Chapter 1: Prenatal, Perinatal and Early Childhood Oral Health Flashcards
Prenatal, Perinatal and Early Childhood Oral Health
Definition of prenatal development stage
- 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
Definition perinatal/neonatal development stage
Refers to mother and/or fetus from 20th week of gestation through 4 weeks post-partum or 28 days extra-uterine life
Definition of infant development stage
Child aged 1 month to 12 months
Definition of toddler development stage
- Originated as term to describe child learning to walk
- Child from age 1 to 36 months
Prenatal Oral Health
- 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)
Steps in oral health care during pregnance
- Understanding implications of pregnancy on oral health
- Implications of oral health on pregnancy
- Protocol for prenatal providers
- Protocol for dental professionals
Implications of pregnancy on oral health
- 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
Implications of oral health on pregnancy
- 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
Protocol for Prenatal Provider
- 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
Protocol for Dental Care
- 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
Analgesics in Pregnant Women
- 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
Antibiotics in Pregnant Women
- Penicillin - acceptable
- Amoxicillin - acceptable
- Cephalexin - Acceptable
- Ceftriaxone - Acceptable
- Clindamycin - Acceptable
- Erythromycin - avoid (maternal hepatotoxicity)
- Tetracycline - avoid
- Fluoroquinolones - avoid
- Clarithromycin - use alternative if possible
Anesthetic in Pregnant Women
Lidocaine - acceptable
Other drugs in Pregnant women
- Chlorhexidine - acceptable for topical use and oral rinse
- Xylitol - no reference available on possible adverse pregnancy effects
Acquisition (window of infectivity)
- 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
