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ODONTOLOGA PEDITRICA ODONTOL PEDITR (Madrid)
Copyright 2009 SEOP Y ARN EDICIONES, S. L. Vol. 17. N. 2, pp. 96-104, 2009

Artculo Original

Embarazo y salud oral


C. PALMA

Departamento de Odontopediatra. Facultad de Odontologa. Universidad de Barcelona

RESUMEN ABSTRACT

La evidencia cientfica indica que la presencia de enferme- Scientific evidence suggests that periodontal disease in the
dad periodontal en la mujer embarazada puede tener conse- pregnant patient can have adverse effects on the outcome of a
cuencias negativas en el resultado del embarazo. Por otro birth. Moreover, maternal microbial flora is one of the most
lado, la flora oral de la madre es uno de los factores ms important caries predictor in a child. Maternal oral health care
importantes de prediccin de caries en un nio; con lo cual la must be based on diminishing the bacterial load, so as to
salud oral materna debe basarse en la importancia de dismi- reduce the probabilities of transmission. All preventive pro-
nuir la carga bacteriana para reducir las probabilidades de grammes should include the assessment of pregnant women,
transmisin. Todo programa de prevencin de caries debe and it is therefore essential that pediatric dentists have pro-
incluir la asesora a futuras madres y, por ello, es imprescindi- found knowledge of all pregnancy and oral health issues so as
ble que el odontopediatra conozca en profundidad todos los to understand the importance of integrating these patients in
aspectos relacionados con el embarazo y la salud oral, para our practice.
comprender la importancia de integrar este grupo de pacientes The aim of this review of the literature is to describe the
en nuestros programas. most relevant aspects of pregnancy and their relation to oral
Este trabajo de revisin bibliogrfica tiene como objetivo health, with special emphasis on the consequences to the
revisar los aspectos ms relevantes del embarazo y su relacin future baby.
con la salud oral, con especial enfoque en las consecuencias
en el futuro beb.

PALABRAS CLAVE: Embarazo. Salud oral. Periodontitis. KEY WORDS: Pregnancy. Oral health. Periodontitis. Preterm
Parto prematuro. Caries precoz en la infancia. birth. Early childhood caries.

INTRODUCCIN rs en prevenir la caries precoz en la infancia en los


futuros hijos, antes de que esta aparezca. Si la educa-
En la vida de una mujer, los mayores cambios fisio- cin y capacitacin a mujeres embarazadas forma parte
lgicos y hormonales ocurren durante el embarazo (1). de los programas de prevencin temprana, la efectivi-
El embarazo cambia el cuerpo de la mujer de muchas dad de los programas es mayor. Por otro lado, estudios
formas y ocasiona ciertos cambios en la cavidad bucal recientes sugieren que algunas condiciones orales de la
que reflejan estas alteraciones fisiolgicas (2). madre pueden tener consecuencias adversas para el
La evidencia indica que las embarazadas presentan nacimiento del beb.
una motivacin especial hacia el aprendizaje sobre el Llama la atencin entonces que la salud bucal y los
cuidado de su propia salud y la del beb (2). Por un cuidados odontolgicos durante el embarazo general-
lado, como odontopediatras, tenemos un especial inte- mente se evitan o se malinterpretan, tanto por parte de
mdicos y dentistas, como por parte de las propias
pacientes (3,4).
Recibido: 27-01-2009 El objetivo de este estudio es revisar los conceptos
Aceptado: 09-03-2009 sobre salud oral en el embarazo y sus implicaciones.
09. 223. C. PALMA:Maquetacin 1 1/10/09 06:56 Pgina 97

