Pregnancy is an exciting and challenging time. The onset of pregnancy initiates hormonal fluctuations that are immediately noticeable.1 Immunological changes also occur that increase susceptibility to gingival and periodontal diseases.
The oral health changes that can occur are not limited to conditions such as dental erosion, periodontal diseases, and pregnancy-specific oral lesions.2 Therefore, emphasizing the importance of the whole-body health of new mothers should include having regular oral health evaluations to educate, monitor, or treat any oral conditions.
Outdated beliefs and evolving guidelines
Previous guidelines for nonemergency dental or dental hygiene care for pregnant patients were restricted to the second trimester. This was thought to be the safest time due to neurological development of the fetus.3 In 2012, the American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA) issued a consensus statement that was a guideline for obstetricians and dentists that stated that dental treatment was safe throughout pregnancy.4
These guidelines encourage early dental examination and treatment and emphasize taking a complete oral health history, examining the mouth for oral problems, counseling pregnant women on oral health, and scheduling a consultation with the dentist as early as possible.
Disconnect between guidelines and practice
While educated in oral health, many OB/GYNs do not provide oral health assessments for patients. Conversely, many women do not seek oral health care during gestation and seem unaware of current guidelines.5 Despite the recommended guidance for routine oral health care services for women during their entire pregnancy, most dentists are not comfortable treating them without clearance from the obstetrician.
Data from the Pregnancy Risk Assessment Monitoring System in 10 states indicates that 56% of mothers did not receive dental care during their most recent pregnancy.6 This could be a result of minimal or complete absence of education about the importance of oral health care services for mothers during pregnancy.
Barriers for providers and patients
Despite changes in guidance, many dentists are still not comfortable treating pregnant women without clearance from the woman’s obstetrician. Some of the apprehension to treat outside the second trimester is because this is the trimester when the most fetal maturation occurs.
Obstetricians are educated about the value of dental care during pregnancy. Despite this knowledge, limited referrals for dental services or oral screenings are performed by obstetricians. They are sometimes faced with barriers that prevent them from referring for dental care.
Barriers to mothers receiving dental care during pregnancy include financial barriers due to associated costs to dental care, lack of knowledge and misbeliefs, dental anxiety, lack of time, dentist unwillingness to treat a woman while pregnant, and the lack of collaboration between health-care providers.7
The need for awareness and integration
To bridge this disconnect, providers and patients must be informed about the safety and importance of oral health care during all stages of pregnancy. Increasing mothers' awareness, better communication between health-care providers, and a developing confidence in dental providers are all crucial to improving access and outcomes for perinatal women.
Studies must continue to explore pregnant women's awareness and perceptions of oral health, the role of OB/GYNs in making referrals, and the barriers that keep women from receiving care. Empowering both dental and medical professionals with up-to-date knowledge and fostering collaboration between them can ensure that oral health becomes a standard part of prenatal care.
References
1. Moore J, Blair F. Periodontal health and pregnancy. Brit J Midwifery. 2017;25(5):289-292. doi:10.12968/bjom.2017.25.5.289
2. Silva de Araujo Figueiredo C, Gonçalves Carvalho Rosalem C, Costa Cantanhede AL, et al. Systemic alterations and their oral manifestations in pregnant women. J Obstet Gynaecol Res. 2017;43(1):16-22. doi:10.1111/jog.13150
3. Livingston HM, Dellinger TM, Holder R. Considerations in the management of the pregnant patient. Spec Care Dent. 1998;18(5):183–188.
4. Onwuka C, Onwuka CI, Iloghalu EI, et al. Pregnant women utilization of dental services: still a challenge in low-resource setting. BMC Oral Health. 2021;21(1). doi:10.1186/s12903-021-01746-2
5. Steinberg BJ, Hilton IV, Iida H, Samelson R. Oral health and dental care during pregnancy. Dent Clins No Amer. 2013;57(2):195-210.
6. Oral health during pregnancy and through the lifespan. The American College of Obstetricians and Gynecology. August 2013. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/08/oral-health-care-during-pregnancy-and-through-the-lifespan
7. Bahramiam H, Mohebbi SZ, Khami MR, Quinonez RB. Qualitative exploration of barriers and facilitators of dental service utilization of pregnant women: a triangulation approach. BMC Pregnancy Childbirth. 2018;18(5):153. doi:10.1186/s12884-018-1773-6
