Oral health in pregnancy

There is a recognised policy agenda which outlines improvements in oral health and access to oral health care as a priority and integral to the health improvement agenda in Scotland. Pregnant women and young children are particularly important groups to support improved oral health behaviours and improved access to oral health care as the consequences of poor oral health can have a lifelong impact.

Good nutrition and a healthy start help to lay the foundations for good oral health throughout childhood and into adulthood and this can start as early as pregnancy with the oral health and nutrition of pregnant women.

Oral health and inequalities during pregnancy

Pregnancy offers opportunities to promote the importance of good oral health to mothers and encourage attitudes and behaviours that will help them protect the oral health of their children.

Rates of oral disease increase with levels of social deprivation. Some evidence associates poor oral health with poor outcomes in pregnancy.

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What are health inequalities?

The WHO defines health inequalities as 'differences in health status or in the distribution of health determinants between different population groups'. For a discussion of health inequalities and their relation to pregnancy, please see Inequalities in antenatal care.

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Policy context

Activity in this area is consistent with the Scottish Government's Action Plan for Improving Oral Health and Modernising NHS Dental Services, with Equally Well, and with the following (external links):

How do inequalities relate to oral health in pregnancy?

Though evidence for Scotland shows an improving picture, oral health continues to be strongly linked to socioeconomic status.

The 2010 National Dental Inspection Programme survey (external link) showed only 46.5% of Primary 1 children in the most deprived fifth of the population had no signs of decay, while the figure for those in the least deprived fifth was 78.7%. The latest data from the National Dental Inspection Programme (NDIP) shows that the dental health or Primary seven (P7) children is continuing to improve. In 2013, 72.8% of P7 children had no obvious decay experience in their permanent teeth, compared with 69.4% in 2011 and 52.9% in 2005, the year of the first NDIP

Women from vulnerable groups are less likely to access antenatal services and other sources of support - a high risk factor for maternal and infant mortality (Growing Up in Scotland 2011) (external link).

Women with complex social problems report discrimination and judgemental behaviour from healthcare staff and that this impacts on their ongoing engagement with services (Reducing Antenatal Health Inequalities: Outcome Focused Evidence into Action Guidance, pp15) (external link).

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What are the risks from oral health problems in pregnancy?

Because of normal hormonal changes during pregnancy, underlying periodontal disease can become more obvious through bleeding gums. However, bleeding gums can also be a sign of periodontal disease, hence the need for regular dental check-ups, including during pregnancy. All instances of bleeding gums should be checked by a dentist.

Some evidence suggests an association between periodontal disease in pregnancy (gum disease), low birth weight and pre-term labour (Dasanayake et al, 2008, external link).

This may be a result of other factors associated with socioeconomic deprivation. However, a suggested biological mechanism is that the bacteria that cause inflammation of the gums and other blood-borne agents associated with periodontal disease reduce the blood supply to the developing foetus and placenta.

The main causes of preterm labour and low birth weight are smoking in pregnancy and poor maternal nutrition. Where poor maternal oral health is a result of high sugar intake, a lack of adequate dental hygiene, infrequent dental check-ups or a combination of these factors, there is a risk of negative parental behaviours and attitudes to oral health affecting the future oral health of the child.

Research has shown that children in disadvantaged groups have less dental decay if there is parental involvement in tooth brushing, if brushing is carried out twice daily with a fluoride toothpaste and if it is started before the age of 1/as soon as the first teeth erupt (Marinho et al 2003 and Pine et al. 2004, external links).

Identifying those at risk

Because oral disease is common, requires expert diagnosis and affects all sections of the population, pregnant women should continue visit their dentist during pregnancy. Women who are not registered with a dentist or who do not regularly visit their dentist should do so. For a discussion of risk factors for inequalities, see Inequalities in Antenatal Care.

A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.

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