Q1. Can I see a dentist while pregnant, and can a tooth be taken out?

At guideline level the answer is yes: a study appraising 7 guideline documents with AGREE-II [Fn10] states that the message these guidelines convey consistently is that preventive, diagnostic, restorative and periodontal procedures and tooth extractions are safe throughout pregnancy [Fn9], and that dental emergency treatments can be provided at any time during pregnancy [Fn11]. The direct population-level evidence comes from a prospective comparative cohort study: 210 pregnancies exposed to dental local anaesthetics during pregnancy (53% of them in the first trimester) compared with 794 unexposed pregnancies [Fn19], with no statistically significant difference in the rate of major anomalies (4.8% versus 3.3%) [Fn20]; the procedures reported most frequently in that study included tooth extraction (31%) [Fn21], and the authors concluded that there seems to be no reason to prevent pregnant women from receiving dental treatment and local anaesthetics [Fn22]. What has to be noted is that the exposed group in that study was 210 pregnancies, a sample size insufficient to detect rare outcomes. Whether a procedure is actually carried out, and when, has to be assessed individually by the dentist together with the obstetric care team.

Q2. My gums keep bleeding during pregnancy — is that normal? Does it need treatment?

It is very common, but common does not mean it needs no treatment: the increase in gingival inflammation caused by hormonal changes in pregnancy is undisputed in the literature [Fn1], the pooled prevalence of bleeding on probing is 67% [Fn5], and it increases as pregnancy progresses [Fn6]. In the same meta-analysis, the pooled prevalence of periodontitis in pregnancy was 40% [Fn4], while the index at the level of structural destruction (attachment loss ≥4 mm) was 24% [Fn5] — that is, the proportion that "bleeds" is far higher than the proportion in which "destruction has occurred". Swollen, red and bleeding gums are precisely the starting signs of periodontal disease [Fn3], so this is a signal that needs to be seen, not a normal state that can be ignored. As for whether treatment improves obstetric outcomes, the direction of the evidence is supportive but the significance becomes more conservative as study quality rises [Fn35][Fn36][Fn39], and this article makes no promise about obstetric outcomes. For how to handle swollen, painful gums in the moment, see canonical card KM-DENTAL-05 (in production).

Q3. How exactly should an older person's denture be cleaned?

The methodological conclusion is clear: the combined use of chemical and mechanical cleaning is significantly more effective than a single cleaning approach [Fn66], and the same conclusion holds in another systematic review [Fn68]. The everyday wording on the official health education page is: brush them every day with a denture care product [Fn63], and take them out at night and put them in water or a denture-cleansing liquid [Fn64]. What has to be known alongside this: denture stomatitis is very common among wearers (worldwide prevalence in the range of 20–67%) [Fn71], its causes include continuous wearing of dentures and a Candida biofilm facilitated by poor oral hygiene [Fn72], and the literature recommends monitoring for its appearance [Fn73]; and there is indeed a gap between wearers' actual cleaning frequency and the recommended guidelines [Fn70]. This passage is a compilation of literature at the level of method and involves no brand; whether it applies has to be assessed by a dentist. For other questions about dentures see canonical cards KM-DENTAL-13 and KM-DENTAL-31 (both in production) and the domain article P07.

🏛 Part of the "reports" topic shelf →

The Complete Guide to Oral Care in Pregnancy and Special Populations: a domain map from physiological background through the grading of care capacity to the pathway for seeking care｜證據鏈

km 編輯部2026-08-13About 24 min read

#證據鏈 #牙醫領域 #孕期 #假牙

本頁是〈The Complete Guide to Oral Care in Pregnancy and Special Populations: a domain map from physiological background through the grading of care capacity to the pathway for seeking care〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

The Complete Guide to Oral Care in Pregnancy and Special Populations: a domain map from physiological background through the grading of care capacity to the pathway for seeking care｜證據鏈

F-Units (fact ledger)

Expand the F1–F27 fact ledger (each entry: source # / confidence / basis / geo / period / caveat)

F1｜The upper-level classifying axis of this domain is care capacity rather than chronological age: oral care decisions should be judged by level of dependency, life expectancy, frailty, comfort and quality of life; caries and periodontal diseases can equally be prevented and treated in older adults; policy should remove the care barriers facing vulnerable elders

Source #: #05｜confidence: high｜basis: clinical_guideline (consensus report of the joint EFP/ORCA working group, PMID 28266112; PublicationType includes Consensus Statement and Practice Guideline)｜geo: universal｜period: J Clin Periodontol, 2017
caveat: This sits at the level of expert consensus rather than being the conclusion of a randomised controlled trial; this entry is a decision framework and supports no claim of effect for any individual procedure.

