Episode 174 Dental Care

Can dental care during pregnancy really impact your baby's health? Join me, Florence, as I crack open the myths and present the facts on this crucial yet often ignored topic. Discover why maintaining good dental hygiene is more important than ever during pregnancy, despite outdated beliefs linking gum disease to preterm birth being debunked by recent studies like the meta-analysis from Norway. We'll delve into the specifics of increased risks like gingivitis and tooth erosion, and highlight the invaluable UK's maternity exemption certificate for free dental care.

In this episode, I emphasize pregnancy as a golden opportunity to establish lifelong oral hygiene habits, benefiting both mother and child. Learn how maternity professionals can play a pivotal role in guiding expectant mothers towards essential dental services and why this conversation is vital for future generations. We also tackle the alarming rates of dental caries in young children and the regional disparities that persist, advocating for broader health discussions that could transform community health outcomes. Don't miss this enlightening episode that bridges the gap between dental care and maternity health!

Want to know more?
https://bmjopen.bmj.com/content/8/3/e018556
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/08/oral-health-care-during-pregnancy-and-through-the-lifespan
https://www.gov.uk/government/publications/child-oral-health-applying-all-our-health/child-oral-health-applying-all-our-health

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
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Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

Chapters

• 0:00 Importance of Dental Care in Pregnancy
• 11:57 Promoting Dental Care in Pregnancy

Transcript

Florence: 0:00

Hello, my name's Florence. Welcome to the OBSpod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife, maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the OBS pod is for you.

Florence: 0:58

Episode 174 dental care. I've stumbled into this topic because I've got to go to the dentist this week and this suddenly got me thinking. I've never done an episode on dental care. You might ask why I think dental care is relevant to maternity, and I guess I think it's relevant because it's something women ask me. Can they go to the dentist? If the dentist needs to do something, can they do that safely? What are my thoughts? So when I started to think about this episode, I immediately thought aha, I need to do this episode because dental care is very important to the health. Care is very important to the health not only of the mother but the baby.

Florence: 1:47

Back when I was doing my membership exams, my specialist exams, one of the things we learned was that there was an association between gum disease and dental disease and low birth weight, infants and preterm birth. So I thought, as I approach this topic, that's what I need to talk about. And then I thought we've had a lot of focus on prevention of preterm birth in the UK in the last few years. It's something we're really working hard to try and reduce because it's responsible for so much perinatal morbidity and mortality, that is, long-term difficulties for babies or, sadly, baby loss. And as I turned my mind to that and the preterm surveillance clinic we have at my own work trying to reduce the incidence of preterm birth and provide women that have a higher chance of preterm birth with additional care and support, I thought I don't actually remember seeing anything relating to dental care. Maybe my belief that gum disease and dental disease has a relationship with preterm birth or low birth weight. Maybe I'm out of date.

Florence: 3:25

So, undertaking a quick search, I found an interesting article and it's open access in the BMJ and I will put it in the show notes so you can take a look. This was done by a team in Norway and they looked at doing a meta-analysis to ask just that Is there actually a relationship between preterm birth and dental disease? Now, when you look at their meta-analysis and the studies included, the numbers look relatively small. They found nine observational studies with nearly 5,000 women, so not huge because they only included studies that included data on women with dental caries and those without who had a preterm birth, and it may be that there isn't that much information where the two things have been compared Right. But if you look at the rate or chance of preterm birth, preterm birth is estimated to have an incidence of 5% to 13%. So you'd imagine that looking at those sorts of numbers nearly 5,000 women you should be able to identify a difference, and what they concluded was that there wasn't actually a difference, or there didn't seem to be a difference in that data, that it didn't seem that having dental disease or dental caries did have an association with preterm birth.

Florence: 5:27

So, straight away, by making this episode, I've learned something new. Of course, it doesn't mean that getting dental treatment in pregnancy is not important. It absolutely is important and looking around online, I found lots of suggestion that actually gum disease and dental caries are a little bit more common in pregnancy. I don't know whether that is perhaps people's fear of undergoing treatment or going to the dentist, and maybe undergoing treatment or x-rays mean that women leave things that little bit longer. Maybe things get that little bit worse before they seek attention.

Florence: 6:26

But also it can be about economics. Do people have access to dental care that they can afford or, better still, is free? In the UK we used to have free NHS dentistry and that's been eroded over my lifetime. But we do have a maternity exemption certificate, which means that women can get free dental care during pregnancy and for the first year of their baby's life, and one of the first things the midwife will explain at the booking appointment is how to apply for this maternity exemption certificate. So it's really important that women are aware that they can, in the UK, access free dental care. And they should access free dental care because if you have an infection that's untreated, whether that's in your teeth or mouth or elsewhere in your body, it's going to have an impact potentially on your health and that of your baby on your health and that of your baby. So all the things that you should be doing to look after yourself out of pregnancy you should be doing in pregnancy and going to the dentist and looking after your teeth and gums is no exception. It's safer and better for your baby if you are safe, healthy and well.

