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© Borgis - Nowa Stomatologia 4/2018, s. 159-165 | DOI: 10.25121/NS.2018.23.4.159
*Elżbieta Pels1, Angelika Kobylińska2, Magdalena Kukurba-Setkowicz3, Anna Szulik4, Renata Chałas5
Dental prophylaxis and treatment in pregnant women. Opinion of the working group of the Polish Alliance for a Cavity-Free Future on dental prophylaxis in pregnant women
Profilaktyka stomatologiczna i postępowanie lecznicze u kobiet w ciąży. Stanowisko grupy roboczej ds. profilaktyki stomatologicznej u kobiet w ciąży Polskiego Oddziału Sojuszu dla Przyszłości Wolnej od Próchnicy
1Chair of Developmental Age Stomatology, Department of Developmental Age Stomatology, Medical University of Lublin
Head of Department: Professor Maria Mielnik-Błaszczak, MD, PhD
2Department of Paediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
3NZOZ Dentist, Kraków
4Dental Practice “Uśmiech” in Zabrze
5Chair and Department of Conservative Dentistry with Endodontics, Medical University of Lublin
Head of Department: Barbara Tymczyna-Borowicz, MD, PhD
Streszczenie
Wstęp. Ciąża jest szczególnym okresem w życiu kobiety, w którym powinna dbać o zdrowie swoje i przyszłego potomka. Pod pojęciem „opieka prenatalna” kryje się kompleksowa i wielospecjalistyczna opieka zdrowotna nad kobietą ciężarną, rozwijającym się płodem, a następnie noworodkiem. Profilaktyka próchnicy w okresie ciąży ma za zadanie nie tylko chronić przyszłą matkę przed powstaniem ubytków próchnicowych, ale również jest profilaktyką próchnicy zębów u nienarodzonego jeszcze dziecka.
Cel pracy. Przedstawienie zaleceń na temat stomatologicznego postępowania profilaktyczno-leczniczego u kobiet w ciąży w odniesieniu do chorób jamy ustnej występujących u matki i dziecka.
Materiał i metody. Elektroniczne wyszukanie piśmiennictwa w medycznych bazach danych (Pubmed, EMBASE, MEDLINE) oraz ręczne cytowanego piśmiennictwa dotyczącego profilaktyki pierwotnie pierwotnej choroby próchnicowej i opieki stomatologicznej w czasie ciąży.
Wyniki. Dostępne piśmiennictwo wskazuje na bezpieczeństwo prowadzenia działań profilaktyczno-leczniczych w czasie ciąży, w tym stosowania środków znieczulenia miejscowego i stomatologicznej diagnostyki radiologicznej. Leczenie stomatologiczne wymaga modyfikacji uwzględniających zmiany zachodzące w ciąży, jednak może być prowadzone z korzyścią dla zdrowia matki i dziecka.
Wnioski. Opieka stomatologiczna nad kobietą ciężarną powinna obejmować przede wszystkim edukację, działania profilaktyczne oraz lecznicze, jeśli zajdzie taka konieczność. Przyszłym matkom należy uświadomić, że już w okresie płodowym można i trzeba dbać o zdrowie jamy ustnej dziecka.
Summary
Introduction. Pregnancy is a special period in the life of a woman, when she cares not only for her own health, but also for that of her unborn child. Prenatal care is defined as comprehensive and multidisciplinary care provided to a pregnant woman, developing foetus, and then a newborn. The aim of caries prevention in pregnancy is not only to protect the future mother from caries, but also to prevent the disease in the child.
Aim. The aim of the paper was to present the recommendations on preventive and therapeutic dental management in pregnant women with regard to oral diseases in the mother and her child.
Material and methods. Electronic search for literature in medical databases (Pubmed, EMBASE, MEDLINE) and manual search for literature on primary-primary prevention of dental caries and dental care in pregnancy.
Results. The available literature indicates the safety of preventive and therapeutic activities during pregnancy, including the use of local anaesthesia and dental diagnostic radiology. Although dental treatment requires some modifications due to pregnancy-related changes, it may be safely used for the benefit of the mother’s and the child’s health.
Conclusions. Dental care in pregnancy should be primarily dedicated to education, prevention and treatment, if needed. Future mothers should be made aware that the child’s oral health can and should be taken care of already in the prenatal period.
Introduction
Many studies on oral colonisation by cariogenic bacteria in children have demonstrated that the child’s parents, mothers in particular, are the source of these pathogens. It was found that maternal caries increases the risk of early-childhood caries (1-3).
Early colonisation of poorly mineralised deciduous teeth by Streptococcus mutans increases the risk of dental caries (2).