F2｜The increase in gingival inflammation caused by hormonal changes in pregnancy is undisputed in the literature, although the exact etiology is not fully understood; the relationship between periodontal disease in pregnancy and adverse pregnancy outcomes is less substantiated because of conflicting evidence

Source #: #W5｜confidence: high (the increase in inflammation) / moderate (the statement that the relationship is not established)｜basis: peer_reviewed (PMID 34463990)｜geo: universal｜period: Periodontology 2000, 2021
caveat: This is a narrative review; "undisputed" is the original text's statement about the direction of the mechanism, and does not mean the mechanism has been fully elucidated (see, from the same source, "the etiology is not fully understood").

F3｜Pooled prevalence of periodontal indices in pregnancy: periodontitis 40%; BOP(+) 67% (CI 0.56–0.80), PD≥4 mm 42% (CI 0.27–0.57), CAL≥4 mm 24% (CI 0.12–0.37); BOP(+) and PD≥4 mm increase gradually as pregnancy progresses, and CAL≥4 mm peaks in the second trimester

Source #: #07｜confidence: moderate｜basis: peer_reviewed (PMID 35998741, an SR/MA of 20 studies)｜geo: universal｜period: J Dent, 2022
caveat: The authors themselves state that heterogeneity among the included studies was high; the confidence interval for periodontitis at 40% is given in the original as [0.15, 1.00], which is extremely wide, and the body of this article draws no inference from that interval. The four indices are not measuring the same thing and must not be compared with each other or averaged.

F4｜Consistent conclusion at guideline level: preventive, diagnostic, restorative and periodontal procedures and tooth extractions are safe throughout pregnancy; emergency treatment can be provided at any time; an examination and prophylaxis are recommended every 6 months

Source #: #W1｜confidence: high｜basis: peer_reviewed (a systematic AGREE-II appraisal of 7 clinical guidelines / consensus statements, PMID 35119241)｜geo: universal｜period: Quintessence Int, 2022
caveat: This paper is an appraisal study of guidelines, not a guideline itself; its PubMed PublicationType is Review. The issuing bodies and years of the 7 appraised guidelines are not listed one by one in the abstract, and this article does not quote their individual contents item by item. "Safe" is a population-level statement of guideline consensus and does not constitute an assurance for any individual pregnant woman.

F5｜Expert consensus (modified Delphi) on management across the whole span from before conception through pregnancy to infancy: it emphasises comprehensive oral assessment before conception, systematic dental care during pregnancy, and collaboration across professions among paediatric dentists, maternal and child health workers and obstetricians

Source #: #04｜confidence: high｜basis: clinical_guideline (PMID 40883270; PublicationType includes Consensus Statement)｜geo: universal｜period: Int J Oral Sci, 2025
caveat: A Delphi consensus is an integration of expert opinion, not primary clinical trial evidence; the abstract carries no specific clinical criteria, and this article quotes no operational recommendation from it.

F6｜Direct population-level evidence on dental local anaesthesia in pregnancy: 210 exposed pregnancies (53% in the first trimester) against 794 comparison pregnancies, with a major anomaly rate of 4.8% versus 3.3% and no statistically significant difference; the most frequently reported procedures were root canal treatment 43%, tooth extraction 31% and tooth restoration 21%

Source #: #11｜confidence: moderate｜basis: peer_reviewed (prospective comparative cohort study, PMID 26227642)｜geo: universal｜period: JADA, 2015; enrolled at the Israeli Teratogen Information Service 1999–2005
caveat: A single country, a single institution, and only 210 pregnancies in the exposed group — a sample size insufficient to detect rare adverse outcomes; the design is observational, not an RCT; enrolment is relatively old (1999–2005) and this round did not find a more recent equivalent direct cohort study. This result must not be read as "risk has been proven absent".

