Encourage pregnant patients to have necessary dental work done, but avoid tetracyclines.
OVER THE PAST FEW YEARS there has been more emphasis placed on dental care and status as it pertains to overall health. In fact, poor dental hygiene is associated with an increased risk of cardiovascular disease, rheumatoid arthritis, and other medical concerns. The proposed mechanism is likely an inflammatory process.
A number of recent studies have also linked periodontal disease to preterm labor, low birthweight, or both, although the exact relationship is unclear.1 A case–control study, for instance, found that women with early spontaneous preterm birth were more likely to have severe periodontal disease than women with indicated preterm births or term births. However, the periodontal disease was not associated with selected markers of upper genital tract inflammation.2 In addition, early nonsurgical periodontal care during pregnancy does not seem to decrease the occurrence of preterm delivery or low birthweight.3 So the research to date does not suggest a cause-and-effect relationship between poor dental status and poor pregnancy outcomes.4
Here are a few suggestions that may make the experience less problematic for both the patient and her dentist, given the advanced pregnancy:
MANY DENTISTS ARE APPREHENSIVE about treating an obviously pregnant woman. It often facilitates her care to write a letter to the dentist outlining the above with a statement that it is acceptable to provide this care during the pregnancy. It is actually best, for the overall health of the mother and the pregnancy, to provide the necessary intervention.
DR. PHELAN, Department Editor, is Professor, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM. A member of the Contemporary OB/GYN Editorial Board, she is an Oral Examiner for the American Board of Obstetrics.
1. Jarjoura K, Devine PC, Perez-Delboy A, et al. Markers of periodontal infection and preterm birth. Am J Obstet Gynecol. 2005;192:513-519.
2. Goepfert AR, Jeffcoat MK, Andrews WW, et al. Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstet Gynecol. 2004;104:777-783.
3. Michalowicz BS, Hodges JS, DiAngelis AJ, et al. Treatment of periodontal disease and the risk of preterm birth. N Engl J Med. 2006;355:1885-1894.
4. Goldenberg RL, Culhane JF. Preterm birth and periodontal disease. N Engl J Med. 2006;355:1925-1927.