New guidelines to emphasize safety of dental treatment during pregnancy

Spotlighting the importance of oral health care for expectant mothers, the California Dental Association (CDA) Foundation has released new guidelines designed to emphasize the safety of dental treatment during pregnancy and ensure women the services they need.

The guidelines were developed by an expert panel of dental and medical professionals who met in 2009 to review scientific literature and new research on the treatment of oral diseases and pregnancy outcomes. The CDA Foundation undertook the project, in collaboration with the American College of Obstetricians and Gynecologists, District IX, to expand dental services to pregnant women and address misconceptions about the importance and safety of oral health during the perinatal period.

"Despite the multiple benefits of dental care for mothers and their babies, many women have nagging concerns about its safety during pregnancy," said Dr. Lindsey Robinson, chair of the CDA Foundation board. "We hope these guidelines put to rest some of those worries and make dental treatment a recognized staple of prenatal care."

The bacteria that causes dental caries (cavities) is transmitted from mothers or other primary caregivers, to the child through behaviors where saliva is shared. Control of dental disease before and during pregnancy not only protects a woman's health, but also reduces the rate of transmission of the pathogenic bacteria from mother to child. But for a variety of reasons, many women do not seek, and often are not advised to seek, dental treatment as part of their overall prenatal care.

Studies have shown that some prenatal care providers do not have an adequate understanding of the consequences that poor oral health has on the mother and child, and that dentists needlessly withhold care because of an unfounded fear of litigation. As a result, critical care may be delayed during the perinatal period, even though pregnancy marks the only time some lower-income women are eligible for dental benefits.

Despite misperceptions about oral health care during pregnancy, the panel concluded that timely diagnosis and treatment of dental disease – including radiographs, periodontal care and the use of local anesthesia – are highly beneficial and far outweigh the known risks of not obtaining care.

Specifically, studies show no link between first-trimester dental procedures and early spontaneous abortion – one common complication of pregnancy. And preeclampsia, another condition that confronts some pregnant women, is not a contraindication for dental care, the panel said.

Robinson and other CDA Foundation leaders hope the guidelines will persuade prenatal specialists to fully integrate dental services into the overall package of care they recommend. Pregnancy is a "teaching moment," Robinson noted, and should be used to encourage expectant mothers to include dental hygiene and treatment as a priority, for their own health and their baby's well-being.

"Prenatal health care providers will welcome these guidelines as an opportunity to collaborate with dental professionals in the care of pregnant women.  Oral health screening and referral should be a routine part of prenatal care," said the project co-chair Ellen J. Stein, MD, MPH, medical director San Francisco County Department of Public Health Maternal, Child and Adolescent Health.