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The year was 1986. The dental patient who Dr. Morales was seeing was visibly upset. When he asked what was wrong, she explained that her sister had suffered a seizure two weeks earlier and fractured her front teeth. The sister had been seen in an emergency room and was referred to an oral surgeon and endodontist for care, but she had not been able to find a dentist willing to treat her. The reason? It was not because she was uninsured, uncooperative, or unwilling to pay for care (she did not fall into any of those categories), but because she was pregnant. With tears in her eyes, Dr. Morales' patient asked if he would be willing to see her sister. His response was an unequivocal…."Of course!"

Her sister came in the following day. She had multiple broken teeth, dental abscesses caused by a bacterial infection and an untreated fracture of her upper jaw. She was in excruciating pain, and it was obvious to Dr. Morales that the infection was certainly a greater risk to her pregnancy than his providing the dental care that she needed. He began on a mission - advocating for the appropriate treatment of women, even if they are expecting a child.

New York Leads the Way Promoting Dental Care for Pregnant Women
Twenty years would pass before New York became the first state in the nation to issue guidelines encouraging the delivery of necessary dental care to prenatal women, prompted in part by yet another tragedy. In this instance, a young pregnant woman who had been unable to access dental care along the New York/Pennsylvania border had overdosed on acetaminophen, resulting in the death of her baby due to liver toxicity. This woman spent several weeks recovering in the hospital and came very close to needing a liver transplant herself.

Several states have followed suit, issuing their own set of guidelines, and in 2012 a statement was released called "Oral Health Care During Pregnancy: A National Consensus Statement." Developed by the Health Resources and Services Administration (of the U.S. Department of Health and Human Services) in collaboration with the American Dental Association and the American College of Obstetrics and Gynecologists, the statement hopes to provide guidance to everyone involved in the care of prenatal women. It asserts that "Oral health care, including the use of X-rays, pain medication, and local anesthesia, is safe throughout pregnancy." These universal standards for healthcare providers help ensure that women will not miss having an oral examination, dental prophylaxis or emergency dental care while pregnant.

Dental Care During the Second Trimester Is Best
While most would agree that, ideally, women should attend to all their oral health needs before even thinking about becoming pregnant, not everyone has the foresight to do so. Many women delay coming to the dentist while they are pregnant because they incorrectly believe that having dental treatment or X-rays poses a risk. As a result, they wait until they have more serious problems that require urgent or emergency treatment such as extractions, root canals and periodontal care. To avoid reaching this point, oral evaluations are recommended as early in a pregnancy as possible to help ensure that all necessary care is completed before the last six weeks of pregnancy.

Ideally, dental care should be scheduled during the second trimester (months 4-6) because most pregnant women are better able to tolerate dental procedures during that time - they are usually past the morning sickness period, and have not yet gained the additional weight that might make sitting in a dental chair uncomfortable.

Why Dental Care During Pregnancy Is Important
It is estimated that more than 75% of pregnant women experience bleeding of the gums or periodontal problems during their pregnancy. Studies examining whether oral health can reduce the incidence of low-birth-weight or pre-term birth have been contradictory, but it has been shown that there may be a relationship between stillbirths and periodontal disease bacteria. While it may not yet be possible to prove scientifically that a causal relationship exists, one thing is certain: women, their families, and all of their healthcare providers can be assured that dental care is not only safe during the prenatal period, it is an essential component of a "healthy" pregnancy.

For more information about guidelines for oral healthcare during pregnancy, visit the following websites:
Oral Health Care During Pregnancy and Early Childhood Practice Guidelines (NYSDOH August 2006)
http://www.health.ny.gov/publications/0824.pdf

Oral Health Care During Pregnancy: A National Consensus Statement (2012)
http://www.mchoralhealth.org/pdfs/OralHealthPregnancyConsensus.pdf

The authors play important roles in the New York Medical College-sponsored general dental practice residency program, which was established in 2012 at Phelps and Open Door Family Medical Center in Port Chester:

Joseph Morales, D.D.S., F.A.C.D. (residency program liaison) is a graduate of Columbia University College of Dental Medicine and has over 32 years of professional experience, with 25 years dedicated to academic dental medicine. He is Professor and Chairman of the Department of Dental Medicine at NYMC's School of Medicine and a fellow in the New York Academy of Dentistry and the American College of Dentists.

Janet Bozzone, D.M.D., M.P.H., F.A.G.D. (residency program site director) has over 30 years of experience in community-based dental programs for the underserved in New York. Dr. Bozzone received her Doctor of Dental Medicine from Fairleigh Dickenson University, School of Dentistry, and a Master of Public Health from the University of North Carolina Chapel Hill. A Fellow in the Academy of General Dentistry, she is Director of Dentistry at Open Door and a faculty member of NYMC's Department of Dental Medicine.

Rosa Martinez, D.D.S. (residency program director) received her doctorate in dental surgery from Columbia University College of Dental Medicine and has over 26 years of professional involvement in graduate dental education and hospital dental services. She is Assistant Professor of Clinical Dental Medicine at NYMC.

 

Pictured here are dental residents Benjamin Geisler, DMD; Christiane Getaz, DDS; Jeannine Holz, DDS; and Roselin Reiss, DMD.

The Dental Residency Program at Phelps
In 2012, Phelps and Open Door Family Medical Center in Port Chester became primary clinical training sites for the New York Medical College General Dental Practice Residency Program. Each year a group of four dental residents undergo a one-year training program, with a second-year option, seeing outpatients at Open Door and treating patients in Phelps' Emergency Department, operating room and inpatient rooms. At Phelps, under the supervision of attending faculty staff of dentists and physicians, they also perform elective surgeries for patients with special needs or children who cannot be treated in an outpatient office.