Oral health during pregnancy

American Family Physician,  April 15, 2008  by Hugh Silk,  Alan B. Douglass,  Joanna M. Douglass,  Laura Silk

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LAURA SILK, MD, is a practicing obstetrician and gynecologist at Health Alliance in Leominster, Mass. She received her medical degree from the University of Massachusetts Medical School and completed a residency in obstetrics and gynecology at the University of Connecticut.

Address correspondence to Alan B. Douglass, MD, Middlesex Hospital, 90 South Main St., Middletown, CT 06457 (e-mail: adouglass@midhosp.org). Reprints are not available from the authors.

Author disclosure: Nothing to disclose.

Figures 1 through 4 were reprinted with permission from the Society of Teachers of Family Medicine, www. stfm.org.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

                                     Evidence
Clinical recommendation              rating     References

Periodontitis may be associated      B          19
  with preterm birth and low
  birth weight.

Preliminary evidence suggests        B          20-22
  that deep root scaling in
  pregnant women with
  periodontitis may help prevent
  preterm birth and low birth
  weight.

Use of oral topical antibacterial    B          26, 27
  treatment of dental caries in
  mothers in late pregnancy and/
  or the postpartum period can
  lower maternal oral bacterial
  load and reduce transmission
  of bacteria to infants.

Clinical recommendation              Comments

Periodontitis may be associated      Recommendation from nine
  with preterm birth and low           case-control studies, two
  birth weight.                        cross-sectional studies, seven
                                       cohort studies, two RCTs, and
                                       two meta-analyses

Preliminary evidence suggests        Consistent findings in two small
  that deep root scaling in            RCTs (21,22); one RCT found
  pregnant women with                  no relationship (2)
  periodontitis may help prevent
  preterm birth and low birth
  weight.

Use of oral topical antibacterial    Consistent findings for xylitol
  treatment of dental caries in        and chlorhexidine (Peridex)
  mothers in late pregnancy and/       in two small RCTs
  or the postpartum period can
  lower maternal oral bacterial
  load and reduce transmission
  of bacteria to infants.

RCT = randomized controlled trial.

A = consistent, good quality patient-oriented evidence;
B = inconsistent or limited quality patient-oriented evidence;
C = consensus, disease-oriented evidence, usual practice, expert
opinion, or case series. For information about the SORT evidence
rating system, see page 1063 or http://www.aafp.org/afpsort.xml.

COPYRIGHT 2008 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning