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.

Guideline on the role of Dental Prophylaxis in Pediatric Dentistry

Resident: Adam J. Bottrill
Date: 23MAR11
Region: Providence
Article title: Guideline on the role of Dental Prophylaxis in Pediatric Dentistry
Author(s): Clinical Affairs Committee
Journal: Pediatric Dentistry Reference Manual
Page #s: 141-142
Vol:No Date: 2010
Major topic: Prophylaxis
Minor topic(s): None
Type of Article: Guidelines

Main Purpose: Provide a guideline for the indications for and benefits of a dental prophylaxis in conjunction with periodic infant oral health assessment.

Key points in the article discussion:

I. General:

A. Microbial plaque is the primary etiological factor in caries and periodontal disease. MOST of this plaque can be removed with home hygiene, but MOST patients do not have the necessary skillz to remain plaque-free for long periods of time.

B. Indications:
1. Removal of plaque, stain, and calculus.
2. Elimination of factors that influence the build-up and retention of plaque.
3. Demonstration of proper oral hygiene methods to the pt/caregiver.
4. Facilitation of a thorough clinical exam.
5. Introduction of dental procedures to the child.

C. Type and frequency varies based on individual risk-assessment:
1. MH.
2. Age and cooperation.
3. Compliance.
4. Past and current caries.
5. FH of caries.
6. Past and current perio health.
7. FH of perio health.
8. OH.
9. Plaque.
10. Calculus.
11. Staining.
12. Local factors that would influence the build-up and retention of plaque.

D. Prophy can be performed with TB, cup, floss, instruments.
1. With no stain or calculus, TB is ok.
2. Rubber cup prophy for extrinsic staining and smoothing edges after scaling.
3. Rubber cup using pumice may be used prior to Fl Tx.
4. abrasive toothpastes and pumice may remove pellicle which may increase chances of enamel loss through exposure to dietary acids.
5. Pumice may remove up to 0.6-4.0 microns of outer enamel (includes the Fl-rich layer).

II. Recommendations:

A. Periodic Prophy should be performed to:
1. Instruct.
2. Remove plaque and calculus.
3. Polish hard surfaces.
4. Remove staining.
5. Facilitate the exam.
6. Introduce dental procedures to young children and apprehensive patients.

B. Practitioner should choose the least aggressive technique that fulfills the goals of the procedure. Least abrasive paste with light pressure.

C. If pumice or course past is used, Fl application indicated.

D. Patients at higher risk should have prophy at more frequent interval than 6 months.
1. Allows for OH monitoring and frequent Tx.

E. Individualized Tx plans are necessary.

Assessment of Article: Short and sweet and common sense. I suppose the AAPD needs to have this guideline, but it seems silly. I'm glad they didn't waste more than 2 pages.