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Periodontal Management of the Pregnant Patient

By now you have probably read something about periodontitis being a concern for pregnant patients. The American Academy of Periodontology (AAP) has done a great deal to get this message to the general public. Press releases have been issued, journal articles have been written and media outlets have responded by having stories about this important subject. Additionally, in the March 2004 Journal of Periodontology (J. Periodontol. 2004;75:495) The AAP issued a statement regarding the periodontal management of the pregnant patient. A review of this statement can help all of us render appropriate care to women at this point in their lives.

There is a growing body of evidence that suggests that women with periodontal disease are at greater risk of delivering pre term or low birth weight babies (PTLBWB). In fact, researchers have suspected that periodontal disease is harmful to the developing fetus since the early 1930's. Factors in addition to periodontitis which also are associated with an increased risk for PTLBWB are smoking, alcohol use, poor diet, frequent genitourinary infections and stress.

Furthermore, women with untreated periodontitis who are pregnant often display more gingival inflammation and are at greater risk for losing periodontal support. Unfortunately for the pregnant patient, treatment options are often limited due to the risk to the developing fetus. The timing of services is usually constrained to a small window of time and often medications usually employed in treating periodontitis cannot be used. For example, tetracycline antibiotics and their derivatives are very often employed in treating the periodontitis patient. They cannot be used during pregnancy. Therefore, The AAP's statement makes some broad recommendations which will benefit the pregnant mother and her unborn fetus.

Counseling all women of child bearing years prior to pregnancy would be helpful. They should be educated about periodontitis as well as the risk the disease poses to the fetus. Women should be instructed in all facets of preventive care with an emphasis on oral hygiene. They should be encouraged to achieve plaque control proficiency before becoming pregnant. Additionally, active periodontal cases should be treated prior to pregnancy.

In many instances the clinician will not have the opportunity to accomplish disease control and prevention counseling prior to the pregnancy. In this case the preventive care should be instituted as early as possible in the pregnancy. When scaling, root planing or even surgery is indicated after examination, the early part of the second trimester is the preferred time frame. Finally, interventive therapy is occasionally needed during other periods of the pregnancy for the treatment of active infection, abscess or other disseminating sources of sepsis. Consultation with the patient's physician is always encouraged.

The statement summarizes by highlighting

5 diagnostic and treatment considerations for the pregnant mother. They include the following: "1. Diagnosis and evaluation of the patient's periodontal condition and medical status. 2. Education of the patient regarding the possible impact of periodontal infection on pregnancy outcomes and periodontal prevention and treatment options. 3. Consideration of consultations with the patient's healthcare professional: a) to ascertain whether other risk factors such as gestational diabetes or high blood pressure are present; and b) to advise that professional of the periodontal status of the patient and any proposed treatment. 4. Consideration of the gestational period, status of pregnancy, and concomitant risk factors for periodontitis that may influence pregnancy outcomes. 5. Periodontal therapy and patient motivation to establish and maintain periodontal health."

A patient's overall health requires the successful management of all potential concerns. Since periodontal health is one facet of the patients overall condition, the prevention and treatment of periodontal disease is essential. Evaluating, diagnosing and treating women before and early in their pregnancies will help you to provide a valuable service for the mother and their developing baby.

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