Vol. 17. N. 2, 2009 EMBARAZO Y SALUD ORAL 97

EMBARAZO Y MANIFESTACIONES BUCALES TABLA I

CONDICIONES FRECUENTES EN EL EMBARAZO Y SU


En contra de la creencia popular, no se ha demostra- MANEJO TERAPUTICO
do una relacin directa entre la caries, que como sabe-
mos es una enfermedad multifactorial, y el embarazo. Vmitos
Sin embargo, el embarazo propicia una serie de cambios Enjuagues bucales con una cucharada de bicarbonato
en la conducta alimentaria y a nivel bucal que pueden sdico diluido en un vaso de agua para neutralizar
promover la formacin de caries en madres que presen- el cido
tan otros factores de riesgo (1). Sensibilidad dental debido a erosiones del esmalte
A nivel microbiolgico se ha comprobado que ciertas Enjuagues de fluoruro de sodio para proteger los
bacterias, como Streptococcus mutans y Lactobacillus dientes erosionados o sensibles
acidofilus, aumentan durante el embarazo (5). Asimis-
mo, aumenta la acidez a nivel salival (pH ms bajo) y Tumor del embarazo
disminuye el potencial de remineralizacin (menor con- Observar, a excepcin de que interfieran con la mas-
centracin de calcio y fosfato) en la gestacin (1). ticacin, sangren mucho o persistan tras el parto.
Otro factor a considerar es que inevitablemente exis- De ser as, deben ser extirpados quirrgicamente,
tir un aumento en la ingesta de alimentos debido a una aunque recidivan si se extirpan durante el embarazo
mayor necesidad energtica. El aumento en la cantidad Gingivitis/periodontitis
y frecuencia de alimentos, el aumento de bacterias y de Medidas estrictas de higiene oral, curetajes profesio-
acidez salival, as como la poca atencin que se presta a nales, uso de enguajues de clorhexidina
la salud oral, pueden elevar el riesgo de caries de la
futura madre (1,2,6). Por otro lado, un alto porcentaje
de mujeres padecen vmitos durante el embarazo y En 1996, Offenbacher y cols. (10) informaron una aso-
estos pueden ocasionar una erosin del esmalte, aumen- ciacin potencial entre la enfermedad periodontal materna
tando el riesgo de caries y sensibilidad dental (1,2). y partos prematuros y bebs con bajo peso al nacer. La
En relacin a la gingivitis, el elevado aumento de hiptesis es que las bacterias periodontales, especialmente
hormonas durante el embarazo, especialmente progeste- anaerobios Gram-negativos, podran fomentar una pro-
rona y estrgenos, afecta especialmente al periodonto. duccin precoz de los mediadores de la respuesta inflama-
El mecanismo exacto por el cual las hormonas aumen- toria, incluyendo citoquinas y prostaglandinas. Este
tan la inflamacin gingival se desconoce (1). La gingi- aumento de los mediadores de la inflamacin a nivel sist-
vitis es el hallazgo oral ms frecuente en embarazadas, mico, podra conducir a un parto prematuro (11).
con una prevalencia de 60-75% (7). Adems, si antes Posteriormente otros estudios (12,13), entre ellos uno
del embarazo la paciente presenta gingivitis, la enfer- realizado en Espaa (9), han encontrado la misma relacin
medad se suele agravar durante la gestacin (1,6). estadsticamente significativa entre periodontitis materna
En el caso de la periodontitis, las toxinas producidas y parto prematuro. Cabe mencionar que tambin existen
por bacterias periodontales estimulan una respuesta estudios que no han logrado demostrar una relacin direc-
inflamatoria crnica. Hasta un 40% de embarazadas ta entre ambos factores (14,15) y por ello an no resulta
presenta algn tipo de infeccin periodontal (8) y esto claro si es que la relacin entre la enfermedad periodontal
puede propiciar situaciones desfavorables, tal como se y el resultado del nacimiento es causal o forma parte de
analiza ms adelante. otros factores maternos (16).
Por ltimo, un 5% de mujeres gestantes presenta un Lo que s resulta evidente es la efectividad del trata-
granuloma pigeno o tumor del embarazo en la enca, miento periodontal en la madre durante el embarazo como
generalmente entre incisivos superiores. Esta lesin vas- medida para reducir los partos prematuros y la prevalencia
cular benigna y asintomtica, tiene una etiologa descono- de bebs con bajo peso al nacer. En todos los estudios se
cida, sin embargo se relaciona con un aumento en la pro- ha demostrado la ausencia de riesgo de realizar el trata-
gesterona, bacterias y factores irritantes locales. Los miento periodontal, tanto para la madre como para el feto
tumores del embarazo aparecen generalmente despus del (12,17,18). En 2004, la Academia Americana de Perio-
primer trimestre, sangran fcilmente y crecen rpidamen- doncia recomend realizar una evaluacin periodontal en
te, para disminuir o desaparecer tras el parto (1,3). todas las mujeres embarazadas o que planeen un embara-
En la tabla I se mencionan algunas condiciones ora- zo. De ser necesario, se debern proporcionar los cuidados
les frecuentes durante el embarazo y su abordaje. preventivos y teraputicos (19).