F7｜Layering of vasoconstrictors in dental anaesthesia during pregnancy: among those reviewed, epinephrine alone had an acceptable safety profile when used correctly; levonordefrin showed insufficient safety data; felypressin is contraindicated because of its oxytocic properties and the risk of uterine contractions

Source #: #10｜confidence: moderate｜basis: peer_reviewed (narrative review, PMID 40649147; 6 narrative reviews and 3 clinical guidelines included after screening 95 papers)｜geo: universal｜period: J Clin Med, 2025
caveat: This is in essence a review of reviews, not a primary population study; its recency (2025) is not the same as new population-level evidence. This entry does not constitute any medication instruction; the choice of drug is made by the dentist, without exception.

F8｜Dental imaging in pregnancy: when correctly performed the radiation dose is unlikely to reach the teratogenic threshold, and necessary radiography is safe at any stage of pregnancy (with the protection premise attached); it should not be restricted when clinically indicated, and the ALADAIP principle should be followed

Source #: #W3 (historical review) / #W4 (systematic review)｜confidence: moderate｜basis: peer_reviewed (PMID 35985884 / 38571778)｜geo: universal｜period: JADA, 2022 / Imaging Sci Dent, 2024
caveat: #W4 explicitly marks that very few dental radiology studies have been conducted to determine the safe radiation threshold for pregnant women, and the literature appraised does not give the number of examinations of each type corresponding to that dose; neither paper is a large population study with primary dose measurement. "Safe" carries the premise of "correct operation plus protective equipment", and the conclusion does not hold when that premise is missing.

F9｜More than half of pregnant women are usually affected by odontogenic pain; the joint statement of the American Dental Association and the American College of Obstetricians and Gynecologists reaffirms that timely oral care is an indispensable constituent of a healthy pregnancy

span: "More than half of pregnant women are usually affected by odontogenic pain"
span: "reaffirming the significance of suitable and timely oral health care as an indispensable constituent of a healthy pregnancy"
Source #: #12｜confidence: low (the proportion) / moderate (the existence of the joint statement)｜basis: peer_reviewed (narrative review, PMID 36268928)｜geo: universal｜period: Eur J Transl Myol, 2022
caveat: The "more than half" figure comes from background narration in a narrative review, and the abstract carries no primary source, population or method of measurement for it; it is among the weaker citations in this article (see weak point 1 in the self-check section). This article uses only its order of magnitude, and uses it for no comparison or inference.

F10｜Whether periodontal / gingival treatment in pregnancy improves obstetric outcomes: three studies agree in direction (treatment is beneficial) but statistical significance becomes more conservative as sample size and study quality rise — 2021 (3 studies, 1,031 people) OR 0.44 significant; 2025 (13 studies) OR 0.85 not significant, and significant only in the lower-quality studies; 2026 (14 RCTs, 8,316 people) GRADE moderate certainty RR 0.85 (95% CI 0.71–1.02), a relative reduction of 15%

Source #: #08 / #06 / #09｜confidence: moderate (direction) / low (any single point estimate of effect)｜basis: peer_reviewed (PMID 34673848 / 39721768 / 41421601)｜geo: universal｜period: 2021 / 2025 / 2026
caveat: All three must be presented together, and OR 0.44 must not be cited on its own while the conservative conclusions of #06 / #09 are dropped; the 95% CI 0.71–1.02 of #09 crosses 1; #09 also records that the added effect of chlorhexidine mouthwash is uncertain (RR 0.49, 95% CI 0.23–1.04, very low certainty of evidence). The authors of all three studies call for better-designed RCTs. This must not be written up as a promise about any obstetric outcome.

F11｜Global epidemiology of tooth loss: the prevalence of complete tooth loss among people aged 20 or older is estimated at almost 7%; for people aged 60 or older the estimate reaches 23%

Source #: #01｜confidence: moderate｜basis: official_statement (WHO Fact sheet, HTTP 200 measured 2026-08-06)｜geo: universal｜period: the page's own JSON-LD carries `dateModified":"2025-03-17` (measured on the file retrieved when it was used, 2026-08-06)
caveat: This is an estimate by an international body (estimated), not a direct measurement from a single study; the WHO fact page does not mark the estimation method or the data year in that passage, and this article uses only its order of magnitude for comparison.