Based on these observations, “primary-primary prevention of dental caries” also known as “pre-prevention of dental caries” was developed to define procedures and instructions for pregnant women aimed at limiting the future severity of caries intensity in the unborn child. The risk of infection in the child may be estimated by assessing maternal oral health and hygiene, especially the severity of dental caries, including the number of active carious lesions (primary and secondary caries), as well as by collecting detailed history of dietary and hygiene habits. Salivary tests to measure maternal titres of cariogenic bacteria and dental plaque staining may be also helpful (1).
Women undergo many changes during pregnancy, mainly hormonal, immune and dietary changes as well as they experience gastrointestinal disorders. All these increase the risk of oral diseases and have an impact on the mode of dental treatment (4-10). Comprehensive dental treatment before pregnancy is most beneficial for the future mother and her child. Dental care of women at childbearing age should therefore include preparation for changes that occur in the oral cavity during pregnancy by educational, preventive and therapeutic activities as well as by providing information essential for the oral health care of newborns. Dentists or dental hygienists should be responsible for providing information on the prevention against dental caries and periodontal diseases, while the implementation of these guidelines and their incorporation in everyday life will depend on the level of understanding of the problem and the conscientiousness of the patients (11-13). Factors that have an impact on the global dental attendance include regular use of dental care before pregnancy, the level of knowledge on oral health and its impact on both pregnancy and child, as well as the conviction about the safety of dental treatment in pregnancy (14-18).
Aim
The aim of the paper was to present guidelines on dental preventive and therapeutic management in pregnant women with regard to oral diseases in the mother and her child.
Material and methods
A review of literature and the recommendations of the World Health Organisation and teams of experts on dental care in pregnancy was performed. Medical databases such as Pubmed, EMBASE, MEDLINE were searched using the following keywords: “primary-primary prevention”, “dental care in pregnan”, “oral health in pregnan”, “dental treatment in pregnan”. The following filters were used: English and Polish language, original papers, review papers, recommendations, and guidelines. Based on literature analysis, recommendations for pregnant women on dental prevention and treatment were developed.
The literature review was performed by the working group of the Polish Alliance for a Cavity-Free Future on dental prophylaxis in pregnant women.
Results
Dental care in pregnancy focuses on three main aspects: preventive measures, therapeutic measures, health promotion.
Collaboration between the gynaecologist and dentist should be the leading principle of health care for pregnant women as health protection in pregnancy requires continuous dental care combined with periodic prenatal check-ups. A questionnaire conducted among 3,439 Polish women up to 5 years after childbirth has demonstrated the important role of the attending obstetrician in increasing the proportion of pregnant women using dental care; a referral from the doctor increased the probability of visiting a dentist (OR = 5.20 (4.05-6.67); p < 0.001). Even higher effectiveness was shown when a written feedback on oral health was required from the dentist (OR = 2.19 (1.3-3.66); p = 0.003) (17, 18). Health education of women, which may help change inappropriate behaviours that promote caries, periodontal and oral mucosa diseases both in women and their future offspring, is equally important. Pregnant women should be informed on this fact as soon as possible to reach an adequate level of awareness and motivation to improve oral hygiene (16, 19, 20).
If inflammatory lesions are found in the oral cavity, these should be eliminated before or during pregnancy.
The following dental aspects should be considered when planning pregnancy:
– elimination of infection foci – the teeth without vital pulp should either be subject to appropriate endodontic treatment or removed,
– elimination of active carious lesions (through the use of fluoride-releasing materials, such as glass-ionomer cements, as long-term temporary fillings for high activity),
– elimination of gingival and oral mucosa inflammatory lesions,
– professional removal of dental deposits,
– fluoride prophylaxis,
– implementation of appropriate eating and hygiene habits.
Preventive actions
Dental prophylaxis in pregnant women involves preventing dental caries, acid erosion of enamel and periodontal diseases (4, 6, 13, 21-23).
Preventive measures in pregnancy are aimed at reducing the levels of cariogenic bacteria and delaying colonisation of the child’s oral cavity with cariopathogens by:
– oral rinsing with 0.12% chlorhexidine solution for 2 weeks, 10-15 mL, twice daily for 30 seconds,
– local application of fluoride compounds (the use of 1450 ppm fluoride toothpaste twice daily, daily use of an oral rinse containing 225 ppm F (0.05% NaF)) – endogenous fluoridation is not recommended (23),
– the use of soft tooth brushes and mild cleaning agents,
– cleaning the surface of the tongue (the deposit on the tongue contains microbes and exfoliated epithelial cells, which are a reservoir for dental plaque),
– the use of xylitol chewing gum 2-3 times daily after meals (5 minutes) (24),
– promoting healthy behaviours, such as avoiding behaviours increasing the risk of transmission of cariogenic bacteria to the child’s oral cavity,
– professional procedures: removal of dental deposits, application of chlorhexidine-containing varnish or fluoride-containing compounds (foams, varnishes, gels),
– implementation of appropriate eating and hygiene habits,
– the use of alkaline oral rinses and enamel remineralisation agents to reduce the risk of acidic enamel erosion.