SALUD ORAL MATERNA Y SU RELACIN OTROS RESULTADOS ADVERSOS


CON EL RESULTADO DEL NACIMIENTO
La preeclampsia es una seria complicacin hipertensi-
PARTO PREMATURO va del embarazo, que afecta a un 5% de mujeres gestantes
y que ocasiona un gran nmero de muertes fetales (16,20).
El parto prematuro (parto con menos de 37 semanas La etiologa de la preeclampsia no es clara y algunos auto-
de gestacin) es una de las causas ms importantes de res han sugerido que la enfermedad periodontal podra ser
morbilidad y mortalidad neonatal; a pesar de grandes uno de los factores de riesgo de este desorden (21). Sin
esfuerzos sanitarios, no ha habido una disminucin en embargo la evidencia del rol de la periodontitis materna
su incidencia (9). en la preeclampsia es poco concluyente y se necesitan
09. 223. C. PALMA:Maquetacin 1 1/10/09 06:56 Pgina 98

98 C. PALMA ODONTOL PEDITR

ms investigaciones para determinar si la relacin entre VISITAS AL DENTISTA


ambas enfermedades es causal o asociada.
Como se mencion anteriormente, el embarazo es un
momento de gran sensibilidad de las mujeres hacia la
DIETA MATERNA educacin sobre los autocuidados y los cuidados para el
futuro hijo, y por ello la educacin prenatal debera
La dieta de la gestante puede afectar el crecimiento y tener siempre un componente odontolgico. Asimismo,
desarrollo dental del feto; sin embargo la influencia de la se ha comprobado que la reduccin en la actividad de
dieta es especialmente evidente cuando las deficiencias caries y de la flora cariognica en la mujer, no slo
nutricionales son severas (22,23). Estos desequilibrios mejora su propia salud, sino que reduce el riesgo de
nutricionales afectan el desarrollo dental, particularmente transmisin bacteriana a su futuro hijo. Las madres que
durante la etapa inicial de crecimiento dental, desde la participan en programas preventivos los cuales permi-
concepcin hasta los 6 meses de vida intrauterina (22). ten reducir su flora cariognica, tienen hijos con menos
El efecto de la ingesta materna de ciertos alimentos caries y estas se desarrollan ms tardamente que en
en las preferencias gustativas del beb, no est muy grupos control (16,29).
estudiado en humanos. Se afirma que la ingesta mater- La tabla II resume los elementos bsicos del asesora-
na de sal favorece la preferencia del beb por la sal, sin miento sobre salud bucal durante el embarazo (2).
embargo no existen estudios determinantes en relacin
a dulces (2,24).
En relacin a la administracin de flor prenatal, la
mayora de autores coinciden en que es inefectivo TABLA II
(2,23). El flor aparentemente atraviesa la barrera pla-
ELEMENTOS PARA EL ASESORAMIENTO SOBRE SALUD
centaria, sin embargo se desconoce cunto de este es BUCAL EN EMBARAZADAS
utilizado por el feto despus de la excrecin materna y
de depositarse en el esqueleto de la madre (25). Objetivos
Resumiendo, los consejos nutricionales a la embara- Educar a los padres acerca del desarrollo dental de su
zada deben incluir principalmente: los beneficios de una hijo
buena alimentacin materna, la falta de evidencia para Educar a los padres sobre patologa bucal y su pre-
apoyar el uso de flor prenatal y el riesgo del aumento vencin
de alimentos cariognicos (2). Proporcionar un ambiente adecuado para el nio

