Spring 2022 www.nvda.org 21 Regarding Medications • Anesthetics such as 2% lidocaine with 1:100,000 epinephrine are acceptable for use. • Antibiotics such as penicillin agents, cephalosporins, and clindamycin are appropriate for non-allergic patients. • Antifungals such as nystatin are well tolerated. • Analgesics such as acetaminophen and opioids such as short use of codeine or Percocet are okay for use during pregnancy. Oral radiographs are not contraindicated during pregnancy. Exposure should be limited via attempts to decrease the number of x-ray exposure and via appropriate shielding of the abdomen and thyroid.6 Prenatal care providers should be consulted, when possible, over the need for IV sedation or anesthesia.5 Clinical Conditions Restorative treatments for conditions such as extractions, root canal, or treatment of dental caries do not have increased risk during the second trimester onward.7 Periodontal disease is associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and preeclampsia.8 However, meta-analysis has shown a non-significant reduction in PTB or LBW with the treatment of periodontal disease with scaling and root planning.9 Nonetheless, treatment during pregnancy may decrease cariogenic bacterial infection from either parent to the child by mouth-tomouth transmission from something as innocent as sharing utensils. The CDC and the American Academy of Pediatrics have worked to create a health communications resource for providers called Protect Tiny Teeth (https://www.aap.org/en/news-room/ campaigns-and-toolkits/oral-health/). Periodontal disease should be aggressively treated in the reproductive age female due to its effects upon pregnancy and childhood dental caries. This should especially be aggressive due to the mixed results of treatment during pregnancy. Interestingly, a recent abstract from the February 2022 Society for Maternal Fetal Medicine showed a 24% reduction in preterm birth and a significant reduction in periodontal disease using xylitol-based gum products when used twice daily in a population with a high incidence of periodontal disease.10 Social Determinants of Health and Oral Health Disparities in oral health are often associated with social factors related to wealth, education, and social status. For example, adults with lower education status have three times the incidence of dental caries and periodontal disease. Patients without dental insurance have lower rates of preventative cleanings and check-ups. Lack of affordable and accessible transportation also affects the ability to seek care. The dental community has had a slower progression to implementation of value- based, even more so than their fellow medicine colleagues, and is still highly stuck in a fee-for-service environment. Modern dental education centers are focusing more on these critical sociologic, educational, and demographic factors that impede care and harm access. Dental health professionals play a critical role in promoting health equity and reducing the burden of overall dental diseases and their effects upon pregnancy.11 Summary • Oral health is an essential driver of physical health and well-being, and poor oral health is associated with abnormal pregnancy outcomes. • Preventative procedures and treatment of oral health conditions should not be withheld during pregnancy. • Routine medications, radiographs, and treatment and prophylaxis of dental conditions should be performed and are not associated with worsening pregnancy outcomes. • Anesthetics and sedation should be discussed with the patient’s obstetric caregiver. • Routine prophylactic care and treatment in low-risk patients without co-occurring medical conditions and procedures not requiring sedation or anesthesia should not be withheld from patients and may exacerbate, delay, and irreparably stop treatment of conditions. Utilizing barriers such as unnecessary obstetrical waivers for routine care and treatment increases patients’ struggles and exacerbates unfair differences due to social determinants of health. 0 References 1) Dietrich T, Webb I, Stenhouse L, Pattni A, Ready D, Wanyonyi KL, White S, Gallagher JE. Evidence summary: the relationship between oral and cardiovascular disease. Br Dent J. 2017 Mar 10;222(5):381-385. doi: 10.1038/ sj.bdj.2017.224. PMID: 28281612. 2) Manger D, Walshaw M, Fitzgerald R, Doughty J, Wanyonyi KL, White S, Gallagher JE. Evidence summary: the relationship between oral health and pulmonary disease. Br Dent J. 2017 Apr 7;222(7):527-533. doi: 10.1038/ sj.bdj.2017.315. PMID: 28387268. 3) D’Aiuto F, Gable D, Syed Z, Allen Y, Wanyonyi KL, White S, Gallagher JE. Evidence summary: The relationship between oral diseases and diabetes. Br Dent J. 2017 Jun 23;222(12):944-948. doi: 10.1038/sj.bdj.2017.544. PMID: 28642531. 4) Corbella S, Taschieri S, Del Fabbro M, Francetti L, Weinstein R, Ferrazzi E. Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association. Quintessence Int. 2016 Mar;47(3):193-204. doi: 10.3290/j.qi.a34980 5) Oral Health Care During Pregnancy Expert Workgroup. Oral health care during pregnancy: a national consensus statement—summary of an expert workgroup meeting. Washington, DC: National Maternal and Child Oral Health Resource Center; 2012. 6) American Dental Association Council on Scientific Affairs. The use of dental radiographs: update and recommendations. J Am Dent Assoc 2006;137:1304–12. 7) Michalowicz BS, DiAngelis AJ, Novak MJ, et al. Examining the safety of dental treatment in pregnant women. J Am Dent Assoc 2008;139:685–95. 8) Daalderop LA, Wieland BV, Tomsin K, et al. Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews. JDR Clin Trans Res. 2018;3(1):10-27. doi:10.1177/2380084417731097 9) Kim AJ, Lo AJ, Pullin DA, et al. Scaling and root planing treatment for periodontitis to reduce preterm birth and low birth weight: a systematic review and meta-analysis of randomized controlled trials. J Periodontol 2012;83:1508–19. 10) Kjersti M. Aagaard, Gregory C. Valentine, Kathleen M. Antony, Haleh Sangi-Haghpeykar, Rose Chirwa, Mary Dumba, Saukani Petro, Debora Nanthuru, Cynthia Shope, Jesse Mlotha-Namarika, Jeffrey Paul Wilkinson, Joshua Aagaard, Ellen J. Aagaard, Maxim D. Seferovic, Judy Levison, LB 1: PPaX: Cluster randomized trial of xylitol chewing gum on prevention of preterm birth in Malawi, American Journal of Obstetrics and Gynecology, Volume 226, Issue 1, Supplement, 2022, Page S777, ISSN 0002-9378. 11) Tellez, M., Zini, A. & Estupiñan-Day, S. Social Determinants and Oral Health: An Update. Curr Oral Health Rep 1, 148–152 (2014). https://doi. org/10.1007/s40496-014-0019-6. NDA President’s Message
RkJQdWJsaXNoZXIy Nzc3ODM=