F12｜Cross-country picture of caries / root caries in older adults: root caries prevalence among community dwellers 8% (Finland) to 74% (Brazil); the situation is worse among institutionalised people; preventive measures effective in other age groups may not suit older adults

Source #: #W7 (prevalence) / #W6 (applicability)｜confidence: low (the prevalence range) / moderate (applicability)｜basis: peer_reviewed (PMID 34682414 / 36058347)｜geo: universal｜period: 2021 / 2022
caveat: The range spans 66 percentage points and crosses different countries and different sampling methods; it serves only as an order-of-magnitude reference for "this exists widely" and must not be used for individual prediction; the authors of #W7 themselves state that prevalence varies widely across countries.

F13｜Effect of professionally applied fluoride in older adults: a review of 7 studies; 38% SDF at 24 months of follow-up gave a decrease in the number of new root caries of 0.55 (95% CI 0.32–0.78), with an overall proportion of arrested root caries of 42% (95% CI 33%–49%)

Source #: #W6｜confidence: moderate｜basis: peer_reviewed (SR/MA, PMID 36058347; PROSPERO CRD42022307025)｜geo: universal｜period: J Dent, 2022
caveat: Only 7 studies were included; the authors call for more well-designed clinical trials. This entry is a population-level result for a professionally applied agent and does not constitute a product recommendation or an instruction for self-treatment; this article provides no operational advice on concentration or method of application.

F14｜Domiciliary professional oral care for care-dependent older adults: mechanical plaque removal performed by dental personnel together with the application of fluoride or chlorhexidine seems beneficial for those at risk of root caries; but a meta-analysis could not be performed because of heterogeneity, and future studies are still needed

Source #: #W8｜confidence: low｜basis: peer_reviewed (SR, PMID 37048831)｜geo: universal｜period: J Clin Med, 2023
caveat: Only 4 studies entered the analysis, all at moderate risk of bias, and no meta-analysis was performed; the original wording is seems beneficial, which must not be rewritten as proven effective.

F15｜Methodological conclusion on cleaning removable dentures: combined chemical and mechanical cleaning is significantly better than a single method (44 prospective studies); another review reaches the same conclusion that combined application is more effective; brushing is the most commonly applied practice; there is a gap between what wearers actually do and the recommended guidelines

Source #: #15 / #16｜confidence: high (combined better than single, because two independent reviews point the same way)｜basis: peer_reviewed (PMID 34922732 / 29120113)｜geo: universal｜period: 2021 / 2018
caveat: The populations included in the two reviews are ordinary denture wearers, not restricted to bedridden or fully dependent people, and no subgroup analysis of that situation was found; #15 also marks that clinical evidence on the effect of cleaning interventions on the properties of denture base materials is limited. This article involves no brand or product.

F16｜Official health-education wording on everyday denture care: brush daily with a denture care product; take the denture out at night and soak it in water or a denture-cleansing liquid

Source #: #02｜confidence: moderate｜basis: official_statement (MedlinePlus / NIH National Institute on Aging, HTTP 200 measured 2026-08-06)｜geo: universal｜period: the page carries `Last updated May 24, 2023` (measured on the file retrieved when it was used, 2026-08-06)
caveat: This is the brief wording of a general health-education page, with no grade of evidence and no references attached; it is presented alongside F15 because it points the same way as that systematic review conclusion, but it does not by itself constitute evidence of a methodological comparison.

F17｜Denture stomatitis: common among wearers of removable dentures, with a worldwide prevalence range of 20–67%; the main causes include the type of denture, continuous wear, and a Candida biofilm facilitated by poor oral hygiene; the literature recommends monitoring for its appearance

Source #: #W10｜confidence: low (the prevalence range) / moderate (causes and recommendation)｜basis: peer_reviewed (SR, 28 papers included, PMID 38786683)｜geo: universal｜period: J Fungi, 2024
caveat: The range spans 47 percentage points, reflecting differences in diagnostic criteria and in populations, and serves only as an order-of-magnitude reference; this entry is a statement of risk and does not constitute a guide to self-diagnosis.

F18｜Overall oral picture of institutionalised older adults: 25 surveys from 19 countries show poor oral cleanliness and poor oral health; those with a poorer oral-health-related quality of life may show signs of poor nutrition

Source #: #W12｜confidence: moderate｜basis: peer_reviewed (SR, PMID 31717812)｜geo: universal｜period: Int J Environ Res Public Health, 2019
caveat: The included studies are surveys and can show association only, not causation; the original wording on nutrition is might show, which must not be rewritten as an inevitability.