Dental treatment in pregnancy
At least two dental visits should take place during pregnancy followed by regular visits every 6 months after delivery in the absence of therapeutic needs. The first visit should be planned at 3-4 months of pregnancy, the second one at 8 months of pregnancy. Considering the risk of toxicity of certain medications during organogenesis and the physical state of the pregnant woman (somnolence, nausea, vomiting) in the first trimester (until 12-13 weeks), an assessment of oral health and the risk of caries along with the estimation of patient’s therapeutic needs is recommended. It is also the right time for education about changes occurring in the woman’s body, appropriate hygiene and controlling dental plaque, as well as prevention of periodontal diseases and local application of fluoride compounds.
The second trimester of pregnancy (14-27 weeks) is an optimal period for dental procedures (if needed).
In this period, the woman’s body is adapted to physiological hormonal changes, the organogenesis is completed, and the risk of premature birth is relatively low.
The recommendations are as follows:
– instructions on hygiene and dental plaque control,
– professional removal of dental deposits in accordance with indications,
– control over disease activity,
– treatment of dental caries and pulp diseases, tooth extractions (4, 6, 7, 22, 25).
These activities should be continued in the first half of the third trimester, however, in the second half stressful situations should be avoided, due to the increasing discomfort resulting from increasing uterine size due to the growing foetus and the risk of inferior vena cava syndrome.
Regardless of the stage of pregnancy, a pregnant woman should be provided with maximum comfort by reducing the time of procedure, ensuring appropriate body position and the possibility to change the position or use the toilet during the visit, as well as by avoiding stressful situations, e.g. by eliminating pain (the use of local anaesthetics, nitrous oxide) (26-28).
Prosthetic and orthodontic treatment, as well as scheduled surgical procedures (implants, gouging of impacted teeth) and teeth whitening procedures should be delayed until after delivery.
Prevention of periodontal diseases

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Piśmiennictwo
1. Dacyna N, Trzaska M, Zawadzka A et al.: Wskaźniki wysokiej liczebności bakterii kariogennych u kobiet ciężarnych. Nowa Stomatol 2017; 22: 63-72.
2. Mitchell SC, Ruby JD, Moser S et al.: Maternal transmission of mutans Streptococci in severe-early childhood caries. Pediatr Dent 2009; 31(3): 193-201.
3. Finlayson TL, Gupta A, Ramos-Gomez FJ: Prenatal Maternal Factors, Intergenerational Transmission of Disease, and Child Oral Health Outcomes. Dent Clin North Am 2017; 61(3): 483-518.
4. Oral Health During Pregnancy and Early Childhood: Evidence-Based Guidelines for Health Professionals. February 2010; http://www.cdafoundation.org/portals/0/pdfs/poh_guidelines.pdf (data dostępu: 10.09.2018).
5. Gon?czowski K, Gandurska-Dyga M, Go?rnik N et al.: Ocena stanu zdrowia jamy ustnej u kobiet ciężarnych. Analiza wybranych wskaz?niko?w. Por Stomat 2005; 10: 27-32.
6. California Dental Association Foundation; American College of Obstetricians and Gynecologists, District IX: Oral health during pregnancy and early childhood: evidence-based guidelines for health professionals. J Calif Dent Assoc 2010; 38: 391-440.
7. Kalińska A, Olczak-Kowalczyk D: Opieka stomatologiczna w czasie ciąży. Med Dypl 2014; 3: 33-43.
8. Barak S, Oettinger-Barak O, Oettinger M et al.: Common oral manifestations during pregnancy: a review. Obstet Gynecol Surv 2003; 58: 624-628.
9. Podsiadło-Urban G, Kiernicka M, Wysokińska-Miszczuk J: Wpływ estrogenów i progesteronu na stan przyzębia w poszczególnych okresach życia kobiety – przegląd piśmiennictwa. Dent Med Probl 2010; 47: 89-96.
10. Naseem M, Khurshid Z, Ali Khan H et al.: Oral health challenges in pregnant women: Recommendations for dental care professionals. SJDR 2016; 7: 138-146.
11. Opydo-Szymaczek J, Borysewicz- Lewicka M: Opieka stomatologiczna nad kobietą w aspekcie profilaktyki próchnicy – na podstawie piśmiennictwa. Czas Stomatol 2005; 58: 188-193.
