Chapter 20

Pregnant patients

INTRODUCTION

Pregnant women are an important target group. Good advice on the oral cavity during pregnancy is important as pregnant patients have an increased risk of gingival damage, caries and tooth erosion. Diet and smoking are also important factors for the oral and general health of the patient and the unborn child.

The oral health educator (OHE) should be able to explain changes that pregnant mothers may have noticed in the health of their mouths, give advice and reassurance, and help them develop an effective oral health routine, which they can continue as their family grows. The OHE should also be able to provide advice on diet and lifestyle.

Pregnant women are generally very receptive to information and keen to do the best they can for their health and that of the coming baby. During routine antenatal care, they are encouraged to seek dental advice, and many, who are not regular dental attendees, will attend during pregnancy for the sake of their coming child. They are encouraged further in the United Kingdom as NHS practices offer free NHS treatment to pregnant women. However, it is often difficult to register with an NHS practice and many pregnant patients therefore opt to stay with their private practice. Despite this, some pregnant patients (particularly in socially-deprived areas) are unaware of the need for good oral hygiene and diet during pregnancy.

Lifestyle advice during pregnancy

It is important not to give out of date or conflicting advice, and OHEs should check what advice other members of the health care team (e.g. midwives) are giving to pregnant women. Be aware of local and national initiatives, such as Healthy Start – an NHS programme which gives good advice on diet and lifestyle for pregnant patients – as well as financial benefits that may be available [1]. In Scotland, Ready Steady Baby [2], and in Wales, the Pregnancy Guide [3] are also very good resources.

Questions on the developing embryo and foetus

The OHE should be able to give advice on how the oral cavity develops in the growing embryo and foetus in case a patient asks, particularly with reference to queries about cleft lip and palate (see Chapter 1).

SUSCEPTIBILITY TO ORAL DISEASES AND CONDITIONS

A patient’s susceptibility to the following oral diseases and conditions can increase during pregnancy.

Erosion (see also Chapter 6)

Susceptibility to erosion can increase during pregnancy due to:

• Vomiting (morning sickness) – regurgitation of stomach acids.
• Increased acidic foods/drinks intake. An increased intake of ‘healthier’ foods by pregnant women may inadvertently increase the amount of acidic drinks and foods during pregnancy, such as fruit, fruit juices and dressed salads.

Prevention/management

Provide advice on:

• Diet. Restricting acidic foods and drinks (and to regular mealtimes).
• Gentle toothbrushing – allow an hour after consuming acidic foods or drinks. Do not brush immediately after vomiting.
• Fluoride application – to increase tooth resistance to acid (e.g. toothpaste and mouthwash).

Caries (see Chapter 5)

Susceptibility to caries can increase during pregnancy, due to:

• Cravings/frequent snacking (often for sweet foods).
• Nausea when toothbrushing and/or a dislike of the taste of a particular toothpaste can lead t/>
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