Mtodos
SALUD ORAL MATERNA Y RIESGO DE Educacin sobre desarrollo dental, prevencin y
CARIES DEL BEB patologa bucal
Demostracin de los procedimientos de higiene oral
Como bien sabemos, las bacterias cariognicas en los en los padres e indicaciones para el futuro beb
bebs tpicamente se adquieren a travs de la transmisin Consejos para instaurar actitudes preventivas
directa de saliva de las madres (26). Mientras ms tem- Evaluacin de la educacin, aceptacin y las necesi-
prana sea la transmisin y ms cariognica la dieta del dades individuales
beb, ms sustancial ser la transferencia. Por esta razn, Contenido
las madres con antecedentes de alto riesgo de caries sern
ms propensas a presentar altos niveles de Streptococcus Salud bucal de los padres
mutans en su saliva y el contagio vertical a sus hijos ser Educacin de los padres sobre los procesos de enferme-
ms efectivo, poniendo a sus hijos en mayor riesgo de dades bucales y sobre higiene oral, para reducir su
desarrollar caries precoz en la infancia (16). carga bacteriana y el efecto de transmisin al futuro
Debido a que la flora bucal tiende a mantenerse esta- beb
ble durante la vida, la flora cariognica de una mujer Motivacin de los padres sobre la higiene oral, para
antes y durante el embarazo anticipa su flora durante los mejorar su propia salud y crear unas ptimas con-
primeros aos de vida del nio, as como la probabili- diciones para el nacimiento
dad de transmitir precozmente la infeccin al beb. El Discusin sobre los cambios en la salud oral materna:
tiempo entre la infeccin y la aparicin de una cavidad cambios gingivales, riesgo de caries por aumento
depender de otros factores, tales como la higiene oral, de carbohidratos, mitos del embarazo y necesidad
la frecuencia en la ingesta de carbohidratos fermenta- de tratamiento dental
bles y la exposicin a fluoruros (16).
Se ha comprobado que el xilitol y la clorhexidina dis- Salud bucal del nio
minuyen la carga bacteriana en la flora materna y redu- Desarrollo del beb, incluyendo aspectos orales y
cen el riesgo de transmisin bacteriana si se utilizan en generales que pueden afectar su salud bucal
los ltimos momentos del embarazo o en el periodo Efectos del estilo de vida sobre el beb: hbitos, abu-
postparto (3). Tomando en cuenta que los ltimos estu- so de sustancias, ingesta de azcares, dieta materna,
dios en preescolares en Espaa indican que casi el 20% flor prenatal y lactancia
de nios a los 3 aos (27) y el 40% a los 5 aos (28) pre- Periodo postnatal: erupcin dental, patrones erupti-
senta caries, sera interesante sugerir estas medidas a las vos, nutricin, hbitos de succin no nutritiva y
pacientes embarazadas. momento de la primera visita al odontopediatra
09. 223. C. PALMA:Maquetacin 1 1/10/09 06:56 Pgina 99

