03/23/2011 Guideline on Perinatal Oral Health Care

Resident: J. Hencler
Date: 03/23/2011

Article title: Guideline on Perinatal Oral Health Care
Author(s): AAPD Council on Clinical Affairs
Journal: AAPD Reference Manual V32/NO6 10/11

Type of Article: Review/Reference/Guidelines

Main Purpose:
Propose recommendations for perinatal oral healthcare (POH), including caries risk assessment, anticipatory guidance (AG), preventative strategies, and appropriate therapeutic intervention.

Key points in the article discussion:
The perinatal period begins w/ the completion of the 20-28th wk of gestation and ends 7-28 days after birth. POH is important in the overall health of pregnant women as well as in their baby. Research continues to show links b/t perio disease and adverse outcomes in pregnancy including preterm deliveries, low birth weight, and preeclampsia. Mothers w/ poor OH and high levels of cariogenic bacteria are at risk for infecting their children resulting in a high caries risk at an early age. The primary goal of POH is to reduce and delay for as long as possible caries transmission of S. Mutans (MS). Physicians, nurses, and other health care professional see expectant mother and their infants more often than dentists and should be aware of the infectious etiology and associated risk factors of ECC.

POH and CARIES:
MS colonization of infants has been shown to occur from time of birth. Vertical colonization from mother to infant is well documented. Recent reports have indicated horizontal transmission from siblings may be a concern. The goal of caries risk assessment is to prevent disease by identifying and minimizing causative factors while optimizing protective factors. The early establishment of a dental home by 12 months of age provides critical opportunities to implement OH practices including, a caries risk assessment and to identify and reduce caries risk.

POH and AG:
AG for mothers may help delay the onset and reduce the impact of MS colonization of the infant. AG should include 1) OH education and 2) OHI. Mothers with severe perio disease have high levels of prostaglandins in their gingival crevicular fluid and blood that may be associated w/ uterine contractions leading to preterm deliveries. 3) Diet and nutritional evaluation should be discussed. 4) Daily fluoride should be promoted and 5) routine professional dental care/tx is safest to perform during the second trimester (14th-20th wk). Consult w/ PCP or Ob/Gyn is recommended. Lastly, 6) Delay of MS colonization should be discussed. The dentist should promote reducing maternal MS levels and delaying MS transmission through behavior guidance and preventative OH practices that promote good OH and overall health for mother and child.

Assessment of article: Great review. Guidelines are fun and we need the know them inside and out.