Missed opportunity?

A news story from the USA caught my eye last week. It was advice on oral health care during pregnancy. It came from, of all people, the American Congress of Obstetricians and Gynaecologists, rather than the dental association.

It contains some good stuff and a warning for the US healthcare system. The advice points out that 35% of women in the USA reported that they did not have a dental visit within the past year and 56% of women did not visit a dentist during pregnancy. Approximately 40% of pregnant women have some form of periodontal disease.

Many of these are from the poorest sections of society with no health insurance. To these the recommendation of the American Dental Association to have 6 monthly dental examinations and cleanings as well as daily brushing and flossing falls on deaf ears.

Despite all the adverse publicity the NHS attracts at present, we can be proud of the fact that dental care during pregnancy (and for a year after) really is ‘free at the point of delivery’ as the politicians keep stressing. I remember around twenty years ago some bright spark at the Department of Health suggested that this concession was unnecessary, but he/she was soon sat on from a great height.

Looking back to the early years when I was involved in dentistry, there were many myths associated with teeth and dentistry. Pregnant mothers were told that they would lose ‘a tooth for every child’ and that the baby would ‘drain the calcium from the teeth and make them go bad'; nothing to do with a cariogenic diet then.

These may still be around but one I remember being told was to keep treatment to a minimum and avoid x-rays at all costs. As one wise old dentist told me: ‘If she miscarries or the baby has a deformity, your dental treatment will get the blame.’ The advice from the US obstetricians has no such qualms.

It says patients should be reassured that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) and local anaesthesia (with or without adrenaline), are safe during pregnancy. Women should be told that extractions, root canals, and restorations (amalgam or composite) may be done at any time during pregnancy.

The importance of routine oral health maintenance, such as limiting sugary foods and drinks, brushing twice a day with fluoridated toothpaste, flossing once daily, and dental visits twice a year, should be stressed. All sound advice from the USA, but I looked for similar guidance in the UK on the NHS Choices website, which only mentions that care is free. A missed opportunity I feel.

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