.4

Summary of oral health findings from surveillance.

Additional information: including any relevant information from an OB/GYN, oral specialist or other health professional.

Assessment of oral findings and any impact on function such as feeding, speech, expression or other difficulties.

Summary of recommended treatment and/or prevention: for example, fluoride varnish, not putting the baby to bed with formula, avoiding drinks with a high sugar content, and other recommendations.

Treatment summary

Recommended next visit (time period).

Why the dental hygienist is an essential part of the multidisciplinary relationship

Efforts to integrate oral health emphasize the value of comprehensive care linking medical and dental professionals. Curriculum programs, such as Smiles for Life, can provide background information in addition to the AAP resources cited.8,9

For example, dental hygienists have a vital role in promoting change in pediatric patients by acting as coaches who can touch on nutrition, encourage good oral hygiene habits and intervene to correct any bad habits that will lead to increase in oral and systemic diseases. Tremendous success in preventing tooth decay among students has been shown to occur when dental hygienists provide the necessary care in school-based oral health programs in low-income neighborhoods.10

Dental hygienists can play a critical role in influencing oral health change by educating patients, offering positive reinforcement, and supporting parents in guiding their children to continue best practices at home.11

The impact of teledentistry: improved outcomes for mother and child

Thanks to teledentistry, dentists and hygienists can serve as readily available advisors to expectant mothers and their healthcare providers to ensure optimal prenatal oral care.

In our opinion, the implementation of teledentistry as part of a pediatric oral health risk assessment protocol can help significantly reduce the incidence of preterm and low birth weight infants and improve overall maternal and child health.12,13

Margaret Scarlett, DDS – A dental futurist, Dr. Scarlett is a practicing dentist, author and consultant to today’s innovators in digital dentistry. After a long career at the Centers for Disease Control and Prevention, Dr. Scarlett is now helping today’s dental groups and private practices embrace the digital transformation of dentistry while helping innovative dental technology companies bring their transformative solutions to DSOs and private practices . She can be reached at [email protected]

Michelle Strange, MSDH, RDH – Michelle is a practicing hygienist with over two decades of dental experience, starting as a dental assistant and graduating with a Bachelor of Health Science degree from the Medical University of South Carolina and a Master of Dental Hygiene degree from the University of Bridgeport. She continues to invest in continuing education by obtaining relevant certifications, such as her Dental Infection Prevention and Control certification. Her community and global endeavors demonstrate her passion for dentistry, from volunteering as a dental hygienist to her world missions. You can reach her at [email protected]

Introduction:

Today’s emphasis on health extends throughout our lives. Recent research shows that oral health is vital to overall health and well-being. This is especially important when it comes to prenatal care.

For example, pregnant women with undiagnosed and untreated periodontal disease are more likely to have premature, low birth weight babies, which leads to several other complications and conditions, such as delayed development and stunting.

References

1. Jang H, Patoine A, Wu TT, Castillo DA, Xiao J. Oral microflora and pregnancy: a systematic review and meta-analysis. Sci Rep. 2021:19;11(1):16870. doi:10.1038/s41598-021-96495-1

2. Centers for Disease Control and Prevention. Pregnancy and oral health. Accessed July 7, 2022. https://www.cdc.gov/oralhealth/publications/features/pregnancy-and-oral-health.html.

3. Oral care during pregnancy and throughout life. American College of Obstetricians and Gynecologists. Oral Health Committee. Accessed July 5, 2022. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/08/oral-health-care-during-pregnancy-and-through-the-lifespan.

4. Risk assessment tool. American Academy of Pediatrics. Accessed July 7, 2022.

https://downloads.aap.org/AAP/PDF/oralhealth_RiskAssessmentTool.pdf.

5. Practical Oral Health Tools for Practitioners. American Academy of Pediatrics. Accessed July 5, 2022. https://www.aap.org/en/patient-care/oral-health/oral-health-practice-tools.

6. Payment of preventive health services. American Academy of Pediatrics. Accessed July 7, 2022. https://www.aap.org/en/patient-care/oral-health/payment-for-oral-health-services.

7. Reissmann DR, John MT, Sagheri D, Sierwald I. Diagnostic accuracy of parent ratings of their child’s oral health-related quality of life. Who Life Res. 2017. 26(4): 881-891. doi: 10.1007/s11136-016-1427-y.

8. Oral health innovation and primary care integration: aligning with the shared principles of primary care. The Primary Care Collaborative. 2021. Accessed July 27, 2022. https://www.pcpcc.org/ resource/innovations-oral-health-and-primary-care-integration-alignment-shared-principles

9. National Oral Health Curriculum: Smiles for Life. Society of Teachers of Family Medicine Oral Health Group. Accessed July 27, 2022. https://www.smilesforlifeoralhealth.org/.

10. Simmer-Beck M, Wellever A, Kelly P. Using registered dental hygienists to promote a school-based approach to dental public health. Am J Public Health. 2017:107(S1):S56-S60. doi: 10.2105/AJPH.2017.303662

11. Why be a dental hygienist? American Dental Education Association. Accessed July 27, 2022. https://www.adea.org/godental/future_dental_hygienists/why_be_a_dental_hygienist_.aspx.

12. Corbella S, et al. Adverse pregnancy outcomes and periodontitis: a systematic review and meta-analysis examining the potential association. Quintessence Int.2016; 47: 193–204. doi: 10.3290/j.qi.a3498

13. Daalderop L, et al. Periodontal disease and pregnancy outcomes: a review of systematic reviews. JDR Clin. Translation competition. 2018; 3: 10–27. doi: 10.1177/2380084417731097.

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