ORAL HEALTH
of babies-to-be
Adopt an active role in the strategic prenatal development of our youngest patients
BY CATHY HESTER SECKMAN, RDH
As hygienists, we put a lot of focus on children. Dr. Alfred formation, and gingivitis
• Vitamin D deficiency: loss of lamina dura, enamel hypoplasia,
Fones’ original intent, after all, was for us to work with cavitated ECC, and white spot lesions3
children in schools.1 We want to catch them early, train A lack of minerals during pregnancy can cause these problems
them (and their parents) in home hygiene, make sure they for the baby’s teeth:
• Calcium deficiency: increased caries
have fluoride available, and watch them grow into caries-free • Magnesium deficiency: hypoplasia
adults with healthy mouths. • Phosphorus deficiency: incomplete calcification, incomplete
But did you ever stop to consider how much we can help dentin formation
children toward that goal before they’re even born? Remember • Fluoride deficiency: loss of systemic benefits
that deciduous teeth begin forming in utero, so a mother’s In contrast, adequate minerals boost cell formation, repair
health and nutrition are vital to the proper formation of teeth. capabilities, and boost collagen synthesis.3
By educating mothers-to-be, we can provide their babies, who Another essential item during pregnancy is a proper amount
are also our patients, with the best possible start on lifelong of protein in the mother’s diet. A deficiency can result in inade-
oral health. quate bone growth for the baby, which in turn can lead to crowded
Presuming the mother is healthy, you might say the first step or rotated teeth. Tooth development could also be interrupted,
toward baby’s oral health is prenatal vitamins, which include and there may be permanent damage to the periodontium.3
important minerals such as folic acid, iron, iodine, and calcium.2 Smoking is a habit that not only harms mother and baby, but
If the mother lacks certain vitamins during pregnancy, here’s is detrimental to a baby’s oral development. Several studies note
what can happen during baby’s tooth development: correlations between smoking and cleft lip or palate, especially
• Vitamin A deficiency: enamel hypoplasia and defective dentin in males. A multivariate analysis done as part of a 2015 Brazil
formation study showed male gender plus maternal smoking resulted in a
• Vitamin C deficiency: gingival hemorrhaging, improper dentin 2.5 time (gender) and a 1.5 time (smoking) greater chance of
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ORAL HEALTH OF BABIES-TO-BE
having a cleft.4 can also cause deficient enamel in permanent dentition.14
Research conducted in 2017 at Virginia Commonwealth Uni- Besides ensuring healthy living and a healthy periodontium,
versity was the first to question the safety of e-cigarettes for there are other steps hygienists can recommend for pregnant women
embryos. When testing several aerosolized e-cigarette liquids in that can help their children’s healthy oral development. For years
vivo during embryonic development, they found defects including researchers have studied pregnant women who use a protocol for
median facial clefts, midface hypoplasia, cranial cartilage and xylitol gums or mints.
muscle defects, and reduced blood supply to the face, all induced One of the more recent randomized controlled trials was con-
by exposure to the aerosols. They found that nicotine was not ducted in Japan. Pregnant women with high mutans streptococci
the main factor, but it exacerbated the effects of other components (MS) levels used gum containing 1.32g of xylitol four times a day
of the e-liquids.5 for at least five minutes. This continued for 13 months, beginning
in the sixth month of preg-
LOW-BIRTHWEIGHT CONNECTIONS For hygienists to have nancy. Some 23% of the
Smoking and deficient nutrition aren’t the only issues that are women showed markedly
linked to poor oral development in infants. We can begin here with
a positive effect on decreased levels of MS, and
information about the connection between periodontal disease pediatric oral health, at 15 months postinterven-
and preterm low birth weight (PTLBW). Research has shown links tion, the levels had not in-
between a mother’s periodontal disease and PTLBW babies. One we don’t need to wait creased. It’s easy to see the
link is prostaglandins.6 High levels of the fatty acids are found in the benefit in this since babies
oral bacteria of women with periodontitis.7 Those same fatty acids until a child’s first are born without MS and
are involved with inflammation control and the smooth muscle acquire it from their
contractions that induce labor.8
dental visit. caregivers.15
C-reactive protein also plays a role in both periodontal disease In a previous study by the same research group, babies of the
and preterm delivery. In one study, pregnant women with periodon- pregnant women who chewed xylitol gum were less likely to
titis had 65% higher CRP levels compared to periodontally healthy colonize MS. Babies of the control group demonstrated MS
pregnant women.9 Other known periodontal pathogens include colonization nearly nine months earlier than the babies of the
gram-negative (anaerobic) bacteria, which can enhance uterine xylitol group.15
contractions and be responsible for premature labor.10 For hygienists to have a positive effect on pediatric oral health,
However, research results do conflict. A 2013 study published we don’t need to wait until a child’s first dental visit. As soon as
in ScienceDirect, for instance, states that while an association a glowing young woman walks into the office and checks off the
was found between periodontal disease and low birth weight, “pregnant” box in her health history update, we can give her all
no association was found between periodontal disease and the information she needs to make healthy choices for her child’s
preterm delivery.11 teeth.