12. Mędrala-Kuder E: Wybrane zwyczaje żywieniowe kobiet w ciąży. Roczn PZH 2006; 57: 389-395.
13. American Academy of Pediatric Dentistry, AAPD: Guideline on Perinatal Oral Health Care. Chicago, Illinois: American Academy of Pediatric Dentistry, 2011; http://www.aapd.org/media/Policies_Guidelines/G_PerinatalOralHealthCare.pdf (data dostępu: 10.09.2018).
14. Saddki N, Yusoff A, Hwang YL: Factors associated with dental visit and barriers to utilisation of oral health care services in a sample of antenatal mothers in Hospital Universiti Sains Malaysia. BMC Public Health 2010; 10: 75.
15. Keirse MJNC, Plutzer K: Women’s attitudes to and perceptions of oral health and dental care during pregnancy. J Perinat Med 2010; 38: 3-8.
16. Thomas N, Middleton P, Crowther C: Oral and dental health care practices in pregnant women in Australia: a postnatal survey. BMC Pregnancy Childbirth 2008; 8: 13.
17. Kobylińska A, Sochacki-Wójcicka N, Dacyna N et al.: The role of the gynaecologist in the promotion and maintenance of oral health during pregnancy. Ginekol Pol 2018; 89(3): 120-124.
18. Kobylińska A, Sochacki-Wójcicka N, Gozdowski D et al.: Opieka stomatologiczna w czasie ciąży w Polsce. Postnatalne badanie ankietowe. Nowa Stomatol 2018; 23(1): 18-24.
19. Boggess KA, Urlaub DM, Massey KE et al.: Oral hygiene practices and dental service utilization among pregnant women. J Am Dent Assoc 2010; 141(5): 553-561.
20. Al Khamis S, Asimakopoulou K, Newton T, Daly B: The effect of dental health ducation on pregnant women’s adherence with toothbrushing and flossing – A randomized control trial. Community Dent Oral Epidemiol 2017; 45: 469-477.
21. Olczak-Kowalczyk D, Wagner L: Zapobieganie i leczenie choroby próchnicowej u dzieci. Borgis, Warszawa 2013: 25-32.
22. Kumar J, Samelson R: Oral health care during pregnancy recommendations for oral health professionals. N Y State Dent J 2009; 75: 29-33.
23. Takahashi R, Ota E, Hoshi K et al.: Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children. Cochrane Database Syst Rev 2017; 10: CD011850.
24. Nakai Y, Shinga-Ishihara C, Kaji M et al.: Xylitol gum and maternal transmission of mutans streptococci. J Dent Res 2010; 89(1): 56-60.
25. Kurien S, Kattimani VS, Sriram R et al.: Management of Pregnant Patient in Dentistry. J Int Oral Health 2013; 5: 88-97.
26. Gończowski K: Leki stosowane do znieczuleń miejscowych w stomatologii. e-Dentico 2014; 4: 24-33.
27. American Academy of Pediatrics Committee on Drugs: Transfer of drugs and another chemicals into human milk. Pediatrics 2001; 108: 776-789.
28. Cengiz SB: The pregnant patient: considerations for dental management and drug use. Quintessence Int 2007; 38: e133-142.
29. Wu M, Chen SW, Su WL et al.: Sex Hormones Enhance Gingival Inflammation without Affecting IL-1β and TNF-α in Periodontally Healthy Women during Pregnancy. Mediators Inflamm 2016; 2016: 4897890.
30. Food and Drug Administration: Labeling and prescription drug advertising: Content and format for labeling for human prescription drugs. Fed Regist 1979; 44: 37434-37467.
31. American Dental Association Council on Scientific Affairs, U.S. Department of Health and Human Services; Public Health Service Food and Drug Administration: Dental radiographic examinations: recommendations for patient selection and limiting radiation exposure. Revised 2012; https://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm116504.htm (data dostępu: 10.09.2018).
32. Michalowicz BS, DiAngelis AJ, Novak MJ et al.: Examining the safety of dental treatment in pregnant women. J Am Dent Assoc 2008; 139(6): 685-695.
otrzymano: 2018-10-16
zaakceptowano do druku: 2018-11-06

Adres do korespondencji:
*Elżbieta Pels
Zakład Stomatologii Wieku Rozwojowego Katedra Stomatologii Wieku Rozwojowego Uniwersytet Medyczny w Lublinie
ul. Karmelicka 7, 20-081 Lublin
tel.: +48 (81) 532-06-19
elzbieta.pels@umlub.pl

Nowa Stomatologia 4/2018
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