F19｜Oral hypofunction (comprising 7 conditions) is associated with impaired general health, predominantly in relation to mastication and swallowing, although the causal relationship still awaits prospective research; people with frailty or sarcopenia have lower tongue pressure, people with frailty have a higher odds ratio for dysphagia, and the results are inconclusive for the sarcopenia population

Source #: #W16 (hypofunction) / #W11 (frailty and swallowing)｜confidence: moderate (association) / low (causation)｜basis: peer_reviewed (PMID 37620920 / 35883642)｜geo: universal｜period: 2023 / 2022
caveat: The studies included in both papers are mainly cross-sectional (#W11 comprised 20 cross-sectional studies plus 4 prospective cohorts), and a prospective association could not be determined because of insufficient information and a limited number of studies; no causal inference may be drawn. The criteria for "oral hypofunction" originate from a single national society (put forward in 2016), and their cross-country applicability is not addressed in the abstract.

F20｜Nursing home-acquired pneumonia (NHAP) carries a high mortality in this population, is associated with poor oral hygiene, and may be caused by aspiration of oropharyngeal flora

Source #: #13｜confidence: high｜basis: peer_reviewed (Cochrane SR, PMID 36383760)｜geo: universal｜period: Cochrane Database Syst Rev, 2022
caveat: This is a statement of background mechanism (may be caused by), not that review's conclusion on effect; for the effect side see F21, and the two must not be mixed.

F21｜The effect of oral care in preventing NHAP has to be layered: 6 RCTs with 6,244 people, all at high risk of bias; on the incidence of pneumonia the evidence is insufficient to determine whether professional and usual care differ; on pneumonia-associated mortality there is low-certainty evidence of RR 0.43 at 24 months (95% CI 0.25–0.76, 454 people); the optimal care protocol cannot be determined from current evidence

Source #: #13｜confidence: low (following the original GRADE rating)｜basis: peer_reviewed (Cochrane SR, PMID 36383760)｜geo: universal｜period: 2022 (the first update of the 2018 version)
caveat: "Insufficient evidence to determine a difference" must not be written as "no effect"; "a reduction in mortality" must not be mis-transcribed as "a reduction in the incidence of pneumonia" — this is an extremely common citation error in this domain. The mortality result comes from only 2 individually randomised studies with 454 people, and another study of 2,513 people reported insufficient evidence at 18 months.

F22｜The barriers caregivers meet in providing oral care have been quantified: care aides provide up to 80% of direct care; residents resisting care 45% (15%–77%), lack of knowledge or training 24% (7%–47%), lack of time 31% (17%–47%); interventions must be tailored to the identified barriers; and the field lacks robust evidence overall

Source #: #14｜confidence: low (each point estimate of prevalence) / moderate (the classification of barriers)｜basis: peer_reviewed (SR/MA, 41 studies, PMID 28531550)｜geo: universal｜period: Int J Nurs Stud, 2017
caveat: The confidence intervals are extremely wide (15%–77%, for instance), and the original states that the methodological quality of the included studies was generally weak; the numbers show only that "this happens often" and must not be used to anticipate the situation of any individual family. The study population is institutional care aides, not family members at home.

F23｜Caregiver training delivered by professionals can improve the oral hygiene of institutionalised older adults: subgroup analysis SMD −0.59 (95% CI −0.88 to −0.31); dental plaque score SMD −0.51 (95% CI −0.76 to −0.26)

Source #: #W9｜confidence: moderate｜basis: peer_reviewed (SR/MA, 14 trials in the qualitative synthesis and 4 entering the quantitative analysis, PMID 40641350; PROSPERO CRD42022309962)｜geo: universal｜period: Int J Older People Nurs, 2025
caveat: Only 4 trials entered the quantitative analysis; 3 studies were at high risk of bias and 5 raised some concerns; the outcomes are oral hygiene indices (denture hygiene index, dental plaque score), not hard clinical outcomes such as pneumonia or death, and must not be extrapolated across levels. The population is institutionalised older adults.

F24｜Classification of the barriers to care for people with disabilities: nearly one billion people with disabilities worldwide face a higher dental risk; five systematic reviews consistently identify financial constraints, provider reluctance, access difficulties, systemic barriers and patient-related factors; the concrete forms include dentists' lack of preparation, structural problems of the treatment space, communication difficulties and lack of awareness of the need

Source #: #W13 (overview) / #W14 (SR)｜confidence: moderate｜basis: peer_reviewed (PMID 39535395 / 32774378)｜geo: universal｜period: Community Dent Health, 2024 / Int J Dent, 2020
caveat: #W13 itself states that methodological differences exist among the reviews it included, affecting the transparency and reliability of the findings; the 16 studies included in #W14 comprise 1 doctoral thesis and 1 monograph. Both are qualitative classifications of barriers and provide no effect size for any intervention. This entry involves no country's system or benefits.

