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 Discover why maintaining good dental hygiene is more important than ever during pregnancy, despite outdated beliefs linking gum disease to preterm birth being debunked by recent studies like the meta-analysis from Norway.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.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
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...

Episode Transcript

Florence (00:00):
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife, maybe birth fascinates
you, or you're simply curiousabout what exactly an
obstetrician is.
You might be pregnant andpreparing for birth.

(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou work in maternity and want
to know what makes yourobstetric colleagues tick, or
you want some fresh ideas andinspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.

(00:58):
Episode 174 dental care.
I've stumbled into this topicbecause I've got to go to the
dentist this week and thissuddenly got me thinking.
I've never done an episode ondental care.
You might ask why I thinkdental care is relevant to
maternity, and I guess I thinkit's relevant because it's
something women ask me.

(01:19):
Can they go to the dentist?
If the dentist needs to dosomething, can they do that
safely?
What are my thoughts?
So when I started to thinkabout this episode, I
immediately thought aha, I needto do this episode because

(01:39):
dental care is very important tothe health.
Care is very important to thehealth not only of the mother
but the baby.
Back when I was doing mymembership exams, my specialist
exams, one of the things welearned was that there was an

(02:00):
association between gum diseaseand dental disease and low birth
weight, infants and pretermbirth.
So I thought, as I approachthis topic, that's what I need
to talk about.
And then I thought we've had alot of focus on prevention of
preterm birth in the UK in thelast few years.

(02:22):
It's something we're reallyworking hard to try and reduce
because it's responsible for somuch perinatal morbidity and
mortality, that is, long-termdifficulties for babies or,
sadly, baby loss.
And as I turned my mind to thatand the preterm surveillance

(02:46):
clinic we have at my own worktrying to reduce the incidence
of preterm birth and providewomen that have a higher chance
of preterm birth with additionalcare and support, I thought I
don't actually remember seeinganything relating to dental care

(03:07):
.
Maybe my belief that gumdisease and dental disease has a
relationship with preterm birthor low birth weight.
Maybe I'm out of date.
So, undertaking a quick search,I found an interesting article

(03:32):
and it's open access in the BMJand I will put it in the show
notes so you can take a look.
This was done by a team inNorway and they looked at doing
a meta-analysis to ask just thatIs there actually a
relationship between pretermbirth and dental disease?

(03:57):
Now, when you look at theirmeta-analysis and the studies
included, the numbers lookrelatively small.
They found nine observationalstudies with nearly 5,000 women,
so not huge because they onlyincluded studies that included

(04:20):
data on women with dental cariesand those without who had a
preterm birth, and it may bethat there isn't that much
information where the two thingshave been compared Right.
But if you look at the rate orchance of preterm birth, preterm

(04:45):
birth is estimated to have anincidence of 5% to 13%.
So you'd imagine that lookingat those sorts of numbers nearly
5,000 women you should be ableto identify a difference, and
what they concluded was thatthere wasn't actually a

(05:08):
difference, or there didn't seemto be a difference in that data
, that it didn't seem thathaving dental disease or dental
caries did have an associationwith preterm birth.
So, straight away, by makingthis episode, I've learned

(05:32):
something new.
Of course, it doesn't mean thatgetting dental treatment in
pregnancy is not important.
It absolutely is important andlooking around online, I found

(05:52):
lots of suggestion that actuallygum disease and dental caries
are a little bit more common inpregnancy.
I don't know whether that isperhaps people's fear of
undergoing treatment or going tothe dentist, and maybe
undergoing treatment or x-raysmean that women leave things

(06:16):
that little bit longer.
Maybe things get that littlebit worse before they seek
attention.
But also it can be abouteconomics.
Do people have access to dentalcare that they can afford or,

(06:37):
better still, is free?
In the UK we used to have freeNHS dentistry and that's been
eroded over my lifetime.
But we do have a maternityexemption certificate, which
means that women can get freedental care during pregnancy and

(07:03):
for the first year of theirbaby's life, and one of the
first things the midwife willexplain at the booking
appointment is how to apply forthis maternity exemption
certificate.
So it's really important thatwomen are aware that they can,

(07:27):
in the UK, access free dentalcare.
And they should access freedental 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

(07:48):
potentially on your health andthat of your baby on your health
and that of your baby.
So all the things that youshould be doing to look after
yourself out of pregnancy youshould be doing in pregnancy and
going to the dentist andlooking after your teeth and
gums is no exception.

(08:09):
It's safer and better for yourbaby if you are safe, healthy
and well.
Researching this topic, I turnedup another interesting article
from the US about the importanceof dental care and maintaining

(08:29):
oral hygiene in the perinatalperiod and it describes a number
of physiological changes thathappen in pregnancy in the oral
cavity, so in the mouth,including more gingivitis, so
increased inflammatory responseto dental plaque, which can

(08:51):
cause more gum bleeding, thepotential for benign, harmless
gum lesions appearing, increasedtooth mobility, which I'd never
heard of, and potentially moretooth erosion, particularly in

(09:13):
women with hyperemesis orexcessive vomiting, because
stomach acid regularly coming upand the tooth enamel being
exposed to that gastric acidreally being quite negative and
causing erosion of that toothenamel quite negative and

(09:38):
causing erosion of that toothenamel.
They also concluded that theredidn't seem to be any
association between maternaldental disease and preterm birth
or low birth weight infants andthis article was interesting
because it commented aboutactually the attitude of
dentists and that dentists maybe a little bit reluctant to

(09:58):
treat pregnant women and a bitnervous about that, and that's
definitely something I've comeacross when a woman has come and
asked me in the antenatalclinic.
I've been to the dentist.
The dentist says I needwhatever treatment.
Can I do that while I'mpregnant?
Is it safe for me to do that?

