What to expect when you're expecting

My 33-year-old female patient told me there were no changes in her medical history when I asked about any updates at her recare visit. I told her that since we had taken radiographs at her previous appointment and there were no apparent problems, we would not take x-rays today. She replied, “Good!” This patient normally has an excellent home-care presentation, and there is very little work for me to do at her cleanings.

As I looked at her mouth, these conditions appeared consistent. However, when I probed and performed her debridement, there was definitely more bleeding than usual. Something about her tissues seemed off. I found myself thinking about her three-year-old son and wondering when or if she and her husband were going to try for a sibling for little Joey. My intuition was speaking loud and clear, and I blurted, “Linda, is there any way you could be pregnant?” She looked at me in amazement and said, “How did you know that?”

I told her it was a hunch based on the bleeding I was seeing. She divulged that she was indeed 11 weeks into her pregnancy. Her reason for not sharing the information was that she and her husband had not yet told anyone, even family. When she saw that I was not going to take radiographs, she felt that she could keep the information to herself.

I explained why it is so important that we be made aware of any changes in our patients’ health histories. I took advantage of my newfound knowledge to educate her in whatever ways I could regarding all that is important in terms of prenatal oral care. She was still reeling from my discovery. I have to say I was shocked that someone who I have been treating on and off for six years would hold back such information. Now it makes me wonder how many times this has happened before with a pregnancy, or any condition for that matter. Probably more than I imagine. The recurrent theme among patients seems to be that nothing in the mouth has any connection to their systemic health.

I told her about her hormonal changes and how they could potentially contribute to an exaggerated tissue response to biofilm in the mouth, hence my seeing more bleeding as I probed and cleaned. Since she had been experiencing morning sickness, I spoke with her about the impact that vomiting can have on her teeth. I gave her suggestions about how she might minimize her nausea, and explained how important it was for her to wait to brush after any episode, and that rinsing immediately with baking soda and water to neutralize was the safer option. I talked about the pH changes that can happen in the mouth during pregnancy, and some of the ways that we can help compensate for such changes.

I moved on to my next patient, still in disbelief that an educated, responsible, newly pregnant patient would not divulge her condition until I prompted her.

Linda left chock-full of new information and some practical tips to apply immediately. I moved on to my next patient, still in disbelief that an educated, responsible, newly pregnant patient would not divulge her condition until I prompted her.

On a semirelated note, in my recent “Whine away your clinical challenges” seminar, two RDHs from different offices mentioned that they dismissed pregnant patients in their first trimester because the patients’ obstetricians refused to offer “clearance” for the women to have routine dental cleanings until they were in their second trimesters. What?! I was flabbergasted and had never heard of such a thing. I thought back to the number of times I had provided cleanings for women who were in early pregnancy. It would not have occurred to me to attain clearance from the obstetrician. Was this a new protocol that I was not yet aware of?

I realized that this might be a fear of liability rearing its ugly head, e.g., the pregnant woman has her teeth cleaned at nine weeks, then suffers a miscarriage at 10 weeks. While the two incidents likely have no connection, the obstetrician does not want to face potential litigation for approving the professional dental cleaning. Never mind that the woman might have inflammation in her mouth that needs to be addressed, and that there is research linking oral inflammation with low birth weight babies and preterm deliveries.1 It’s true the research is not conclusive, but the fact that any EBR exists at all is a reason for pregnant women to have all possible tools in place. Minimize as much harmful oral bacteria as possible professionally, and then educate about the importance of self-care during a time when hormones can wreak havoc.

It’s a sad commentary when a fear of litigation beats out any counseling that promulgates best care for patients. We need to push for ongoing awareness from the medical community about the importance and impact of prenatal oral care. Onward we go; it is in our hearts’ core!

EILEEN MORRISSEY,RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Rowan College at Burlington County. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.

Reference

1. Cobb CM, Kelly PJ, Williams KB, Babbar S, Angolkar M, Derman RJ. The oral microbiome and adverse pregnancy outcomes. Int J Women’s Health. Published August 8, 2017. Accessed December 22, 2017.