Tailoring appointments: Pregnant patients

This RDH has many ways that she helps pregnant patients. Besides providing them with good oral care during their pregnancy, she starts them off on the road to motherhood with a few tips for the oral care of their babies. Find how what she recommends here.

Sep 1st, 2018
1809rdhmel P01

By Katie Melko, MSDH, RDH

I love having pregnant women in my chair for prophylaxes! It allows me to really hone in on proper home care for mother and child. Since most soon-to-be mothers are concerned about doing everything right, it is rare that they become upset when I review oral hygiene instructions.

By the time I finish explaining the importance of home care, they usually have many questions for me. This is a great opportunity to build rapport with patients and gain their trust. Let’s be honest; this interaction is something that often gets pushed aside because of the high demand placed on hygienists to produce and do more throughout the day.

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Pregnant patients

It is usually through the medical history that I find out a woman is pregnant. I like to ask a few questions to feel out whether the patient is happy about the pregnancy before I congratulate her. Most of the time the woman is happy, but I do have patients who aren’t exactly thrilled with the situation, and I have to respect that too. I usually ask how far along they are, when they’re due, if it is a high-risk pregnancy, and how they’re feeling.

Based on their answers, I can usually detect if the pregnancy is good news or not, and then I can continue on with boy or girl questions, offer congratulations, and more. It is always good to have the information about the patient’s obstetrician on file in case the dentist needs to consult with him or her about the patient’s case.

Unless the patient has sensitivity, I start the cleaning with the Cavitron. The ultrasonic is a good lavage treatment and usually soothing for the gingiva. After this, I hand scale, polish, floss, and finish with a post rinse. Through the years I’ve found that many pregnant patients don’t want mint-flavored paste because it makes them nauseous. So I offer other flavors, and most patients choose fruit flavors.

For pregnant patients who need scaling and root planing but don’t want it done, I give them information about the correlation between pregnancy and periodontal disease. Research has concluded that there are associations between “periodontitis and preterm birth, low birth-weight babies, low birth-weight babies born prematurely, and the development of preeclampsia.”1 Many patients have no idea that their oral health has anything to do with the rest of their body. I love having this opportunity to educate them on how oral health affects systemic health.

Here are my top five must-haves for pregnant patients:

1. Cavitron

2. Choices of flavored prophy paste

3. Post rinse with Listerine Total Care

4. Oral hygiene instructions and nutrition education

5. Recare plan

Recare

Recommending four-month recall appointments helps prevent pregnancy gingivitis. It also allows me to provide continuing education and discuss oral health with patients. I always tell pregnant patients that they can develop growths on the gingiva because of their increased hormones, and I explain how important it is to check their mouth regularly and recognize any abnormalities.

Home care

Many patients don’t realize how important it is to brush before bedtime. I always discuss the effects of oral bacteria that can develop when there is decreased saliva production during the night. This is new information for many patients, but even if I think they know the information, I talk about it anyway. Sometimes patients don’t know as much as I think they do, and sometimes it takes hearing the same thing multiple times before they grasp what they’re told.

I recommend brushing twice a day, flossing, and using a nonalcoholic mouthwash. If patients are suffering with morning sickness or have signs of erosion, I recommend they not brush immediately after vomiting and that they use baking soda and a water rinse to help neutralize the pH of their oral cavity.1 If patients are resistant to flossing, I recommend a Waterpik, which also helps with pregnancy gingivitis.

I also go over dos and don’ts for the baby. One of my favorites is not to clean the pacifier with their mouth; I explain how this can transfer bacteria to the baby.

Here are the top five topics I cover with pregnant patients:

1. Baby’s first dental visit

2. Not putting the baby to bed with a bottle

3. Wiping the baby’s gums with a washcloth

4. Not letting the baby stick his or her fingers in the mother’s mouth

5. Teething tips

Conclusion

Working with pregnant patients can be a challenge, but it can also be a great way to help mothers prepare for their baby’s birth and not feel overwhelmed. Obstetricians don’t always cover the basics of maternal and baby oral health, so this is often new information for expectant mothers. I always feel good after appointments with pregnant patients because I feel like I have helped educate them as well as cleaned their teeth. The thank yous and hugs are always a nice surprise, but nothing beats getting to meet the baby at the mother’s next appointment!

Now, go out there and tailor your appointments, and let me know if it helps make a difference in your day!

Reference

1. Oral Health Topics: Pregnancy. American Dental Association website. www.ada.org/en/member-center/oral-health-topics/pregnancy. Updated June 21, 2018. Accessed July 30, 2018.

Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She has practiced dental hygiene since 2009.

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