Abstract
ObjectivesTo review the content of recommendations within antenatal oral healthcare guidance documents and appraise the quality of their methodology to inform areas of development, clinical practice, and research focus.MethodA systematic search of five electronic databases, Google search engine, and databases from relevant professional and guideline development groups published in English, developed countries, and between 2010 and 2020 was undertaken to identify guidance documents related to antenatal oral healthcare. Quality of documents was appraised using the Appraisal of Guidelines Research and Evaluation II tool, and a 3-step quality cut-off value was used. Inductive thematic analysis was employed to categories discreet recommendations into themes.ResultsSix guidelines and one consensus statement were analysed. Two documents developed within Australia scored ≥60% across five of the six domains of the quality appraisal tool and were recommended for use. Four documents (developed in the United States and Canada) were recommended for use with modifications, whilst one document (developed in Europe) was not recommended. A total of 98 discreet recommendations were identified and demonstrated considerable unanimity but differed in scope and level of information. The main content and number of recommendations were inductively categorised within the following clinical practice points: risk factor assessments (n = 2), screening and assessment (n = 10), pre-pregnancy care (referral, n = 1), antenatal care (health education and advice, n = 14; management of nausea and vomiting, n = 7; referral, n = 2), postnatal care (health education and advice, n = 1; anticipatory guidance, n = 6), documentation (n = 4), coordinated care (n = 4), capacity building (n = 6), and community engagement (n = 1).ConclusionThe methodological rigour of included guidance documents revealed areas of strengths and limitations and posit areas for improvement. Further research could centre on adapting antenatal oral healthcare guidelines and consensus statements to local contexts. More high-quality studies examining interventions within antenatal oral healthcare are needed to support the development of recommendations.
Highlights
Oral health is a critical component of general health and wellbeing
These guidance documents were developed from three continents including North America, Australia (n = 2, AGDH and NACCHO/RACGP), and Europe (n = 1, EFP)
Most documents were developed for implementation at a national level (n = 5, AAPD, AGDH, CDAF, NACCHO/ RACGP and OHCDPEW), state or province levels (n = 1, PSBC) or international level (n = 1, EFP)
Summary
Oral health is a critical component of general health and wellbeing. Pregnancy signifies a unique and vulnerable period in a woman’s life and increases susceptibility to oral diseases such as periodontal disease and dental caries due to complex hormonal, behavioural, and physiologic changes [1]. Evidence has suggested an association between periodontal diseases and risk of adverse pregnancy outcomes during pregnancy, including preeclampsia, low-birthweight and preterm birth [2]. Other evidence has demonstrated the impact of poor oral health of women throughout the lifespan and that of their children, including the development of dental caries, impaired nutrition, increasing dental costs, and diminished quality of life [3]. These outcomes can be worse for women who are vulnerable, disadvantaged or Indigenous [1]. In light of the evidence, maintaining oral health during pregnancy has been continually recognised as a pressing public health concern worldwide [4], whilst oral healthcare topics relating to pregnancy have been introduced into formal medical pedagogy [5], professional development training [6], and integrated primary healthcare models [7]
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