Context

Perinatal oral health care refers to oral health care during pregnancy and early childhood. Pregnant women with untreated oral health problems may be at increased risk for preterm labour, low birth weight babies and other adverse health outcomes. During pregnancy, hormonal changes can make expectant mothers more susceptible to preventable oral health problems, such as gingivitis and tooth decay. Infants can acquire oral bacteria from their mother's oral cavity, which can contribute to Early Childhood Caries (ECC). ECC is one of the most common chronic diseases of childhood and can have a negative impact on children's physical, emotional and social well-being. Other diseases, both viral and fungal, can be transmitted from caregiver to child as well, leading to soft tissue inflammatory conditions. Poor maternal oral health, malnutrition and exposure to environmental factors and certain medications during pregnancy may lead to development/milestone delays and disruptions in enamel and dentine formation, which may predispose to ECC.

Scope

This policy statement aims to provide a framework for delivering comprehensive and accessible oral health care to expectant mothers and their infants, to improve maternal and infant oral health outcomes and reduce disparities in access to care.

Principles

Perinatal oral health care should be included in all policies that promote mother and child health and wellbeing. Oral health care should begin as early as possible in all women of child-bearing age to identify and address potential risk factors by education, prevention and early intervention for both mother and child.

Policy

Oral health care for expectant mothers and their infants should be:

• comprehensive, addressing not only the oral health of expectant mothers and infants but also their overall health and well-being;
• evidence-based, using guidelines and recommendations developed by professional organizations, and based on the best available scientific evidence;
• person-centered, tailored to the individual needs of expectant mothers and infants, considering their unique circumstances and preferences;
• collaborative and integrated, involving dental providers, obstetricians, pediatricians and other health and social care providers as appropriate;
• accessible and affordable for all expectant mothers and infants, regardless of their socioeconomic status, following the principle of Universal Health Coverage (UHC);
• consistent, culturally and linguistically appropriate, targeting pregnant women and their infants, particularly those from vulnerable populations.

Therefore, FDI encourages:

• education of mothers, families and caregivers on how to promote oral health and prevent oral diseases using anticipatory guidance and motivational interviewing and other evidence-based strategies. The message should focus on the importance of oral health care for the expectant mother, the early start of oral health care for children, healthy feeding practices, including emphasis on breastfeeding, limiting sugar intake, exposure to fluoride through the use of fluoride toothpaste or/and drinking water that is fluoridated and regular dental check-ups, typically starting by age 1 or when the first primary tooth is visible;
• incorporation of perinatal and infant oral health in dental and other healthcare professions undergraduate and professional continuing education;
• research that addresses the following:

• identification of risk factors for oral health problems in pregnant women and infants, including social determinants of health;
• examination of the effectiveness, cost-effectiveness and sustainability of different interventions to improve perinatal and infant oral health;
• exploration of the barriers and facilitators to accessing oral health care for pregnant women and infants.

• Governments to:

• provide funding for programmes and services that support perinatal and infant oral health care including promotion, prevention and access;
• develop policies and regulations that support perinatal and infant oral health care, such as mandating dental screenings for expectant mothers and infants;
• require dental coverage to be included in public and private health insurance plans;

• National Dental Associations to:
  • develop and promote guidelines and standards of care for perinatal and infant oral health;
  • provide education and training for dentists and other health providers on perinatal and infant oral health;
  • advocate for policy change at local and national levels;
  • raise public awareness about the importance of perinatal and infant oral health;
  • collaborate with other healthcare providers to deliver multidisciplinary comprehensive care to expectant mothers and infants.

Keywords

early childhood caries, Universal Health Coverage, primary health care, perinatal care.

Disclaimer

The information in this Policy Statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

References

1. American Academy of Pediatric Dentistry. Perinatal and Infant Oral Health Care. In: The Reference Manual of Pediatric Dentistry. Chicago, IL; 2021. p. 262-6.
2. American Academy of Pediatrics. Policy Statement: Oral Health Risk Assessment Timing and Establishment of the Dental Home. Pediatrics. 2015;136(3):e737-e746.
3. World Health Organization. Oral Health and Pregnancy. https://www.who.int/oral_health/publications/oral_health_pregnancy/en/. Published 2013. Accessed September 2021.
4. World Health Organization. Ending childhood dental caries: WHO implementation manual. Geneva: World Health Organization; 2019. License: CC BY-NC-SA 3.0 IGO. https://apps.who.int/iris/handle/10665/330643?show=full. Published 2019. Accessed November 26, 2021.
5. Early Childhood Caries: IAPD Bangkok Declaration. Int J Paediatr Dent2019 May;29(3):384-386. doi: 10.1111/ipd.12490 
6. World Health Organization. Exclusive breastfeeding for optimal growth, development, and health of infants. Geneva: World Health Organization. https://www.who.int/elena/titles/exclusive_breastfeeding/en/. Accessed August 19, 2022

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