Treating pregnant dental patients: CDA answers your questions

February 2, 2023
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Edited 2/6/23 to correct the length of time postpartum medical and dental services are covered for Medi-Cal patients. Currently, Medi-Cal covers post-partum medical and dental care for 12 months following birth.

Have you ever considered that some of the patients who benefit from your care do not have any patient records? That is, they won’t until after their carriers give birth to them and make an appointment for baby’s first oral health evaluation.

While fetal dental treatment is not a field of practice, pregnant people and their unborn babies benefit from prenatal dental care. The links between maternal, fetal and children’s oral health cannot be ignored. Studies show that the condition of a mother’s oral health before, during and after pregnancy can impact their children’s risk for tooth decay.

  • Untreated periodontal disease in pregnant women can harm their systemic health and may be linked to low birth weight and and/or preterm birth.
  • Carriers can unintentionally transmit caries-causing bacteria to newborns, increasing children’s risk of tooth decay.
  • Children are more than three times as likely to have tooth decay if their mothers have untreated tooth decay.

Dr. Diana Ramos, California Surgeon General, confirms, “Oral health care is an important part of overall health, especially during pregnancy. Regular dental visits can also help detect any potential problems before they become serious. As a practicing obstetrician gynecologist for almost 30 years, I've seen how good oral hygiene can help prevent gum disease, which can lead to pregnancy complications such as preterm labor and birth and low birth. Dental care during pregnancy is safe and a part of a healthy pregnancy for mom and baby.”

Despite recommendations from the American College of Obstetricians and Gynecologists that dental care should continue throughout pregnancy, some pregnant patients — and even some health professionals — do not understand that oral health care is an important component of a healthy pregnancy.

As recently as 2018, the California Maternal and Infant Health Assessment data indicated that less than 44% of Californians with a live birth had a dental visit during pregnancy. While official numbers are not yet available, it is likely that these percentages have not increased but rather decreased during this decade due to the COVID-19 pandemic.

Understanding that many women and their health care providers still have questions and concerns when it comes to the safety and efficacy of dental care during pregnancy, CDA encourages dentists take a proactive approach to communicating with patients and their health care providers about pregnancy and dental care. CDA’s experts have seen an increase in questions from members regarding appropriate prenatal dental care. Here are some of those questions and answers that may help you educate patients and other caregivers about maternal oral health.

Question: Does my pregnant patient need clearance from their OB-GYN to schedule dental care?

 No, clearance from a prenatal health care provider is not necessary. Contrary to popular belief, medical consultation is not a standard practice for pregnant patients receiving dental care. Preventive, diagnostic and restorative treatment is safe throughout pregnancy and is effective in improving and maintaining oral health throughout a patient’s lifetime.

ACOG recognizes the safety of dental care during pregnancy, noting that, “Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) and local anesthesia (lidocaine with or without epinephrine), are safe during pregnancy. Conditions that require immediate treatment, such as extractions, root canals, and restoration (amalgam or composite) of untreated caries, may be managed at any time during pregnancy.”

While clearance for dental care is not necessary, it is appropriate to open a dialogue of communication with a pregnant patient’s medical provider. This dialogue will naturally begin when reviewing the patient’s health history prior to treatment. Once the patient discloses pregnancy, it is appropriate to ask for permission to consult with the patient’s prenatal caregiver.

Once permission has been granted by the patient and documented in the patient records, it is helpful to reach out to the patient’s prenatal health provider to develop a working relationship should consultation be needed later. Questions to ask a pregnant patient’s obstetrician may include:

  • When is the expected delivery date?
  • Is this a high-risk pregnancy? If so, are there any special concerns or contraindications for dental care?
  • Is there a recommended medication for pain control, if necessary?

It is worth noting that early research does correlate dental disease with fertility complications in both male and female patients. When a patient discloses they are seeking treatment for infertility, it is not only appropriate but supportive to the well-being of your patient to consult with their fertility specialist.

CDA members can download confidential medical health history forms in both English and Spanish, and TDIC policyholders can access a sample medical consultation form.

Question: What dental treatments can be safely offered to pregnant patients?

As previously noted, pregnancy should not be a reason to delay dental treatment. Except in certain high-risk pregnancies, there are very few contraindications to dental care and treatments during pregnancy. Although ACOG has a statement regarding postponing elective nonobstetric general surgery and some invasive procedures (e.g., cardiac catheterization or colonoscopy) until after delivery, dental treatments are not lumped in this category. Instead, ACOG’s statement on oral care during pregnancy recommends that oral conditions requiring immediate treatment, such as periodontal or endodontic treatment, extractions, or restoration of untreated caries, can be managed at any time during pregnancy.

Question: Are there any special considerations to be aware of when providing care to pregnant patients?

As with any patient who visits your practice, the physical and emotional comfort of your pregnant patient should be a priority before, during, and after treatment. Make sure to address any questions they have about how treatment or medication may affect their unborn baby and provide information about the important link between maternal oral health and infant health.

The American Dental Association notes that during pregnancy, some oral health conditions are more common due to a variety of physical and hormonal changes. These include:

  • Gingivitis due to hormonal changes that exaggerate the response to bacteria in the gum tissue.
  • Dental caries due to changes in diet such as increased snacking due to cravings, increased acidity in the mouth due to vomiting, dry mouth or poor oral hygiene stemming from nausea and vomiting.
  • Pyogenic granuloma (also known as granuloma gravidarum) may develop due to hormonal changes.
  • Enamel erosion or staining stemming from vomiting because of morning sickness may be detected.

Some individuals who lack the resources for dental care prior to pregnancy can receive care during pregnancy because state benefits for women and children extend to dental care.

The Medi-Cal Dental Program covers dental services during pregnancy and 12 months postpartum. When you provide treatment to a pregnant or postpartum patient on Med-Cal, look at it as an opportunity to offer vital oral health care and education to an underserved community member. Make sure the patient feels welcome and all treatment is offered in a judgement-free zone. Your commitment to providing care and education in a respectful, positive way can give the pregnant patient and unborn child a lifetime of health benefits.

Question: As a dentist, what care or education should I offer my pregnant patients?

Along with encouraging your pregnant patient to continue brushing, flossing and having regular cleaning appointments, talk to them about preventing specific pregnancy-related oral health risks. Patients suffering from morning sickness should be encouraged to avoid toothbrushing immediately after vomiting, which exposes the teeth to stomach acids. Instead, they should opt for rinsing with a diluted solution of 1 cup water and 1 teaspoon of baking soda to neutralize the acid.

Pregnancy is an ideal time to educate parents about good pediatric oral health habits. Encourage them to take care of tiny teeth right from the start and reassure them that you are there to support their efforts. Make sure to inform them about these beneficial infant oral hygiene habits:

  • Wipe baby gums twice a day with a soft, clean cloth — in the morning after the first feeding and right before bed to reduce the bacteria and sugars that cause dental caries.
  • Once baby’s first tooth emerges, start brushing its teeth twice a day with a smear (rice-grain sized) of toothpaste.
  • Schedule the baby’s first dental visit before its first birthday to spot signs of dental problems early.

Dentists make important contributions to the current and future health of pregnant patients and their unborn children. Along with providing care, it is imperative that you communicate the safety and efficacy of dental treatment throughout pregnancy to patients and other health care providers. Your support and encouragement can make a difference in maternal and infant health and early establishment of beneficial oral hygiene habits.

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