Florence: 8:18

Researching this topic, I turned up another interesting article from the US about the importance of dental care and maintaining oral hygiene in the perinatal period and it describes a number of physiological changes that happen in pregnancy in the oral cavity, so in the mouth, including more gingivitis, so increased inflammatory response to dental plaque, which can cause more gum bleeding, the potential for benign, harmless gum lesions appearing, increased tooth mobility, which I'd never heard of, and potentially more tooth erosion, particularly in women with hyperemesis or excessive vomiting, because stomach acid regularly coming up and the tooth enamel being exposed to that gastric acid really being quite negative and causing erosion of that tooth enamel quite negative and causing erosion of that tooth enamel. They also concluded that there didn't seem to be any association between maternal dental disease and preterm birth or low birth weight infants and this article was interesting because it commented about actually the attitude of dentists and that dentists may be a little bit reluctant to treat pregnant women and a bit nervous about that, and that's definitely something I've come across when a woman has come and asked me in the antenatal clinic. I've been to the dentist. The dentist says I need whatever treatment. Can I do that while I'm pregnant? Is it safe for me to do that? The dentist wants to know and I guess that's a little bit like all sorts of other medical professionals being a little bit scared and apprehensive of pregnancy because it's not within their comfort zone, whereas for us, all I see day in, day out is pregnant women or new mums. So it's very much in my comfort zone. So, yes, using antibiotics, using local anaesthetic, using mouth rinses you can even use salt water are all acceptable and safe treatments to have in pregnancy. And, like many of the topics I've tackled in the podcast, having treatment, having a filling, having root canal, having whatever needs to be done, done during pregnancy and undertaken during pregnancy is safer, sensible and a good thing to do during pregnancy, because delaying and leaving untreated the complications and problems is much more likely to be worse for you and your baby. And dental x-rays, equally, can easily be performed, shielding the rest of the mum's body.

Florence: 11:57

The same American article points out that pregnancy can be that little opportunity. So it's a moment where a woman will seek healthcare, will seek expert advice, will seek healthcare, will seek expert advice and therefore, regardless of whether we're a dentist, as a midwife, as a doctor, we can encourage women to have good oral hygiene habits. The article talks about pregnancy being a teachable moment, a moment where a woman is maybe more invested in looking after herself and that habits, like some of the other things we've discussed maybe stopping smoking or stopping drinking are habits she may carry into her later life and also teach to her children as they're growing up. So therefore, good dental care and good dental hygiene is part and parcel of that opportunity to talk to women about their health longer term. So this is a super quick episode.

Florence: 13:17

What's my zesty bit? That's hilarious. That just immediately made me think about lemon juice on my teeth. Don't think that acid's very good for them, but anyway, that aside, my zesty bit Well, my zesty bit is, I guess don't be scared and think if you've got teeth and gum problems, you're suddenly going to have a preterm baby, because that seems to be out the window. Dental care know that accessing that care is safe and a good thing to do and think, yes.

Florence: 14:13

What are the general things I can do to improve my health during pregnancy, one of which is looking after your mouth and teeth, and as maternity professionals, it's our responsibility to make sure they know they can access free dental care in the UK and, if you're listening in another country. Think about what access to dental care women perhaps have where you are. But also ask them about have they got any teeth or gum problems? Are they noticing their gums bleed? Reassure them that that's normal in pregnancy, but also explain to them that looking after their general health and brushing their teeth and looking after them is a valuable thing and it's not just about growing a baby. It's okay to look after themselves too, looking after their general future health and part of that although, like many things in medicine, we've split that off and that's dentistry it's all part of your body. It's all important to look after, and pregnancy may give you an opportunity to think about that and focus on that a little bit more and valuing yourself and valuing the health of your body now and longer term, and hopefully, if we can encourage women to think about their general overall health and include their teeth in that, that will spill over into bringing up that child.

Florence: 15:57

There are all sorts of problems, I know with increasing dental caries in young children, and that's one of the reasons we're looking at sugar intake and sugar in food production. I've put a link to a government publication about child oral health that shows just under a quarter of five-year-olds in the latest survey 2019 had tooth decay and each child with tooth decay will have, on average, three to four teeth affected. It also documents that this can happen very early on in life, with 11% of three-year-olds having visible tooth decay with, on average, three teeth affected. That's really quite shocking. There's also huge regional inequality, with children from the most deprived areas having more than twice the level of tooth decay than those from the least deprived. So by discussing broader issues with women, we're also helping improve the health of our future generations perhaps.

Florence: 17:21

I very much hope you found this episode of the OBS pod interesting. If you have, it'd be fantastic if you could subscribe, rate and review on whatever platform you find your podcasts. As well as recommending the OBS pod to anyone you think might find it interesting, there's also tons of episodes to explore in my back catalogue, from clinical topics, my career and journey as an obstetrician and life in the NHS more generally. I'd like to assure women I care for that I take confidentiality very seriously and take great care not to use any patient identifiable information unless I have expressly asked the permission of the person involved, on that rare occasion when it's been absolutely necessary. If you found this episode interesting and want to explore the subject a little more deeply, don't forget to take a look at the programme notes, where I've attached some links.

Florence: 18:33

If you want to get in touch to suggest topics for future episodes, you can find me at TheObsPod, on Twitter and Instagram, and you can email me theobspod at gmailcom. Finally, it's very important to me to keep TheObsPod free and accessible to as many people as possible, but it does cost me a very small amount to keep it going and keep it live on the internet. So if you've enjoyed my episodes and by chance, you do have a tiny bit to spare, you can now contribute to keep the podcast going and keep it free via my link to buy me a coffee. Don't feel under any obligation, but if you'd like to contribute, you now can. Thank you for listening.