With pre-eclampsia, a late-pregnancy toxemia characterized by
hypertension, edema, albuminuria, and eventual kidney damage, Cathy Hester Seckman, RDH, worked in dentistry 32 years, including 12
the research is more confusing. Periodontal disease has been found years as a pediatric hygienist. Officially retired from clinical hygiene, she still
in 64% of pre-eclamptic women and 36% of non-pre-eclamptic fills in occasionally at the same pediatric practice. She is multi-published in
women, leading to uncertainty about a significant link. A systematic dental magazines, works part-time as an indexer, and is the author of three
review found it “questionable whether periodontal disease plays a novels, more than a dozen short stories, and an Arcadia Publishing history of
causal role in the pathogenesis of pre-eclampsia.”12 A later meta-anal- her hometown. Her new book, Ohio Day Trips, will be published by Adven-
ysis concluded that a mother’s diagnosis of periodontal disease was tureKEEN on March 1.
an “independent predictor” of the toxemia.13
What are the links between PTLBW and infant oral health? A REFERENCES
2015 article in the International Journal of Clinical Pediatric Den- 1. https://en.wikipedia.org/wiki/Alfred_Fones
2. https://www.webmd.com/baby/guide/prenatal-vitamins#1
tistry states that the short prenatal period of PTLBW babies affects 3. Stegeman C, Davis JR. 2005. Dental Hygienist’s Guide to Nutritional Care;
tooth development. Elsevier Saunders.
One of the problems is that teeth are not remodeled like bone— 4. Martelli DR, Coletta RD, Oliveira EA, Swerts MS, Rodrigues LA, Oliveira MC,
any developmental damage is permanent. Damaged enamel in Martelli JH. Association between maternal smoking, gender, and cleft lip and palate.
Braz J Otorhinolaryngol. 2015 Sep-Oct;81(5):514-9. Epub 2015 Jul 22.
PTLBW babies is decreased in thickness, and defects include a 5. Kennedy AE, Kandalam S, Olivares-Navarrete R, Dickinson AJG. E-cigarette
rough, granular, and poorly mineralized appearance. Since two aerosol exposure can cause craniofacial defects in Xenopus laevis embryos and
thirds of calcium and phosphorus stores are deposited during the mammalian neural crest cells. PLoS One. 2017 Sep 28;12(9):e0185729.
6. Ahmad Haerian-Ardakani A, Eslami Z, Rashidi-Meibodi F, Haerian A, Dallalnejad
last trimester, the teeth of PT babies are compromised. Some studies
P, Shekari M, Moein Taghavi A, Akbari S. Relationship between maternal periodontal
indicate that damage can occur to permanent as well as primary disease and low birth weight babies. Iran J Reprod Med. 2013 Aug; 11(8): 625–630.
dentition, and proper timing of tooth eruption may be affected. 7. Shanthi V, Vanka A, Bhambal A, Saxena V, Saxena S, Shiv Kuma S. Association
Neonatal health problems such as infections and respiratory diseases of pregnant women periodontal status to preterm and low-birth weight babies: A
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systematic and evidence-based review. Dent Res J (Isfahan). 2012 Jul-Aug; 9(4): 12. Kunnen A, van Doormaal JJ, Abbas F, Aarnoudse JG, van Pampus MG, Faas
368–380. MM. Periodontal disease and pre-eclampsia: a systematic review. J Clin Periodontol.
8. Jones RL. Functions of prostaglandins. Pathobiol Annu. 1972;2:359-80. 2010 Dec; 37(12):1075-87.
9. Pitiphat W, Joshipura KJ, Rich-Edwards JW, Williams PL, Douglass CW, Gillman 13. Huang X, Wang J, Liu J, Hua L, Zhang D, Hu T, Ge ZL. Maternal periodontal
MW. Periodontitis and plasma c-reactive protein during pregnancy. J Periodontol. disease and risk of preeclampsia: a meta-analysis. J Huazhong Univ Sci Technolog
2006 May; 77(5): 821–825. Med Sci. 2014 Oct;34 (5):729-35. Epub 2014 Oct 16.
10. Bansal J, Bansal A, Kukreja N, Kukreja U. Periodontal diseases as an emerging 14. Zaidi I, Thayath MN, Singh S, Sinha A. Preterm birth: A primary etiological factor
potential risk factor for adverse pregnancy outcomes: A review of concepts. J Turk for delayed oral growth and development. Int J Clin Pediatr Dent 2015;8 (3): 215-219.