F25｜Oral health of adults with intellectual disabilities: they are still shown to experience poor oral health, including high levels of poor oral hygiene and gingivitis, with many also affected by periodontitis and untreated decay; but this is largely preventable through proactive oral care support

Source #: #W15｜confidence: moderate｜basis: peer_reviewed (SR, 33 of 3,958 papers included, PROSPERO CRD42018089880, PMID 31119825)｜geo: universal｜period: J Intellect Disabil Res, 2019
caveat: The original states explicitly that the included samples (14 papers from users of dental services, 10 from Special Olympics athletes) are not necessarily representative of the wider population with intellectual disabilities, and they must not be generalised into "people with disabilities are all like this".

F26｜The starting signs of periodontal disease are swollen, red and bleeding gums — this is the definitional basis this article uses when reading gingival bleeding in pregnancy

Source #: #03｜confidence: moderate｜basis: official_statement (the official health-education page of the US NIDCR, HTTP 200 measured 2026-08-06)｜geo: universal｜period: the page carries `Last Reviewed` as `November 2024` (measured on the file retrieved 2026-08-06, in the `` block)
caveat: This is a definitional statement on a general health-education page, with no grade of evidence and no references attached; this entry is the definitional basis of a symptom and does not constitute a criterion for self-diagnosis, and it is not specific to the pregnant population — the aggravation seen in pregnancy is carried by F2 (#W5).

F27｜Oral health and dental treatment are essential during pregnancy; and despite dental treatment being safe during pregnancy for mother and baby, many dentists are still reluctant to treat pregnant people

Source #: #W2｜confidence: moderate｜basis: peer_reviewed (review, PMID 37201975; PublicationType: Review)｜geo: universal｜period: J Evid Based Dent Pract, 2023
caveat: This is a statement in a review article rather than a primary survey, and "many dentists" carries no quantified proportion; this article uses only its direction (resistance exists on the service side) and works it up into no percentage. The word "safe" carries the qualifications of F4 and F6: it is a population-level statement and does not constitute an assurance for any individual pregnant woman.

Compliance note

This article is a compilation of health education and current medical information; it is general health-education material, does not solicit medical business, does not constitute medical advertising, and does not constitute a diagnosis or a treatment recommendation.
This article provides no monetary amount, fee or reimbursement information, recommends no medical institution, dentist, brand or product, contains no identifiable case, and carries no third party's subjective comment on any course of treatment.
This article contains no medication, dosage or procedural instruction. Citations involving anaesthetic drugs, vasoconstrictors, fluoride agents and cleaning agents are all population-level study conclusions; the choice of drug or agent is made by the dentist (together with the obstetric or care team where necessary), without exception.
This article provides no procedural steps for tooth brushing, oral cleaning or swallowing care. The pathway the literature supports is professionals training the caregivers; the technique has to be demonstrated and adjusted in person by a dentist or an oral hygiene professional according to the person's actual condition.
All statements involving pregnancy are conclusions at guideline and population level and do not constitute an assurance of safety for any individual pregnant woman; whether to carry out a procedure, when, and by what method has to be assessed individually by the dentist together with the obstetric care team.
All the data in this text are population-level study results; the actual method of treatment and its effect vary from person to person and must be assessed by a dentist before any decision.
This article is a draft. It has not passed the publication gate, the four language versions are not yet complete, and it is for internal review only.

