In my opinion, necessary dental care and elective dental procedures should be available to all pregnant women. Recent studies have shown a correlation between oral health and adverse pregnancy outcomes (Kerpen & Fleischer, 2006; Offenbacher, 2006). According to Paquette (2006), most clinical studies have confirmed a strong and consistent relationship between periodontal disease and preterm birth (PTB) and/or low birthweight (LBW). PTB and LBW are leading causes of infant mortality and morbidity in the United States and pose significant risks of long-term disabilities (pulmonary abnormalities, cerebral palsy, and other neurodevelopmental delays) and psychological stress for infants and their families. These physical, emotional, and financial tolls on families may be devastating and life altering.

Periodontal disease, a chronic low-grade infection of the gums, has been associated with PTB and LBW and has been estimated by some to account for 30% to 50% of all preterm births (Offenbacher, 2006). As a matter of fact, maternal oral bacteria have been found in human amniotic fluid, demonstrating that pathogens from the mother's mouth are transmitted to the uterine cavity, thus presenting an infectious, inflammatory challenge to the fetus (Kerpen & Fleischer 2006; Offenbacher, 2006). Professional organizations such as the National Center for Education in Maternal and Child Health, the American Dental Association, the American Academy of Pediatrics, the March of Dimes, and the American Academy of Periodontology have issued recommendations encouraging the promotion of oral health in pregnant women. In support of these recommendations, New York State's Department of Health published Oral Health Care During Pregnancy and Early Childhood Practice Guidelines (NYSDOH, 2006). The Guidelines state that pregnancy is not a reason to defer routine dental care and necessary treatment for oral health problems because dental care is safe and effective during pregnancy. Dental diagnosis and treatment of disease processes that need immediate attention can be provided safely in the first trimester of pregnancy. Necessary treatment can be provided throughout pregnancy (although the period between 14 and 20 weeks is optimal); delay in necessary treatment could result in significant risk to the mother and fetus.

Despite advances in the field of neonatology over the past 30 years, PTB and LBW remain serious problems and contribute to high rates of infant mortality and morbidity. Decreasing the rate of PTB and LBW would not only benefit individual infants and families but also have an enduring effect on society. Providing oral healthcare to pregnant women is more economically, emotionally, and psychologically cost effective than caring for premature or LBW infants. Although no multicenter trials have linked periodontal disease and PTB, waiting for such evidence is not in the best interest of women and infants. Oral healthcare is safe and effective during pregnancy. I believe that dental procedures for pregnant women should be an integral component of prenatal care and overall good health.

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