Ger Gynecol Assoc. 2011 Sep 1;12(3):176-80. 15. Shinga-Ishihara CA, Nakai YA, Milgrom PC, Söderling ES, Tolvanen MD,
11. Yen-Li Wang, Jui-DerLiou, Whei-LinPan. Association between maternal Murakami KA. Xylitol carryover effects on salivary Mutans Streptococci after 13
periodontal disease and preterm delivery and low birth weight. Taiwanese Journal of months of chewing xylitol gum. Caries Res 2012;46:519–522.
Obstetrics and Gynecology, Volume 52, Issue 1, March 2013, Pages 71-76.
OWN YOUR ROLE IN CURBING ADDICTION
continued from pg. 38 and addiction. and the lack of alternative treatment. Let’s
should be handled. Included in this state- The US Postal Service and the Depart- educate our patients with the ever-grow-
ment are the importance of a thorough ment of Homeland Security are strength- ing list of diagnostic tools we have at our
medical and dental history, drug contra- ening the inspection of packages coming disposal so they can grasp what treatment
indications, history of substance abuse, into our country that could contain even is needed for their pain and why.
and utilization of PDMPs. synthentic opioids such as fentanyl. The We have many continuing education
It is recommended that dentists have US government now commits to distrib- courses available to inform us, and it is up
these difficult conversations with patients uting nearly $1 billion in grants for addic- to us as professionals to follow up with
about misuse and abuse of opioids. Den- tion prevention treatment, and over $50 new information regarding the best avail-
tists should also be considering all treat- million to support law enforcement pro- able treatment for patients. This does not
ment options to get the patient out of pain grams that assist those facing prison and include the overprescribing of opioids.
so relapse does not occur. NSAIDs should facing addiction. I challenge all hygienists to have those
be considered first-line therapy for acute tough discussions with patients who are
pain management, and recognize multi- THE CHALLENGE willing to checkmark a box to tell you they
modal pain strategies. Dentists should beTO DENTISTRY are drug addicts. Take an extra look at
coordinating with specialists and other I challenge the field of dentistry (including patients’ eyes during head and neck exam.
doctors on how to best prescribe on a larger
myself). What used to be an easy fix for us Run your patients through your state’s
scale. Lastly, dentists (and dental hygien-
has now become a playing piece in the PDMP as an extra precaution. Write thor-
game of addiction. We need to ough notes in charts that describe changes
work together to find solutions that you see in patients.
I challenge all hygienists to have that help people, rather than Promote change in our profession by
those tough discussions with patients mask their symptoms. creating better technology to find alter-
While this may not be as se- native ways to treat dental pain. Use dif-
who are willing to checkmark a box rious of an issue to some, it is the ferential diagnoses, and refer to specialists.
to tell you they are drug addicts. beginning of an epidemic. I have We have a great opportunity to help our
heard countless stories on how loved ones in our community overcome
prescribed opioids were the gate- the battle of addiction and opioid sub-
ists) are encouraged to seek continuing way to other drugs, such as heroin. Ten stance abuse. All it takes is for each one
education in addictive disease and pain years ago, my classmates were getting pre- of us to rise up in agreement and say,
management related to opioid prescribing. scribed two weeks’ worth of opioids for “Enough is enough.”
We should all be working together. standard third molar extractions. We were
The Centers for Disease Control and sixteen years old. Can I link the heroin Carly Scala, RDH, is a dental educator and sales
Prevention has launched a prescription overdoses of these former classmates to representative who specializes in dental hygiene
awareness campaign to put faces on the what could have been their first opioid clinical supplies and CE courses. In addition,,
danger of opioid abuse. CVS Caremark encounter? That we may never know. Carly practices clinically in Parkersburg, W.V.
announced last month that it will limit If we can change something on our end and works as an editor/writer in hygiene publi-
certain first-time opioid prescriptions to to make these pills less accessible, we cations remotely. Carly has been an ADHA mem-
seven-day supplies. The FDA is requiring should. Let’s treat the pain versus treating ber since graduating in 2014 and spends her free
that manufacturing drug companies of the symptoms. Dental pain management time dreaming of teeth and playing with her two
prescription opioids to provide more with opioids continued to be common chubby pugs. She can be contacted at scalardh@
training to prescribers to prevent abuse practice because of patient expectation gmail.com.
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