Source list

Date of retrieval and measurement: 2026-08-06 (all sources measured the same day with curl / PubMed E-utilities, HTTP 200; the verbatim spans passed a programmatic comparison)

Sources already verified in the anchor file (`ida-pillars/anchors/P20-anchors.md`)

#	basis	Title	Source	PMID / URL
#01	official_statement	Oral health (WHO Fact sheets)	World Health Organization	https://www.who.int/news-room/fact-sheets/detail/oral-health
#02	official_statement	Dentures (MedlinePlus Health Topic; content attributed to NIH: National Institute on Aging)	U.S. National Library of Medicine	https://medlineplus.gov/dentures.html
#03	official_statement	Gum Disease	U.S. NIDCR (National Institute of Dental and Craniofacial Research)	https://www.nidcr.nih.gov/health-info/gum-disease
#04	clinical_guideline	Expert consensus on the treatment of oral diseases in pregnant women and infants.	Int J Oral Sci, 2025 (PublicationType: Consensus Statement)	PMID 40883270｜https://pubmed.ncbi.nlm.nih.gov/40883270/
#05	clinical_guideline	Dental caries and periodontal diseases in the ageing population: call to action… Consensus report of group 4 of the joint EFP/ORCA workshop…	J Clin Periodontol, 2017 (PublicationType: Consensus Statement, Practice Guideline)	PMID 28266112｜https://pubmed.ncbi.nlm.nih.gov/28266112/
#06	peer_reviewed	Role of periodontal treatment in pregnancy gingivitis and adverse outcomes: a systematic review and meta-analysis.	J Matern Fetal Neonatal Med, 2025	PMID 39721768｜https://pubmed.ncbi.nlm.nih.gov/39721768/
#07	peer_reviewed	Prevalence of periodontal disease in pregnancy: A systematic review and meta-analysis.	J Dent, 2022	PMID 35998741｜https://pubmed.ncbi.nlm.nih.gov/35998741/
#08	peer_reviewed	Does Treatment of Gingivitis During Pregnancy Improve Pregnancy Outcomes? A Systematic Review and Meta-Analysis.	Oral Health Prev Dent, 2021	PMID 34673848｜https://pubmed.ncbi.nlm.nih.gov/34673848/
#09	peer_reviewed	Effect of dental treatments on reduction of preterm birth: a systematic review and meta-analysis.	Am J Obstet Gynecol MFM, 2026	PMID 41421601｜https://pubmed.ncbi.nlm.nih.gov/41421601/
#10	peer_reviewed	Review of the Safety and Clinical Considerations of Vasoconstrictor Agents in Dental Anesthesia During Pregnancy.	J Clin Med, 2025	PMID 40649147｜https://pubmed.ncbi.nlm.nih.gov/40649147/
#11	peer_reviewed	Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: A prospective comparative cohort study.	JADA, 2015	PMID 26227642｜https://pubmed.ncbi.nlm.nih.gov/26227642/
#12	peer_reviewed	Antibiotic use in endodontic treatment during pregnancy: A narrative review.	Eur J Transl Myol, 2022	PMID 36268928｜https://pubmed.ncbi.nlm.nih.gov/36268928/
#13	peer_reviewed	Oral care measures for preventing nursing home-acquired pneumonia.	Cochrane Database Syst Rev, 2022	PMID 36383760｜https://pubmed.ncbi.nlm.nih.gov/36383760/
#14	peer_reviewed	Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis.	Int J Nurs Stud, 2017	PMID 28531550｜https://pubmed.ncbi.nlm.nih.gov/28531550/
#15	peer_reviewed	CLEANING OF REMOVABLE DENTAL PROSTHESES - A SYSTEMATIC REVIEW.	J Evid Based Dent Pract, 2021	PMID 34922732｜https://pubmed.ncbi.nlm.nih.gov/34922732/
#16	peer_reviewed	Hygiene practices in removable prosthodontics: A systematic review.	Int J Dent Hyg, 2018	PMID 29120113｜https://pubmed.ncbi.nlm.nih.gov/29120113/

Declaration in section zero of the anchor file: under the owner's decision of 2026-08-06 that the whole line is global, Taiwanese regulations, national insurance and health-bureau material are not used as the basis for any medical or institutional claim in this article; local systems are all linked downstream to the corresponding TW canonical card and to P12. The three sources at official_statement level in this article are all public health-education pages of an international body (WHO) or of United States federal research institutions (NIH/NLM, NIDCR); their content is a universal description of oral health and contains no institutional claim specific to any one country.

WRITER-ADDED SOURCES (added by this article, with measured evidence)

Reason for adding: the anchor file covers four patient questions, but the scope of this domain article also includes (a) the guideline-level basis for the timing of treatment in pregnancy and the safety of dental imaging in pregnancy, (b) the physiological mechanism of gingival change in pregnancy and the upper-level framing of whether the relationship is established, (c) the epidemiology of root caries in older adults and the evidence on its management, (d) domiciliary care for care-dependent older adults, (e) denture-related mucosal inflammation, (f) oral hypofunction and swallowing, (g) the evidence on the effect of caregiver training, and (h) the classification of barriers on the care-seeking pathway for people with disabilities. All 16 sources below were measured locally with curl (HTTP 200) and passed a programmatic verbatim comparison; the anchor file was not modified.

