SLIDE 1 December 2, 2013 Healthy Smile Happy Child Telehealth Presentation
umschrot@cc.umanitoba.ca
SLIDE 2 Recent report of an expert
working group on “Oral Health Care During Pregnancy”
October 2011 in Washington,
DC at Georgetown University
Sponsored by:
- Health Resources & Services
Administration, Maternal & Child Health Bureau
In collaboration with:
- American College of Obstetricians &
Gynecologists
- American Dental Association
http://www.mchoralhealth.org/PDFs/Oralhealthpre gnancyconsensusmeetingsummary.pdf
SLIDE 3
Pregnancy is a unique time characterized
by complex physiological changes, which may adversely affect oral health
Oral health is key to overall health and
well-being.
Preventive, diagnostic and restorative
dental treatment is safe throughout pregnancy and is effective in improving and maintaining oral health.
SLIDE 4
Many health professionals do not provide oral health
care to pregnant women.
Many pregnant women, even those with dental disease,
do not seek or obtain needed dental care.
SLIDE 5 “Pregnancy is not an illness”
In many cases, neither pregnant women nor health
professionals understand that oral health care is an important component of a healthy pregnancy.
Evidence suggests that infants and young children
- ften acquire caries-causing bacteria from their
mothers
SLIDE 6
Education in regards to oral health care during
pregnancy is needed as it can reduce the transmission of bacteria from mothers to their children.
For this reason it is essential for health
professionals (e.g., dentists, hygienists, assistants, therapists, physicians, midwives, nurses, etc.) to provide pregnant women with appropriate and timely oral health care.
SLIDE 7
SLIDE 8 In 2006 the New York State Department of Health
produced Oral Health Care During Pregnancy and Early Childhood: Practice Guidelines
Other guidelines for perinatal oral health care
followed:
- American Academy of Pediatric Dentistry
- California Dental Association Foundation
- South Carolina Department of Health and Environmental
Control
- The University of Washington School of Dentistry
SLIDE 9
http://www.health.ny.gov/publications/0824.pdf
SLIDE 10
SLIDE 11
SLIDE 12 The recently published Oral Health Care During
Pregnancy: A National Consensus Statement- A Summary of an Expert Workgroup Meeting urges people to review the consensus statement and work with their health professional colleagues in medicine and dentistry to implement the guidance
SLIDE 13 During the initial prenatal evaluation
- Take an oral health history of the patient.
- Questions that can be asked include the following:
Do you have swollen or bleeding gums, a toothache, problems eating or chewing food or other problems in your mouth? Since becoming pregnant, have you been vomiting? If so, how often?
SLIDE 14
Do you have any questions or concerns about getting
- ral health care while you are pregnant?
When was your last dental visit? Do you need help finding a dentist? Check the mouth for problems such as swollen or bleeding gums, untreated dental decay, mucosal lesions, signs of infection or trauma. Document findings in patients chart
SLIDE 15
Pregnant women need reassurance that oral health care
including the use of radiographs, pain medications, and local anesthesia is safe throughout pregnancy.
If the last dental visit took place > 6 months ago, or
they have any oral health problems they should be advised to schedule an appointment with a dentist ASAP.
If urgent care is needed make a formal referral to a
dentist who maintains a collaborative relationship with the prenatal care health professional.
Encourage women to seek oral health care, practice
good oral hygiene, eat healthy foods and attend prenatal classes during pregnancy.
SLIDE 16
Establish partnerships with community
based programs.
Provide a referral to a nutrition professional
if counseling is needed.
Integrate oral health topics into prenatal
classes.
SLIDE 17 Provide culturally and linguistically appropriate care.
Take time to make sure woman understand the information being provided to them.
On the patient intake form, include questions about oral
health.
Name & contact information of dental professionals, reasons for and date of last dental visit, previous dental procedures.
SLIDE 18 Establish relationships with dental professionals in the
community.
Develop a formal referral process where by the dental
professional agrees to see the referred individual in a timely manner and to provide subsequent care.
Share important information about pregnant woman with
- ther oral health professionals and coordinate care with
- ral health care professionals as appropriate.