Vol. 17. N. 2, 2009 EMBARAZO Y SALUD ORAL 99

La prctica actual limita los tratamientos que no sean


de urgencia al segundo trimestre de embarazo (2), por la
preocupacin sobre los posibles riesgos teratognicos
durante el primer trimestre y sobre la incomodidad de la
mujer en el silln dental durante el tercer trimestre. Sin
embargo, a la fecha, ninguna agencia gubernamental ha
ofrecido protocolos sobre el manejo odontolgico en
mujeres embarazadas (16). La evidencia indica que no
existe ningn inconveniente en realizar tratamientos
dentales rutinarios durante el embarazo. En relacin a la
anestesia, tanto la anestesia tpica como la local (espe-
cialmente lidocana), se pueden utilizar en mujeres
embarazadas con total seguridad (30). En relacin a las
radiografas, se debe explicar a las embarazadas que el
haz de rayos no se dirige hacia el abdomen y la cantidad
de radiacin es muy pequea; siendo el riesgo teratog-
nico de la exposicin 1.000 veces menor que el riesgo
natural a padecer un aborto espontneo (4). Por ello, se
pueden realizar radiografas dentales durante el embara-
zo, minimizando la exposicin a la radiacin mediante
la colocacin de un delantal de plomo sobre el abdomen
(31).
Idealmente, no se debera administrar ningn frma-
co durante el embarazo, especialmente durante las 13
primeras semanas; sin embargo a veces la prctica dicta
lo contrario (4). Afortunadamente, la mayora de agen-
tes comunmente utilizados en Odontologa, a excepcin
del metronidazol y la aspirina, pueden ser utilizados con
relativa seguridad (4,7). La penicilina y amoxicilina son Fig. 1. Toda mujer embarazada debe realizarse un diagnsti-
co de su estado bucal y recibir informacin acerca de los
antibiticos de primera lnea y el acetaminofn puede correctos hbitos de salud bucal.
ser utilizado con confianza para manejar el dolor (3).
Siempre ser conveniente una interconsulta con el gine-
clogo. embarazadas deberan estar informados de que no existe
riesgo alguno en realizar visitas y tratamientos rutina-
rios en ningn momento del embarazo.
CONCLUSIONES

Dada la fuerte relacin que existe entre las condicio-


nes de higiene oral y la salud en general, la salud bucal
por s misma debera ser un derecho para todos las per- CORRESPONDENCIA:
Camila Palma
sonas (16). Sin embargo, si la evidencia cientfica Departamento de Odontopediatra
sugiere que la enfermedad periodontal de la madre pue- Facultad de Odontologa
de ser un factor de riesgo de parto prematuro, tanto la Universitat de Barcelona
educacin como las medidas de higiene oral deberan Va Augusta, 28-30
08007 Barcelona
estar especialmente enfocadas hacia mujeres embaraza- e-mail: dracpalma@yahoo.com
das.
Como odontopediatras, debemos ser conscientes de
que la efectividad de los programas preventivos en la
infancia depender en gran medida de la educacin a
futuras madres y a los proveedores de salud (gineclo-
gos, pediatras, mdicos de familia, etc.). Si la flora oral BIBLIOGRAFA
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Vol. 17. N. 2, 2009 101

Original Article

Pregnancy and oral health


C. PALMA

Department of Pediatric Dentistry. School of Dentistry. Barcelona University

RESUMEN ABSTRACT
La evidencia cientfica indica que la presencia de enferme- Scientific evidence suggests that periodontal disease in the
dad periodontal en la mujer embarazada puede tener conse- pregnant patient can have adverse effects on the outcome of a
cuencias negativas en el resultado del embarazo. Por otro birth. Moreover, maternal microbial flora is one of the most
lado, la flora oral de la madre es uno de los factores ms important caries predictor in a child. Maternal oral health care
importantes de prediccin de caries en un nio; con lo cual la must be based on diminishing the bacterial load, so as to
salud oral materna debe basarse en la importancia de dismi- reduce the probabilities of transmission. All preventive pro-
nuir la carga bacteriana para reducir las probabilidades de grammes should include the assessment of pregnant women,
transmisin. Todo programa de prevencin de caries debe and it is therefore essential that pediatric dentists have pro-
incluir la asesora a futuras madres y, por ello, es imprescindi- found knowledge of all pregnancy and oral health issues so as
ble que el odontopediatra conozca en profundidad todos los to understand the importance of integrating these patients in
aspectos relacionados con el embarazo y la salud oral, para our practice.
comprender la importancia de integrar este grupo de pacientes The aim of this review of the literature is to describe the
en nuestros programas. most relevant aspects of pregnancy and their relation to oral
Este trabajo de revisin bibliogrfica tiene como objetivo health, with special emphasis on the consequences to the
revisar los aspectos ms relevantes del embarazo y su relacin future baby.
con la salud oral, con especial enfoque en las consecuencias
en el futuro beb.

PALABRAS CLAVE: Embarazo. Salud oral. Periodontitis. KEY WORDS: Pregnancy. Oral health. Periodontitis. Preterm
Parto prematuro. Caries precoz en la infancia. birth. Early childhood caries.

