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Condensed from the Guideline on Perinatal Oral Health Care
(The guideline is heavily supported by evidence based scientific literature. For a complete list of the sources utilized, please see the American Academy of Pediatric Dentistry Guideline)

Research continues to show close relation linking periodontal oral health care and adverse outcomes in pregnancy with pre term deliveries, low birth weight infants, and preclampsia

Poor oral health and high levels of cryogenic oral bacteria in mothers are at grater risk for infecting their children's with the bacteria and increasing their children's caries risk at an early age. Dental caries in infants is a disease that is preventable. Determining those mothers at higher risk for transferring cariogenic bacteria to their children improves opportunities for preventive intervention.

The primary goal of perinatal oral health care with regards to caries transmission, is to lower the numbers of cariogenic bacteria in an expectant mother's mouth so that Mutans Streptococci (MS) colonization of the infant can be delayed as long as possible. Timely delivery of educational information and preventive therapies to these parents can help prevent the later need for dental rehabilitation in their children.

Physicians, nurses, and other health care professionals are far more likely to see expectant mother than are dentists. Therefore, it is essential that these providers be aware of the infectious etiology and associated risk factors of caries and early childhood caries (ECC), make appropriate decisions regarding timely and effective interventions for pregnant women, and facilitate the establishment of a dental home.

The higher the levels of Mutant Streptococci (MS) in the mother's saliva, the greater the risk of the infant being colonized.

Caries risk assessment can be performed to determine the patient's relative risk for cavities. The goal is to prevent disease by identifying and minimizing causative factors, (eg. microbial burden, dietary habits, plaque accumulation) and optimizing protective factors (eg. fluoride exposure, oral hygiene, sealants).

Caries risk assessment tools can aid the identification of reliable predictors and allow health care professionals to identify and refer high risk patients.

The perinatal period is an opportune time to educate and perform dental treatments on expectant mothers.

Systematic literature reviews suggest an association between periodontal disease and an increased risk of adverse pregnancy outcomes, including preterm deliveries and low birth weight babies. Periodontal infections, which can be a reservoir for inflammatory mediators, may pose a threat to the placenta and fetus which can increase the likelihood of preterm delivery. Mothers with severe periodontitis have high levels of prostaglandin in their gingival crevicular fluid and blood. In turn, these increased levels of prostaglandin may be associated with uterine contractions leading to preterm deliveries.
Fortunately, research shows that scaling and root planning during pregnancy can reduce the likelihood of preterm deliveries and low birth weight babies. These data thus emphasize the need for perinatal intervention.

Removal of active caries with subsequent restoration is important to suppress maternal Mutant Streptococci (MS) reservoirs and has the potential to minimize the transfer of Mutant Streptococci (MS) to the infant, thereby decreasing the infant's risk of developing early childhood caries (ECC). The safest time to perform dental treatment during pregnancy is in the second trimester, or the 14th-20th weeks.

• AAPD Recommendations

1.- Every expectant mother should receive a comprehensive oral health evaluation from a dentist and, if not previously accomplished, establish a dental home as early as possible during pregnancy. The first visit should consist of review of medical, dental and dietary histories, risk assessments for caries and periodontal disease, diagnosis of disease and other conditions, oral health education, and anticipatory guidance. Radiographic assessment and treatment of oral conditions should be performed with attention to maternal and fetal safety and patient control.

2.- All primary health care professionals who serve pregnant women provide education on the etiology and prevention of ECC. Oral health counseling and referral for comprehensive oral examination and treatment during pregnancy is especially important for the mother.

3.- The curriculum of all medical, nursing, and allied health professional programs include education in perinatal oral health, including the infectious etiology of ECC, methods of oral health risk assessment, anticipatory guidance, and the need for early establishment of a dental home.

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