If the patient does not have a dental home, explain the
importance of optimal oral health during pregnancy.
SLIDE 19
Take an oral health history (ask questions such as when was
the last visit, how many weeks pregnant are you, any mouth pain etc?)
In addition to reviewing the dental history, review medical and
dietary histories including use of tobacco, alcohol and recreational drugs.
Perform a comprehensive oral examination, which includes a
risk assessment for dental caries and periodontal disease.
Take radiographs to evaluate and definitively diagnose oral
diseases and conditions when clinically indicated.
SLIDE 20
Provide emergency or acute care at any time during
the pregnancy as indicated by the oral condition.
Develop, discuss with women and provide a
comprehensive care plan that includes prevention, treatment and maintenance throughout pregnancy.
SLIDE 21
Discuss pros/cons of treatments Use standard practice with placing restorative materials. Position pregnant women appropriately during care
(e.g., keep the woman's head at a higher level that her feet, place a pillow under her hip and ask for her own comfort suggestions).
SLIDE 22 Help pregnant women complete applications for
insurance or other sources of coverage, social services
On the patient intake form, record the name and
contact information of the prenatal health professional.
Establish partnership with community based programs
that serve pregnant women with low income.
SLIDE 23
Pharma maceuti utical A Agent nt Indic dication, C , Contrain indi dicatio ion & & Spe pecia ial C Consid ideratio ions Analgesics Acetaminophen May be used during pregnancy Acetaminophen with Codeine, hydrocodone or Oxycodone Codeine Meperidine Morphine
SLIDE 24
Pharma maceuti utical A Agent nt Indic dication, C , Contrain indi dicatio ion & & Spe pecia ial C Consid ideratio ions Analgesics Aspirin May be used in short duration during pregnancy; 48 to 72 hours. Avoid in 1st and 3rd trimesters Ibuprofen Naproxen
SLIDE 25
Pharma maceuti utical A Agent nt Indic dication, C , Contrain indi dicatio ion & & Spe pecia ial C Consid ideratio ions Antibiotics Amoxicillin May be used during pregnancy Cephalosporins Clindamycin Metronidazole Penicillin
SLIDE 26
Pharma maceuti utical A Agent nt Indic dication, C , Contrain indi dicatio ion & & Spe pecia ial C Consid ideratio ions Antibiotics Ciprofloxacin Avoid during pregnancy Clarithomycin Levofloxacin Moxifloxacin Tetracycline Never use during pregnancy
SLIDE 27
Pharma maceuti utical A Agent nt Indic dication, C , Contrain indi dicatio ion & & Spe pecia ial C Consid ideratio ions Anaesthetics Local anaesthetics with epinephrine (e.g., Bupivicaine, lidocaine, mepivicaine) May be used during pregnancy
SLIDE 28 Pharma maceuti utical A Agent nt Indic dication, C , Contrain indi dicatio ion & & Spe pecia ial C Consid ideratio ions Anesthetics Nitrous Oxide (30%) May be used during pregnancy when typical or local anaesthetics are inadequate. Pregnant women require lower levels of nitrous
- xide to achieve sedation; consult
with prenatal care health professionals
SLIDE 29
Pharma maceuti utical A Agent nt Indic dication, C , Contrain indi dicatio ion & & Spe pecia ial C Consid ideratio ions Over the counter antimicrobials Cetylpridinium chloride mouth rinse May be used during pregnancy Chlorhexide mouth rinse Xylitol
SLIDE 30 Practice good oral health hygiene
Brush your teeth with fluoridated toothpaste twice a day Replace toothbrush every 3-4 months Floss daily Rinse every night with an over the counter fluoridated alcohol free mouth
rinse. Eat Healthy Foods
Each a variety of healthy foods such as fruits, vegetables, whole grain
products and dairy products.
Limit sugar intake Water and milk is preferred over sugar drinks such as coke, or flavored
drinks.
SLIDE 31
Encourage dental care for pregnant women Provide oral health care services to pregnant women Develop relationships with those professionals
already providing prenatal care and accept referrals
Target at-risk moms-to-be Philosophy of harm reduction and non-judgmental
approach to care
SLIDE 32
SLIDE 33
Thank You!