INTRODUCTION conditions of women can have adverse consequences on


the birth of the baby.
During the life of a woman, the greatest physiologi- It should be noted that oral health and dental care
cal and hormonal changes occur during pregnancy (1). during pregnancy is generally avoided or misinterpreted
Pregnancy changes the body of a woman in many ways by doctors as well as dentists, and by the patients them-
and certain changes arise in the oral cavity that reflect selves (3,4).
these physiological disturbances (2). The object of this study is to revise the concepts on
Evidence indicates that pregnant women have a par- oral health during pregnancy and their implications.
ticular motivation to learn about looking after their
health and that of the baby (2). On the one hand, as
pediatric dentists, we have a particular interest in pre- PREGNANCY AND ORAL MANIFESTATIONS
venting early caries during childhood of future sons and
daughters before these appear. If the education and Contrary to popular belief, a direct relationship has
training of pregnant women forms a part of early pre- not been demonstrated between caries, which as we
vention programs, the effectiveness of the programs is know is a multifactorial disease, and pregnancy. How-
greater. Moreover recent studies suggest that some oral ever, pregnancy fosters a series of changes in nutritional
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and oral habits that can lead to the formation of caries in TABLE I
mothers with other risk factors (1).
COMMON CONDITIONS DURING PREGNANCY AND
At a microbiological level it has been proved that THEIR THERAPEUTIC MANAGEMENT
certain bacteria, such as Streptococcus mutans and
Lactobacillus acidofilus, increase during pregnancy Vomiting
(5). Likewise salivary acidity increases (lower pH) and Mouthwash with a spoonful of sodium bicarbonate
the remineralization potential decreases (lower con- diluted in a glass of water in order to neutralize the
centration of calcium and phosphate) during pregnan- acid
cy (1).
Another factor to be taken into consideration is that Dental sensitivity due to enamel erosion
inevitably there will be an increase in food consumption Sodium fluoride mouthwash for protecting eroded or
due to a greater energetic need. The increase in quantity sensitive teeth
and frequency of food, and the increase in bacteria and
salivary acidity, as well as the little attention given to Pregnancy tumor
oral health, may increase the risk of caries of the future These should be observed unless there is interference
mother (1,2,6). On the other hand, a high percentage of with mastication, excessive bleeding or if they per-
women suffer from vomiting during pregnancy and this sist after the birth. If so, they should be surgically
may cause erosion of enamel, increasing the risk of removed, although they may reappear if removed
caries and dental sensitivity (1,2). during the pregnancy
With regard to gingivitis, the high increase in hor-
mones during pregnancy, particularly progesterone and Gingivitis/periodontitis
estrogens, particularly affects the periodontium. The Strict oral hygiene, professional curettage, use of
exact mechanism by which hormones increase gingival chlorhexidine mouthwash
inflammation is unknown (1). Gingivitis is the most
common oral finding in pregnant women with a preva-
lence of 60-75% (7). In addition, if before the pregnan-
cy the patient has gingivitis, the disease tends to worsen tors at a systemic level, could lead to a premature
during the gestation period (1,6). birth (11).
In the case of periodontitis, the toxins produced Later, other studies (12,13), including one carried out
because of periodontal bacteria stimulate a chronic in Spain (9), found the same statistically significant
inflammatory response. Up to 40% of pregnant women relationship between maternal periodontitis and prema-
have some type of periodontal infection (8) and this can ture birth. It should be mentioned that there are also
lead to unfavorable situations, as will be analyzed fur- studies that have not been able to demonstrate a direct
ther on. Lastly, 5% of pregnant women have a pyogenic relationship between both factors (14,15) and it is there-
granuloma or pregnancy tumor of the gingiva, general- fore still not clear if the relationship between periodon-
ly of the upper incisors. This benign and asymptomatic tal disease and the birth result is causal or whether it
vascular lesion is of unknown etiology, however it is forms part of other maternal factors (16).
related with an increase in progesterone, bacteria and What is clear is the effectiveness of maternal peri-
local irritating factors. Pregnancy tumors generally odontal treatment during the pregnancy as a way of
appear after the first term, bleeding easily and growing reducing premature births and the prevalence of low-
rapidly, reducing or disappearing after the birth (1,3). weight babies. All the studies have shown the absence
Table I shows some of the common oral conditions of any risk from carrying out periodontal treatment, for
during pregnancy and their approach. the mother as well as the fetus (12,17,18). In 2004, the
American Academy of Periodontology recommended
carrying out a periodontal evaluation of all pregnant
women or those planning a pregnancy. Should it be nec-
THE RELATIONSHIP BETWEEN MATERNAL essary preventative and therapeutic care should be giv-
ORAL HEALTH AND BIRTH RESULT en. (19).

