Dental clinical care during pregnancy

The FDI World Dental Federation’s new definition of oral health emphasizes the relevance of oral health in promoting a healthy, good quality of life through science-based practie¹. It is recommends that the mother is supported by a comprehensive health care team, such as an obstetrician, a nutritionist, a physiologist if necessary, and that a dentist joins efforts to adjust the diet of the pregnant woman and to evaluate her dental condition. The dentist should not only eliminate any source of infection, but also treat periodontal disease, which if left untreated can be a risk factor for premature birth².

Prenatal dental care should provide preventive and curative actions during the gestational period, promoting health and improving the quality of life for both mother and child. The dentist must investigate oral changes and diseases during dental anamnesis and clinical examination. He/she must pay attention to gestational changes, such as salivary alterations, periodontal disease, gingival hyperplasia, pregnancy granuloma, dental caries and dental erosion due to vomiting. This is done to better interact with the pregnant woman, encouraging her to incorporate good oral health habits in the family routine³.

The inclusion of activities designed to promote oral health from an early age requires motivation from the Dentists Team Work to encourage pregnant women; early parents or caregivers to provide a health environment for their babies and children. The success of these actions requires the creation of a bond of trust and respect between the family, obstetrician, dentist, pediatrician and pediatric dentist, working together, from pregnancy or early childhood. The success of these actions requires the creation of a bond of trust and respect between the family, obstetrician, dentist, pediatrician and pediatric dentist, working together, from pregnancy or early childhood ^{3, 4}.

 Women should be encouraged to seek routine dental care during pregnancy⁵. Dental visits should be encouraged as part of safe and effective prenatal care. The dentist must ensure that the following points form part of the treatment plan^3,6,7,8:

• Develop and discuss the treatment plan, clarifying benefits, risks and alternative procedures
• Provide emergency care at any time, regular and emergency dental care is safe at any stage of pregnant 6
• Perform dental prophylaxis, allowing the proper diagnosis of caries and intervene with preventive strategies
• Althought local anesthetics are considered safe for use during the whole gestational period, and lidocaine 2% with epinephrin (1:100,000 or 1:200,000) should be the first choice, it should be used carefully.
• For Digital or common radiography an abdominal lead apron with thyroid protector must be used;
• Periodontal treatment performed before and/or during pregnancy may avoid potential maternal-fetal risks
• Reassure women that oral health care, including use of radiographs, pain medication, and local anesthesia, is safe throughout pregnancy; periodontal scaling, root planning and tooth polishing can all be performed; elective treatment is safe when appropriately indicated⁷
• Always provide information about good habits and care to promote the baby’s oral health, educating the mother and providing anticipatory guidance to improve oral health during and after pregnancy⁸
• Advice and motivate parents and caregivers to carry out correct at home baby’s oral health; this should include brushing as soon as the first tooth erupts.
• Parents and caregivers should be instructed that breastfeeding is the best source of nutrition for the newborn and infant; however, this needs to be handled sensitively in each case to ensure that both mother and baby are comfortable with the process and healthy

¹ https://www.fdiworlddental.org/advocacy-strategy-FDI’s definition of oral health, [accessed Jun 01 2022].

² Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. J Am Dent Assoc. 2016; Dec;147(12):915-917. doi: 10.1016/j.adaj.2016.10.001. https://www.who.int/news-room/feature-stories/detail/landmark-global-strategy-on-oral-health-adopted-at-world-health-assembly-75, [accessed Jun 01 2022].

³ Ruiz DR;Groisman,S. A promoção da saúde oral materno-infantil integrada à clínica pediátrica.Tratado de Pediatria 5.ed.Sociedade Brasileira de Pediatria. ISBN 9786555764222.V 2, Section 39,Cahpter 1, from page 1456 to 1461,may,2022.

⁴ Ruiz DR, Groisman S. Pregnant dental clinical protocol. In:Andrade DJC, Ruiz DR, Groisman S, coordinators.Promotion of maternal and child oral health. [ebook on the Internet]. São Paulo; 2022. 195 p. Available from: http://www.diferencas.net/. ISBN 9798428370911. (PDF) PROMOTION OF MATERNAL AND CHILD ORAL HEALTH. Available from: https://www.researchgate.net/publication/360268526_PROMOTION_OF_MATERNAL_AND_CHILD_ORAL_HEALTH#fullTextFileContent [accessed Jun 01 2022].

⁵ Oral Health During Preganacy – A National Consensus.PDF. https://www.mchoralhealth.org/PDFs/OralHealthPregnancyConsensus.pdf(acessed august 23th.)

⁶ Center of Disease Control states, “Regular and emergency dental care is safe at any stage of pregnancy. https://www.cdc.gov/oralhealth/fast-facts/pregnancy/index.html#:~:text=Children%20with%20poor%20oral%20health,school%20because%20of%20dental%20pain.&text=Regular%20and%20emergency%20dental%20care%20is%20safe%20at%20any%20stage%20of%20pregnancy.&text=Women%20are%20encouraged%20to%20seek%20routine%20dental%20care%20during%20pregnancy. .(Acessed august 23th.)

⁷ Oral Health Care During Pregnancy Expert Workgroup. Oral Health Care During Pregnancy: A National Consensus Statement. Washington, DC: National Maternal and Child Oral Health Resource Center; 2012. https://www.cdc.gov/oralhealth/fast-facts/pregnancy/index.html#:~:text=Children%20with%20poor%20oral%20health,school%20because%20of%20dental%20pain.&text=Regular%20and%20emergency%20dental%20care%20is%20safe%20at%20any%20stage%20of%20pregnancy.&text=Women%20are%20encouraged%20to%20seek%20routine%20dental%20care%20during%20pregnancy..(Acessed august 23th.)

⁸ American Academy of Pediatric Dentistry-https://www.aapd.org/research/oral-health-policies-recommendations/oral-health-care-for-the-pregnant-adolescent/, [accessed Jun 01 2022].