Thursday, May 5, 2011

Should dentists provide dental care to pregnant women through the second trimester?


Every day, dentists across the country decide whether or not to provide dental care to a patient who is pregnant. On the one hand, they realize the patient needs to maintain her good oral health, especially if she has periodontal disease, a relatively common and destructive problem during pregnancy. On the other hand, dentists traditionally have lacked the scientific evidence to make informed decisions about the possible effects of dental care, if any, to the developing child. The lack of data has caused many dentists to err strongly on the side of caution, especially during the second trimester when the child’s development accelerates and, in theory, exposure to infectious oral bacteria or dental products could have adverse effects. But the fundamental questions remain: Should dentists provide dental care to pregnant women through the second trimester? If so, which types of treatment are safe to provide?

Over the last five years, newer scientific evidence has provided answers to these important questions. The data so far indicate that mothers who receive dental care through the second trimester - both general and periodontal treatment – do not appear to increase their risk of adverse events during pregnancy.

Some of the most scientifically rigorous data come from the NIDCR-supported Obstetrics and Periodontal Therapy Trial (OPT). In 2006, the OPT reported in the New England Journal of Medicine that pregnant women, most with early-to-moderate periodontitis, benefitted from general and periodontal care without an increase in preterm births or other negative pregnancy outcomes. All mothers had been randomly assigned to receive either: (1) scaling and root planing of the teeth prior to the 21st week of pregnancy, then monthly tooth polishings or (2) scaling and root planing after delivery, meaning women in this control group did not have their periodontal disease treated during their pregnancies. All women were 16 years or older and between 13 and 17 weeks pregnant upon entry into the study.

Now, as published online in the journal Pediatrics on April 11, the investigators report findings from a follow-up study of the OPT patients and their children born during the original trial. The researchers evaluated the neurodevelopment of 411 children, including 32 preterm infants, two years after the study. They tested the children using the Bayley Scales of Infant and Toddler Development (Third Edition) and the Preschool Language Scale (Fourth Edition). The former is a well-recognized assessment instrument for cognitive and motor functions in young children; the latter is frequently used to assess language skills in this age group.

The scientists found no difference in the neurodevelopment of children from mothers previously assigned to the treatment or control group. They also report slight associations between improvements in a mother’s periodontal attachment loss during the original study and higher cognitive and motor skills in their children. But both the associations are so weak, the scientists considered them “to be of little or no clinical significance.”

* Michalowicz BS, Hodges JS, Lussky RC, Bada H, Rawson T, Buttross LS, Chiriboga C, Diangelis AJ, Novak MJ, Buchanan W, Mitchell DA, and Papapanou PN. Maternal Periodontitis Treatment and Child Neurodevelopment at 24 to 28 months of Age, Pediatrics 2011 April 11 [Epub ahead of print]

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