Some dentists avoided treating the women, and prenatal providers often failed to discuss the subject.
But now a growing body of evidence reveals the importance of good oral health in protecting both a mother and her newborn, experts say.
A woman can easily transmit bacteria from her mouth to her baby, starting the infant on a spiral toward serious dental problems.
"My opinion is that this is not on the radar screen of most women," said Jeff Wood, chairman of the pediatric department at the University of the Pacific School of Dentistry in San Francisco.
The most important time for women to ensure they have good oral health is before becoming pregnant. But it is not too late during pregnancy to visit a dentist and get problems resolved, experts say.
"When children are born, they don't have bacteria in their mouths, at least not initially," Wood said. Yet within six months, studies have shown a high correlation between bacteria in the mother's mouth and that found in the infant.
The transmission can take place by such simple acts as blowing on a spoon to cool food, kissing a baby on the mouth, or sharing something to eat.
As a pediatric dentist, Wood said he often deals with the results of a mother's poor oral health when he treats children with rampant tooth decay, which can lead to lifelong problems.
"It's so easily preventable," he said.
In February, a panel of California experts agreed, concluding that the benefits of dental care during pregnancy far outweigh the perceived risks.
The California Dental Association and American College of Obstetricians and Gynecologists brought together medical experts to examine the latest evidence and issue guidelines for pregnant women, dentists and prenatal care providers.
The group concluded that routine dental care, including X-rays with proper protection and the use of local anesthesia, can be undertaken at any time during pregnancy with no additional risk to the fetus when compared with the risk of not providing care.
The recommendations were based in part on guidelines issued in New York in 2006 after a pregnant woman with a severe toothache refrained from going to the dentist because she feared it could harm her fetus. She took massive doses of Tylenol instead.
The fetus died of liver toxicity from the large amount of Tylenol, and the woman had acute liver failure and needed a transplant, said Jane Weintraub, chairwoman of the division of oral epidemiology and dental public health at the UC San Francisco School of Dentistry.
Weintraub, who co-led the California panel, said many dentists have had little or no training in how to treat pregnant women.
"Until recently, we didn't have the data to support that it was safe," she said. "But it's safe and effective, and women need to take care of their oral health, both for themselves and their baby."
Most experts agree that bacteria can easily be transmitted from a mother to her newborn, but there are conflicting views about whether a mother's poor oral health can harm her fetus.
Wood notes that studies have shown a link between poor oral health and women delivering preterm or low-birthweight babies.
But Weintraub said the California panel concluded that although early studies showed such a link, the latest have not found a correlation.
Regardless of which studies are right, Contra Costa County health leaders believe there are enough concerns that they have been encouraging prenatal providers to ask pregnant women whether they have had a routine dental exam within the past year and to schedule one if they have not, said Itika Greene, perinatal services coordinator.
Greene noted that pregnancy may be the one time many low-income women can be reimbursed for dental care. California has eliminated dental care for adult Medi-Cal recipients in a budget-cutting move, but continues to provide such care for pregnant women.
A recent report involving a stillbirth raises additional concerns about poor oral health and the fetus, Wood said.
In that case, the woman had pregnancy-associated gingivitis, an inflammation of the gums that often occurs because of the hormonal changes that women experience during pregnancy, according to a February report in the journal Obstetrics and Gynecology. After the stillbirth, researchers discovered the same bacteria in the placenta and fetus as in the mother's plaque. They concluded the bacteria may have moved from the mother's mouth to the uterus when the immune system was weakened during a respiratory infection.
"We know that some bacteria that are infectious can cross the placental barrier," Wood said. "It's so important for a woman's oral health to be under control."
The message has yet to reach many pregnant women, however. Several women interviewed this week before a prenatal education class at the John Muir Women's Health Center said they had not paid much attention to how oral health might affect their newborns.
"To be honest with you, I've never really thought about it," said Crystal Willis, of Fairfield, who is pregnant with twins. "Maybe the awareness isn't as great as it should be."
Craig Strunk, of Oakley, said no one had mentioned oral health to his wife, Marilyn, who is pregnant with twin girls. He questioned whether it is one more needless thing to worry about.
"If a mother's mouth bacteria is so detrimental to the fetus, wouldn't this have been mentioned before, or maybe we wouldn't have survived as a species?" he said. "I question the data."
The panel of experts, however, concluded that the data exists. They encouraged prenatal providers to educate pregnant women about the issue and to refer them for dental care, if needed.
"I'm always alarmed by the number of patients whose perception is that you go to the dentist only when you have a toothache," Wood said.
source: insidebayarea
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