commentary C D A J O U R N A L , V O L 5 0 , Nº 4
C.E. Credit: Part 3 of 3
Oral Health Intervention Before Pregnancy: A Preconception Approach Rachel Anderson, BS, and Hugh Silk, MD, MPH
AUTHORS Rachel Anderson, BS, is a medical student at the University of Massachusetts Chan Medical School. Conflict of Interest Disclosure: None reported.
Hugh Silk, MD, MPH, FAAFP, is a professor in the department of family medicine and community health at the University of Massachusetts Chan Medical School. He also teaches at the Harvard School of Dental Medicine. Conflict of Interest Disclosure: None reported.
O
ral disease is prevalent and has wide-ranging ramifications that have an important impact on overall health across the lifespan.1 Almost 100% of adults will suffer from caries, which can be complicated by abscesses, hospitalization and death,2 and 50% of adults will suffer from periodontitis, which has been linked to numerous poor health outcomes.3 The devastating effects of poor oral health are experienced disproportionately by communities of color and those who are impoverished. These disparities are provoked by limited access to care, systemic racism and competing priorities of health and social needs.4 Efforts have been made at nearly every stage of the lifecycle to reduce the burden of oral disease including prenatal, pediatric and geriatric care. However, interventions in the preconception phase, which encompasses the entire lifecycle during which a person is not but could become pregnant, beginning at menarche and concluding with menopause, have been limited, and this could represent an untapped opportunity to improve oral and systemic health outcomes for people of childbearing age and their offspring.5
Importance of Oral Health in the Preconception Phase
The preconception phase, prior to a pregnancy, may be particularly important for caries prevention in children born to mothers with significant oral disease (FIGURE ). Oral disease begins early in life as soon as teeth begin to erupt, and early caries affect a child’s growth, selfesteem and long-term dental outcomes in adulthood.6–8 Studies have shown that caries-causing bacteria are passed from caregivers to offspring around the time of tooth eruption in infants.9 If people received oral health care prior to pregnancy and their bacterial load was decreased at this time, caries rates in children would likely be reduced.10 In addition to increasing caries risk in offspring, oral disease during pregnancy can be harmful for the pregnant individual’s health. Periodontal disease has been linked to adverse pregnancy outcomes including preeclampsia, gestational diabetes, preterm delivery and low birth weight.11–13 As such, treatment of oral disease prior to pregnancy could be conducive to nurturing healthy mothers, healthy pregnancies and healthy infants. There are numerous barriers to dental care during pregnancy, and pregnant individuals are less inclined to be seen by APRIL 2 0 2 2
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