Determinación de la concentración de flúor en saliva en mujeres gestantes incluidas en un programa de salud oral

Résumé

Introduction: Pregnancy implicates a higher risk to contract oral diseases like tooth decay or periodontal disease. Likewise, certain oral diseases have been related to bad pregnancy outcomes (preeclampsia, preterm birth…). It would be necessary a Preventive Oral Health Program that allows the pregnant women a good control over their oral health and the access to preventive methods. The objectives of this study were to evaluate dietetic and hygienic habits, risk of caries, oral health status (decay and periodontal) and its influence in oral health-related quality of life in pregnant patients. The variations in fluoride concentrations in saliva of different fluoride varnishes throughout time (MI Varnish Clinpro White Varnish and Profluorid Varnish) were evaluated as well. Material and Methods: A randomized clinical trial has been carried out since 2018 in pregnant women belonging to the oral health preventive program from Clínica Odontológica Universitaria in Universidad de Murcia. This study consisted of 4 groups (n=20), control group, Clinpro White Varnish group, Profluorid Varnish group and MI Varnish group. Various questionnaires were used in order to gather sociodemographic habits, hygienic habits, beliefs, epidemiological Indexes (DMFT and CPI), caries risk (CAMBRA) and oral health-related quality of life index (OHIP-14). Three check-ups took place during pregnancy (day 1, 15 and 30), during each visit, the different indexes were evaluated and a sample of saliva was collected to analyze fluoride concentration in saliva after the application of the fluoride varnishes. Results: The average profile of the pregnant women was mean age 34,3 years old, Spanish (83,15%), married (55%), a pregnancy status of 22 weeks, medium-high cultural level (42%) and first timers (56%). In relation to hygienic habits, 88,7% brushed 2-3 times a day with fluoridated toothpaste. The oral health level shows a mean DMFT of 7,2, the percentage of surfaces with plaque was 52% and low caries risk (51,69%) (CAMBRA), ICDAS 2 code was observed in 15,6% of the teeth and CPI code 2 was the most common in the first visit (55%). The oral health-related quality of life domains with higher (worse) score were psychological disability and physical pain. A worse quality of life has been related to a higher caries risk, higher values in DMFT, higher ICDAS codes (5,6) and higher plaque index. Fluoride concentration in saliva is high in the three fluoride varnish groups immediately after its application but, after 15 days these levels drop to baseline-like levels. Conclusion: Although pregnant women have a high cultural level and good hygienic and dietetic habits, some negative myths and beliefs as well as damaging habits were detected, being these ones easily preventable by promoting oral health. Generally, pregnant women show epidemiological indexes similar to the general Spanish population, as well as good oral health-related quality of live, which is directly influenced by the presence of tooth decay and plaque. The incorporation of pregnant women to the preventive program, has had positive impact in periodontal registered values. The MI Varnish application seems to have a better performance in comparison to the other varnishes employed, as far as fluoride concentration in saliva is concerned but, in all groups, fluoride concentration in saliva drops to baseline-like concentrations after 15 days.