(10:20):
The dentist wants to know and Iguess that's a little bit like
all sorts of other medicalprofessionals being a little bit
scared and apprehensive ofpregnancy because it's not
within their comfort zone,whereas for us, all I see day in
, day out is pregnant women ornew mums.

(10:41):
So it's very much in my comfortzone.
So, yes, using antibiotics,using local anaesthetic, using
mouth rinses you can even usesalt water are all acceptable

(11:02):
and safe treatments to have inpregnancy.
And, like many of the topicsI've tackled in the podcast,
having treatment, having afilling, having root canal,
having whatever needs to be done, done during pregnancy and

(11:26):
undertaken during pregnancy issafer, sensible and a good thing
to do during pregnancy, becausedelaying and leaving untreated
the complications and problemsis much more likely to be worse

(11:46):
for you and your baby.
And dental x-rays, equally, caneasily be performed, shielding
the rest of the mum's body.
The same American article pointsout that pregnancy can be that
little opportunity.
So it's a moment where a womanwill seek healthcare, will seek

(12:12):
expert advice, will seekhealthcare, will seek expert
advice and therefore, regardlessof whether we're a dentist, as
a midwife, as a doctor, we canencourage women to have good
oral hygiene habits.
The article talks aboutpregnancy being a teachable
moment, a moment where a womanis maybe more invested in

(12:35):
looking after herself and thathabits, like some of the other
things we've discussed maybestopping smoking or stopping
drinking are habits she maycarry into her later life and
also teach to her children asthey're growing up.

(12:56):
So therefore, good dental careand good dental hygiene is part
and parcel of that opportunityto talk to women about their
health longer term.
So this is a super quickepisode.

(13:17):
What's my zesty bit?
That's hilarious.
That just immediately made methink about lemon juice on my
teeth.
Don't think that acid's verygood for them, but anyway, that
aside, my zesty bit Well, myzesty bit is, I guess don't be

(13:40):
scared and think if you've gotteeth and gum problems, you're
suddenly going to have a pretermbaby, because that seems to be
out the window.
Dental care know that accessingthat care is safe and a good

(14:04):
thing to do and think, yes.
What are the general things Ican do to improve my health
during pregnancy, one of whichis looking after your mouth and
teeth, and as maternityprofessionals, it's our
responsibility to make sure theyknow they can access free
dental care in the UK and, ifyou're listening in another

(14:28):
country.
Think about what access todental care women perhaps have
where you are.
But also ask them about havethey got any teeth or gum
problems?
Are they noticing their gumsbleed?
Reassure them that that'snormal in pregnancy, but also

(14:50):
explain to them that lookingafter their general health and
brushing their teeth and lookingafter them is a valuable thing
and it's not just about growinga baby.
It's okay to look afterthemselves too, looking after

(15:15):
their general future health andpart of that although, like many
things in medicine, we've splitthat off and that's dentistry
it's all part of your body.
It's all important to lookafter, and pregnancy may give
you an opportunity to thinkabout that and focus on that a
little bit more and valuingyourself and valuing the health
of your body now and longer term, and hopefully, if we can

(15:42):
encourage women to think abouttheir general overall health and
include their teeth in that,that will spill over into
bringing up that child.
There are all sorts of problems,I know with increasing dental
caries in young children, andthat's one of the reasons we're

(16:07):
looking at sugar intake andsugar in food production.
I've put a link to a governmentpublication about child oral
health that shows just under aquarter of five-year-olds in the
latest survey 2019 had toothdecay and each child with tooth

(16:29):
decay will have, on average,three to four teeth affected.
It also documents that this canhappen very early on in life,
with 11% of three-year-oldshaving visible tooth decay with,
on average, three teethaffected.
That's really quite shocking.

(16:51):
There's also huge regionalinequality, with children from
the most deprived areas havingmore than twice the level of
tooth decay than those from theleast deprived.
So by discussing broader issueswith women, we're also helping

(17:13):
improve the health of our futuregenerations perhaps.
I very much hope you found thisepisode of the OBS pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
review on whatever platform youfind your podcasts.

(17:36):
As well as recommending the OBSpod to anyone you think might
find it interesting, there'salso tons of episodes to explore
in my back catalogue, fromclinical topics, my career and
journey as an obstetrician andlife in the NHS more generally.
I'd like to assure women I carefor that I take confidentiality

(18:00):
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
permission of the personinvolved, on that rare occasion
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore

(18:24):
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
If you want to get in touch tosuggest topics for future
episodes, you can find me atTheObsPod, on Twitter and
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(18:50):
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(19:12):
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