INTRODUCTION
You may be drawn to this book from the bookstore shelf or from a website due to its appealing physical features. The book sports a soft, pur,ple cover featuring a pregnant woman’s silhouette and a clearly stated title. Upon opening it, you will view a concise table of contents consisting of 7 chapters, appendices, and an index. Each chapter contains key points, subtitles, charts, and tables along with a robust list of references. All the chapters are designed for easy reading and quick searches. Important information is found in highlighted boxes, tables, and figures, all of which are presented in a colourful manner with titles and subtitles.
The author, Daniel Ninan, DDS, is also a coauthor of a neonatal study published in the Journal of Obstetrics, Gynecology, and Neonatal Nursing . At the time of book publication, he was an assistant professor of dental education services at Loma Linda University School of Dentistry. Dr. Ninan maintains a dental practice in San Bernardino, California, and is active in organized dentistry, serving on the Tri-County Dental Society’s New Dentist Committee and Communication Committee, as well as on committees and councils within the SAC Health System, which offers affordable health care services particularly to uninsured individuals and their families.
The book’s intent is to be a quick reference guide on how to maximize the safety of the pregnant woman and her unborn child while performing dental procedures. The author shares his observations about dental professionals who are reluctant to treat pregnant clients for fear of causing harm to either the unborn baby or the expectant mother. The book can be used by oral health professionals such as dentists and dental hygienists. Further, the author feels that other health professionals such as nurses would find the book useful for consultations with their pregnant clients and possible dental referrals.
CHAPTER OUTLINES
In chapter 1, “Perceptions about dental treatment during pregnancy,” the author describes the perceptions of the dental or prenatal care provider as well as the pregnant woman’s perceptions of and attitudes towards dental office visits. He highlights an absence of dental referrals and a common perception of dental treatment as unsafe during pregnancy.
Under subheadings in chapter 2, “Considerations for treating pregnant patients,” the author lists circumstances and treatment options where consultation with the woman’s prenatal care provider is needed for dental treatment and indicates which trimester is best suited for routine dental treatment.
Chapter 3, “Complications and the impact of dental care,” categorizes the physiological changes during pregnancy and how dental treatment may need to be modified to account for them.
Chapter 4, “Procedures and treatment guidelines,” describes safety concerns pertaining to dental restorative and preventive treatments. Radiographs, filling materials, scaling and root planing safety form the first half of the chapter whereas prevention of oral diseases through nutritional counselling and self-care for the pregnant client forms the last half.
The final 3 chapters delve into the details of possible medications pregnant women can and cannot use whether in the care of their perinatal health care provider or the dental professional.
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ANALYSIS
Our immediate question when opening the book was why the title and the table of contents are focused on pregnancy and do not include pre- and post-natal stages. The term commonly used is “perinatal,” meaning the time before, of, and after birth. After perusing the book, we found short mentions of pre- and post-pregnancy information embedded in the chapters. Nonetheless, as clinicians with experience in perinatal programs, we felt the book should have been titled Dentistry and the perinatal patient and included all stages of pregnancy in its content.
Even though the purpose of the book is to alleviate the fears of dental professionals who are hesitant to treat perinatal women, it unfortunately has the opposite effect. The risks associated with treating pregnant women are presented in a tone of fear, and there are numerous recommendations for pregnant clients to contact their health care provider before or during dental treatment. The chapters thunder on about what could go wrong, with the resulting message that pregnancy is something about which to be concerned. In chapter 2, there is an unsettling background tone of worry generated by titles and subtitles such as “Emergency…,” “Urgent…,” “Necessary…,” “Effective…,” “Safety Considerations,” “Consequences…,” etc. Chapter 3 continues in the same alarming tone, discussing the physiological changes during pregnancy and emphasizing the complications a dental or health professional may observe rather than the normality of pregnancy. This approach makes one ponder if dental professionals would actually want to see and treat a pregnant client.
In chapter 6, medications not to be used during breastfeeding are discussed, which prompted us to ask why the post-pregnant woman would consult a dentist about this medication and not her physician or health specialist in the first place.
The book applies a clinical treatment focus to pregnancy. Very little of the book is devoted to preventive dental care and to special considerations women may have during their pregnancies. For example, chapter 4 has a disappointingly short few paragraphs devoted to preventive education for infant oral care. In contrast, there is plenty of information about guidelines for children’s caries treatment. We discussed this aspect of the book and both concluded that having children is a natural stage in a woman’s life and should be treated as such rather than as a potential risk factor for disease.
On the positive side, the book includes information that may be new to some dental practitioners or a knowledge refresher for others. Tables summarize categories of treatment and medications. However, one of the limitations of using textbooks as a source of evidence is the currency of the information. The author provides a comprehensive list of references to a variety of good sources: systematic reviews, primary research papers, peer-reviewed literature reviews, professional and government white papers, as well as expert edited textbooks. Yet the most recent reference publication date was 2012, even though the book was published in 2018. Further, most of the information found in this book could be accessed via free online peer-reviewed journals or professional websites that offer expert, evidence-informed guidelines. A good example of the latter is found in the appendices. Both the Sample Consult Forms and the Caries Risk Assessment Form from the American Academy of Pediatric Dentistry and American Dental Association are updated frequently. The forms included in this textbook are already outdated. The appendices also contain a list of recommended websites. We randomly chose a few and found many inactive links.
CONCLUSION
This book tends to treat pregnancy as an exclusively clinical condition rather than as part of the normal life cycle of most women. Furthermore, the dearth of information about prevention before, during, and after pregnancy limits its value to dental hygienists. For dental or other health care providers to keep abreast of the oral care needs of their perinatal clients, we recommend saving your money and not buying the book. Instead, review recent, updated primary sources in journals and on reputable professional websites. If there are safety concerns about a specific therapy, consult with the client’s perinatal health care providers before proceeding.
Diane Cameron, BN, RN, IBCLC, works as a public health nurse for the Interior Health Authority in Cranbrook, British Columbia, Canada. She is also a certified lactation consultant.
Rae McFarlane, MEd, RDH, works for the Interior Health Authority in Cranbrook, British Columbia, Canada as a community dental hygienist supervisor. She is also a clinical assistant professor in the dental hygiene degree program, University of British Columbia, and served as CJDH book review editor from January 2014 to January 2020.