Chapter 1: Prenatal, Perinatal and Early Childhood Oral Health Flashcards
Prenatal, Perinatal and Early Childhood Oral Health
1
Q
Definition of prenatal development stage
A
- relates to pregnant women and occurring before birth
- marked by weeks from first day of last menstrual period; conception 2 weeks after last period
- mean duration of pregnancy = 280 days (40 weeks)
- term: period from 36 weeks to 41 weeks + 6 days
- preterm: 20 weeks to 36 weeks
- low birth weight: infants weighing less than 2500g at birth
2
Q
Definition perinatal/neonatal development stage
A
Refers to mother and/or fetus from 20th week of gestation through 4 weeks post-partum or 28 days extra-uterine life
3
Q
Definition of infant development stage
A
Child aged 1 month to 12 months
4
Q
Definition of toddler development stage
A
- Originated as term to describe child learning to walk
- Child from age 1 to 36 months
5
Q
Prenatal Oral Health
A
- 3.9 million births in 2014 in US
- 4.1 million predicted in 2020
- ~half unplanned pregnancy (dental providers need to be aware of this population)
6
Q
Steps in oral health care during pregnance
A
- Understanding implications of pregnancy on oral health
- Implications of oral health on pregnancy
- Protocol for prenatal providers
- Protocol for dental professionals
7
Q
Implications of pregnancy on oral health
A
- Women more susceptible to oral disease secondary to hormonal changes
- Normal changes = nausea, vomiting, gastroesophageal reflux, friable gingival tissue
- Normal changes can increase risk for dental caries, gingival/periodontal disease, infection and erosion
8
Q
Implications of oral health on pregnancy
A
- Poor oral health associated with decreased birthweight, growth restriction, preterm delivery, early pregnancy loss, intrauterine fetal demise
- Treatment for oral disease not consistently shown to affect birth outcomes
9
Q
Protocol for Prenatal Provider
A
- Assess women’s oral health status
- Perform oral health counseling including safety of radiographs/local anesthetic/oral health practices
- Refer to Dental Home as needed
- Work with dental professionals to coordinate care
10
Q
Protocol for Dental Care
A
- Pregnancy is not a reason to postpone routine/necessary dental treatment
- ALARA principle for radiographs
- Manage oral disease as necessary
- Be familiar with safety of medications
- Position semi-seated position, pillow under right hip
- Consult prenatal health care providers as necessary
- Address post-op pain with OB/GYN as needed
11
Q
Analgesics in Pregnant Women
A
- Aspirin - avoid
- Acetaminophen - safe
- Ibuprofen - avoid in 1st and 3rd trimester, limit length of use
- Naproxen - avoid in 1st and 3rd trimester, limit length of use, use other NSAID if possible
- Codeine - use minimum effective dose
- Morphine - use minimum effective dose
- Meperidine - withdrawal symptoms may occur in neonate
12
Q
Antibiotics in Pregnant Women
A
- Penicillin - acceptable
- Amoxicillin - acceptable
- Cephalexin - Acceptable
- Ceftriaxone - Acceptable
- Clindamycin - Acceptable
- Erythromycin - avoid (maternal hepatotoxicity)
- Tetracycline - avoid
- Fluoroquinolones - avoid
- Clarithromycin - use alternative if possible
13
Q
Anesthetic in Pregnant Women
A
Lidocaine - acceptable
14
Q
Other drugs in Pregnant women
A
- Chlorhexidine - acceptable for topical use and oral rinse
- Xylitol - no reference available on possible adverse pregnancy effects
15
Q
Acquisition (window of infectivity)
A
- complex oral microbiome
- timing of bacterial acquisition is controversial with evidence suggesting occurring at birth from mother to child
- S. mutans and related bacteria more easily colonize newly erupted teeth than those upon which stable bacterial colonization is already present, but process can shift over child’s lifetime
16
Q
Modifiers of Acquisition
A
- Tooth surfaces with developmental defects colonized easier
- Diet rich in fermentable carbohydrates contributes to increase in cariogenic related bacteria
- Infants born via C-section colonized by S. mutans earlier
17
Q
Breast Feeding Recommended Time
A
AAPD and WHO recommend exclusive breastfeeding for first 6 months of life, continued through 1 year or longer as mutually desired by mother or infant
18
Q
Breast Feeding Contraindications
A
- medical conditions of mother or infant
- environmental contaminants in milk due to maternal exposure
- medications or drugs in milk due to maternal use
19
Q
Benefits of Breast Feeding
A
- Infant: bonding, immunologic (maternal antibodies), metabolic, cardiovascular, less SIDS
- Mother: reproductive (less blood loss, increased child spacing), decreased postpartum depression/child abuse, decreased development of rheumatoid arthritis, CV disease, breast/ovarian cancers
20
Q
Challenges of Breast Feeding
A
- difficulty ranges from 25%-80%
- latching problems, poor infant sucking, insufficient weight gain, sore nipples, breast engorgement, poor milk supply, mastitis
- ankyloglossia (controversial whether frenectomy improves breastfeeding)
21
Q
Ankyloglossia
A
- prevalence: 5%, higher prevalence in males
- 50% babies with ankyloglossia who are breastfed have no feeding trouble
- limited evidence on benefit of surgical intervention
22
Q
Nonnutritive Sucking Benefits
A
- AAP states delay introduction of pacifier until after breastfeeding is well-established
- pacifier use protective for SIDS
- pacifier not associated with decrease in duration of breastfeeding
23
Q
Challenges of NNS
A
- Prolonged NNS can lead to malocclusion
- Counsel early and recommend cessation by 3 years of age (or with establishment of terminal planes of occlusion)
- Prolonged pacifier use (past 6 months) may increase incidence of otitis media, increase risk for oral candida and GI infections
24
Q
Recommended Pacifiers
A
- shield of pacifier should be 1.5 inches across at least and have ventilation holes
- do not tie pacifier to neck, hand or crib (strangulation hazard)
25
Motivational Interviewing
- use open-ended questions
- use non-judgmental affirmation and reflective listening
- use periodic summary statements
26
Caries Risk Assessment 0-5 High Risk Factors
- Mother/caregiver has active caries
- Parent/caregiver has low socioeconomic status
- Child has >3 between meal snacks/beverages
- Child is put to bed with bottle containing natural or added sugar
- Child has >1 decayed/missing/filled surfaces
- Child has active white spot lesions or enamel defects
- Child has elevated mutans streptococci levels
27
Caries Risk Assessment 0-5 Moderate Risk Factors
- Child has special health care needs
- Child is a recent immigrant
- Child has plaque on teeth
28
Caries Risk Assessment 0-5 Low Risk Factors
- Child receives optimally-fluoridated drinking water or fluoride supplements
- Child has teeth brushed daily with fluoride toothpaste
- Child receives topical fluoride from health professional
- Child has dental home/regular dental care
29
Key Concepts of Chronic Disease Model for Early Childhood Oral Health
- dental caries is complicated disease with many factors
- CDM aims to address underlying risk factors
- caregivers actively engaged
- self-management skills including setting goals, monitoring behavior, evaluating progress
- limit number of self-management goals to 1-2 items at each encounter
- use motivational interviewing, coaching, role-modeling, etc.
- every dental encounter is opportunity for health management
- frequency of health management visits should be established based on risk level
30
Chemotherapeutic Agents for ECOH
- Fluoride toothpaste
- Fluoride varnish
- SDF and silver nitrate
- topical iodine
- casein phosphopeptide amorphous calcium photphate
- Xylitol
- Chlorhexidine varnish/gel
- probiotic bacteria