PREMATURE BIRTH

Premature birth (birth with less than 37 weeks of ges- OTHER ADVERSE RESULTS
tation), is one of the most important causes of morbidity
and neonatal mortality. In spite of major efforts in the Pre-eclampsia is a serious hypertensive complication
health sector, there has been no reduction in incidence during pregnancy affecting 5% of pregnant women
(9). leading to a great number of fetal deaths (16,20). The
In 1996, Offenbacher et al. (10) reported a poten- etiology of pre-eclampsia is not clear and some authors
tial association between maternal periodontal disease have suggested that periodontal disease could be one of
and preterm and low birth weight babies. The hypoth- the risk factor of this disorder (21). However, the evi-
esis is that periodontal bacteria, particularly gram dence on the role of maternal periodontitis in pre-
negative anaerobes, could encourage an early inflam- eclampsia is not very conclusive and more investigation
matory mediator response, including cytokines and is needed in order to determine if the relationship
prostaglandins. This increase in inflammatory media- between both diseases is causal or associated.
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Vol. 17. N. 2, 2009 PREGNANCY AND ORAL HEALTH 103

MATERNAL DIET cation should always have a dental component. More-


over, it has been confirmed that a reduction in caries
The diet of the pregnant mother can affect the growth activity and of cariogenic flora in the woman, not only
and dental development of the fetus. However, the improves her health, but it also reduces the risk of bac-
influence of diet is particularly evident when the nutri- terial transmission to the future child. The mothers par-
tional deficiency is severe (22,23). This nutritional ticipating in preventative programs, which permit
imbalance affects dental development particularly dur- reducing cariogenic flora, have children with less caries
ing the initial stage of dental growth, from conception to and that these develop later than in control groups
6 months of intrauterine life (22). (16,29).
The effect of maternal consumption of certain foods Table II sums up the basic elements of oral health
on the babies taste preferences has not been widely assessment during pregnancy (2).
studied in humans. It has been stated that maternal con-
sumption of salt favors this preference in the baby for
salt, however there are no conclusive studies with TABLE II
regard to sweet food (2,24). POINTS OF ADVICE ON ORAL HEALTH IN PREGNANT
With regard to the administration of prenatal fluo- WOMEN
ride, most authors agree that it is ineffective (2,23). Flu-
oride apparently crosses the placenta barrier; however, Objectives
it is not known how much of this is used by the fetus Educate parents on the dental development of their
after maternal excretion and after being deposited in the child
mothers skeleton (25). Educate parents on oral pathology and its prevention
In short, nutritional advice to the pregnant woman Provide adequate surroundings for the child
should include mainly: the benefits of good maternal
diet, the lack of evidence to support the use of fluoride, Methods
and the risks from an increase in cariogenic food (2). Education on dental development, prevention and
oral pathology
Oral hygiene procedures should be demonstrated to
MATERNAL ORAL HEALTH AND CARIES parents and instructions for the future baby given
RISK IN THE BABY Advice should be given for establishing preventative
attitudes
As is well known, cariogenic bacteria in babies are Evaluation of education, acceptance and needs of the
typically acquired through the direct transmission of the individual
mothers saliva (26). The earlier the transmission and
the more cariogenic the diet of the baby, the greater the Content
transmission. For this reason, mothers with a back-
ground of high caries will be more likely to have high Oral health of parents
levels of Streptococcus mutans in their saliva and the Education of parents on oral disease processes and
vertical contamination of children will be more effec- oral hygiene so that the bacterial load is reduced
tive, with children becoming more at risk of developing together with the transmission effect on the future
early caries during infancy (16). baby.
Due to oral flora tending to remain stable throughout Motivation of the parents on oral hygiene in order to
ones life time, a womans cariogenic flora before and improve their own health and to create the best
during pregnancy is a forerunner of the childs flora birth conditions
during the his first years. The time between infection Discussion on the changes in maternal oral health:
and the appearance of a cavity will depend on other fac- gingival changes, caries risk due to an increase in
tors such as oral hygiene, the frequency with which fer- carbohydrates, myths in pregnancy and the need for
mentable carbohydrates are consumed and the exposure dental treatment
to fluoric acid (16).
It has been confirmed that xylitol and chlorhexidine Oral health of the child
reduce the bacterial load of maternal flora and that they Development of the baby, including oral and general
reduce bacterial transmission if used in the last aspects that may affect his oral health
moments of the pregnancy or in the postpartum period Effect of life style on the baby: habits, substance
(3). Taking into account that the latest studies on abuse, sugar intake, maternal diet, prenatal fluoride
preschool children indicate that 20% of 3 year olds (27) and breastfeeding
and 40% of 5 year olds (28) have caries, suggesting Postnatal period: tooth eruption, eruption patterns,
these measures to all pregnant women is of interest. nutrition, non-nutritious sucking habits and timing
of first visit to the pediatric dentist

