Strive-the Student View
February, 2007 edition

The Research Experience

 
By Kimberly Hanson, Stephanie Brunner and Elizabeth Rugroden

When you first see a double blue line on a pregnancy test stick, the last thing on your mind is the quality of your oral health. Unknown to most expectant mothers is that periodontal disease has been linked directly to low birth weight babies and preterm labor. Therefore, with the help of our Student American Dental Hygienists' Association (SADHA) advisor, Debbie Schumacher, RDH, BS, we developed a presentation for prenatal classes. Our presentation discusses oral hygiene during pregnancy, infancy and childhood.

It is important for women to have regular dental care throughout their pregnancy and good home care to prevent pregnancy gingivitis. Over half of pregnant women experience the signs and symptoms of gingivitis. If gingivitis goes untreated, it may progress to periodontal disease. According to a five-year study conducted at the University of North Carolina, pregnant women who have moderate to severe periodontal disease are seven times more likely to deliver a premature child than women with healthy gums.[1] Preterm delivery usually results in giving birth to a low birth weight baby. Periodontal disease releases toxins into the mother's bloodstream. These toxins have the potential to prematurely trigger prostaglandin, which is a hormone that induces labor. Toxins also reach the placenta, which can interfere with the growth and development of the fetus. The National Institute of Dental and Craniofacial Research estimates that as many as 18 percent of preterm, low birth weight babies born in the United States each year may be attributed to oral infections.[2]

The Relationship of Oral Health of the Baby and the Parents
The experience of caring for a new infant can be overwhelming, and parents may be unaware that something as simple as sharing a spoon can spread Streptococcus mutans. To provide optimal health for their infant and to prevent the spread of bacteria, xylitol products are recommended for caregivers. For example, chewing gum with xylitol will help prevent the bacteria from adhering to the enamel, reduce plaque buildup and allow the enamel to remineralize. Fluoridated water or supplements are ways to prevent decay or aid in remineralization.

It is important for infants to see a dentist as early as 6 to 12 months. At these appointments, dental hygienists should check for early childhood caries (ECC) and educate parents on all aspects of oral health care. They may demonstrate the "lift the lip" technique used to look for ECC, explain to parents how they can detect demineralization in its early stages and show them how to accomplish daily oral hygiene for their baby.

If optimal oral hygiene is not valued and achieved, early childhood caries (ECC) may result. It is estimated that one out of seven preschool-aged children has ECC, and this can lead to premature loss of primary teeth.[3] Losing primary teeth too soon can lead to speech problems, facial growth disturbances, chewing difficulties, crowding in permanent dentition and low self-esteem. If a child does develop decay, their teeth should be restored rather than extracted. Accidental tooth loss or avulsion obviously cannot always be prevented. If this does occur, the tooth can be kept vital for up to an hour to be re-implanted into the child's mouth. Another aspect of good oral hygiene is proper nutrition. Foods such as cheese, berries, and vegetables are anti-cariogenic, and including these foods in a child's diet is another way to aid in the prevention of ECC.

The Prenatal Presentation
This research gave us the tools to develop a presentation that includes a PowerPoint slide show, informational pamphlets, and pre/post quizzes. We contacted the prenatal class director, Heather Costly, at Luther Midelfort Hospital in Eau Claire, Wis., who suggested dates when we could present our program. We combined our research and prevention tools into a 30-minute presentation. We focused on preventing oral diseases rather than treating future problematic circumstances.

Upon our arrival, Ms. Costly instructed her class, "Listen closely. This is information that you will not get from your nurse practitioner, OB/GYN, pediatrician or anyone else." Having been a nurse and prenatal class director for some time, she found this information important because it was not being taught in most prenatal classes. The parents were receptive to our presentation and shocked by some of the information we provided, particularly the transmission of bacteria from parent to child. With the help of our pre/post quizzes, we found that some of this information was new to them, and that they did learn something. A few of the questions on our pre-quizzes were consistently answered incorrectly. One of them was: Is your baby born with cavity-causing bacteria? Many of the parents thought they were, when in fact babies are not born with cavity-causing bacteria and they acquire it through transmission. Another question commonly answered incorrectly concerned which foods are noncariogenic. Due to the lack of knowledge and education about these topics, we feel there is a need to reach out to more expectant parents.

In order to distribute this information to all expectant parents, we need more health care professionals to be well versed in this area of need. One of the ways we, as dental hygienists, can make an impact is through educating nurses, midwives, pediatricians, gynecologists and any other health care professionals involved in prenatal care. We have recently completed a course that qualifies us to educate and teach healthcare professionals and instruct them on how to properly apply fluoride varnish. We are continuing our program at Luther Midelfort and are working on a presentation to educate the staff at our local Women Infants and Children (WIC) clinic.

We believe that implementing this presentation in prenatal classes will assist expectant parents in providing optimal oral care for themselves and their children. The systemic link to oral diseases should be understood and valued by all health care professionals. Then proper oral hygiene during pregnancy, infancy and childhood could become part of standard prenatal care. This was a wonderful experience for us and we hope to see the addition of oral education in more areas of health care.

References

1. Loos K. Periodontal disease: can it cause preterm birth? Available at http://parenting.ivillage.com.
2. Mayo Foundation for Medical Education and Research. Oral health and overall health: why a healthy mouth is good for your body. Available at www.mayoclinic.com/ health/dental/DE00001, Feb 18 2005.
3. Platt LJ, Cabezas MC. Early childhood dental caries. Policy Brief. University of California. Available at www.ucop.edu/cprc/platt2.pdf.

Additional Resource
Xylitol.Org: www.xylitol.org

Kimberly Hanson is currently in her final year of the dental hygiene program at Chippewa Valley Technical College in Eau Claire, Wis. She also has a bachelor's degree in Spanish from the University of Wisconsin-River Falls. She is an active member of her SADHA group and a representative for her dental hygiene class. She plans to, in the future, obtain a bachelor's degree in dental hygiene or education.

Stephanie Brunner is currently in her final year of the dental hygiene program at Chippewa Valley Technical College in Eau Claire, Wis. She is an active member of her SADHA group. She plans on working toward a bachelor's degree in dental hygiene at the University of Minnesota.

Elizabeth Rugroden is currently in her final year of the dental hygiene program at Chippewa Valley Technical College in Eau Claire, Wis. She is an active member of her SADHA group and is the secretary of her dental hygiene class. She hopes to, in the future, obtain a bachelor's degree in education or dental hygiene.