VISITS TO THE DENTIST


Current practice limits treatments that are non-urgent
As mentioned previously, pregnancy is a time of to the second trimester of the pregnancy (2), because of
great sensibility in women towards education on self- fears on the possible teratogenic risks during the first
care and the care of their future child, and prenatal edu- trimester, and of the discomfort of being in a dental
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chair during the third trimester. However, to date, no


government agency has offered protocols on dental
management in pregnant women (16). Evidence would
indicate that there is no inconvenience in carrying out
routine dental treatment during pregnancy. With regard
to anesthesia, topical as well as local anesthesia (partic-
ularly lindocaine), can be used in pregnant females with
complete safety (30). With regard to radiographies, it
should be explained to pregnant women that the beam
of light does not go to the abdomen and the amount of
radiation is very small, with the teratogenic risk of
exposure being 1000 time less than the natural risk of
suffering a miscarriage (4). Therefore, dental radiogra-
phies can be carried out during a pregnancy, minimizing
radiation exposure by placing a lead apron on the
abdomen (31).
Ideally, no medication should be administered during
a pregnancy, particularly during the first 13 weeks.
However, experience sometimes dictates the opposite
(4). Fortunately, most commonly used agents in den-
tistry, with the exception of metronidazole and aspirin
can be used with relative safety (4,7). Penicillin and
amoxicillin are first-line antibiotics and acetaminophen
is reliable for pain management (3). Consulting a gyne-
cologist is always advisable.

CONCLUSIONS
Fig. 1. All pregnant women should have a diagnosis of their
oral health and they should receive information on correct
Given the close relationship between a persons oral oral health habits.
hygiene and their general health, oral health as such
should be a right for every individual (16). However,
scientific evidence suggests that periodontal disease in a
mother can be a risk factor in premature births, and edu- the probabilities of transmission to the baby. Likewise,
cation as well as oral hygiene measures should be we should make the most of the opportunity and offer
focused in particular on pregnant women. mothers information on the risk of childhood caries, and
As pediatric dentists we should be aware that the oral hygiene habits should be taught for the first years
effectiveness of preventative programs during infancy of life.
depends largely on the education of future mothers and Taking these factors into account, it is essential that
of health providers (gynecologists, pediatricians, family women consult a dentist before becoming pregnant, and
doctors, etc). If maternal oral flora is one of the most at least once a trimester during the gestation (4) (Fig. 1).
important factors in the prediction of caries in the child Dentists as well as pregnant women should be informed
(26), maternal oral health should be based on the impor- as to there being no risk at all from carrying out routine
tance of decreasing the bacterial load in order to reduce visits and treatments at any point in a pregnancy.