#	basis	Title	Source	PMID / URL
#W1	peer_reviewed	Clinical practice guidelines for oral health care during pregnancy: a systematic evaluation and summary recommendations for general dental practitioners	Quintessence Int, 2022 (AGREE-II appraisal of 7 guidelines; PublicationType: Review)	PMID 35119241｜https://pubmed.ncbi.nlm.nih.gov/35119241/
#W2	peer_reviewed	LOCAL ANESTHETICS AND PREGNANCY. A REVIEW OF THE EVIDENCE AND WHY DENTISTS SHOULD FEEL SAFE TO TREAT PREGNANT PEOPLE	J Evid Based Dent Pract, 2023	PMID 37201975｜https://pubmed.ncbi.nlm.nih.gov/37201975/
#W3	peer_reviewed	A historical review of the effects of dental radiography on pregnant patients	JADA, 2022	PMID 35985884｜https://pubmed.ncbi.nlm.nih.gov/35985884/
#W4	peer_reviewed	Impact of dental imaging on pregnant women and recommendations for fetal radiation safety: A systematic review	Imaging Sci Dent, 2024	PMID 38571778｜https://pubmed.ncbi.nlm.nih.gov/38571778/
#W5	peer_reviewed	Periodontology and pregnancy: An overview of biomedical and epidemiological evidence	Periodontology 2000, 2021	PMID 34463990｜https://pubmed.ncbi.nlm.nih.gov/34463990/
#W6	peer_reviewed	Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: A systematic review	J Dent, 2022 (SR/MA; PROSPERO CRD42022307025)	PMID 36058347｜https://pubmed.ncbi.nlm.nih.gov/36058347/
#W7	peer_reviewed	A Systematic Review on Caries Status of Older Adults	Int J Environ Res Public Health, 2021	PMID 34682414｜https://pubmed.ncbi.nlm.nih.gov/34682414/
#W8	peer_reviewed	The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review	J Clin Med, 2023	PMID 37048831｜https://pubmed.ncbi.nlm.nih.gov/37048831/
#W9	peer_reviewed	Effectiveness of Educating Caregivers on Oral Health of Institutionalized Older Adults: A Systematic Review and Meta-Analysis	Int J Older People Nurs, 2025 (PROSPERO CRD42022309962)	PMID 40641350｜https://pubmed.ncbi.nlm.nih.gov/40641350/
#W10	peer_reviewed	A Systematic Review of Denture Stomatitis: Predisposing Factors, Clinical Features, Etiology, and Global Distribution of Candida spp.	J Fungi (Basel), 2024	PMID 38786683｜https://pubmed.ncbi.nlm.nih.gov/38786683/
#W11	peer_reviewed	Association of Oral Function and Dysphagia with Frailty and Sarcopenia in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis	Cells, 2022	PMID 35883642｜https://pubmed.ncbi.nlm.nih.gov/35883642/
#W12	peer_reviewed	Oral Health and Its Associated Factors Among Older Institutionalized Residents-A Systematic Review	Int J Environ Res Public Health, 2019	PMID 31717812｜https://pubmed.ncbi.nlm.nih.gov/31717812/
#W13	peer_reviewed	Barriers to oral health care for persons with disabilities: An overview of systematic reviews	Community Dent Health, 2024	PMID 39535395｜https://pubmed.ncbi.nlm.nih.gov/39535395/
#W14	peer_reviewed	Barriers in Access to Dental Services Hindering the Treatment of People with Disabilities: A Systematic Review	Int J Dent, 2020	PMID 32774378｜https://pubmed.ncbi.nlm.nih.gov/32774378/
#W15	peer_reviewed	Oral health of adults with intellectual disabilities: a systematic review	J Intellect Disabil Res, 2019 (PROSPERO CRD42018089880)	PMID 31119825｜https://pubmed.ncbi.nlm.nih.gov/31119825/
#W16	peer_reviewed	Association between oral hypofunction and general health: a systematic review	BMC Oral Health, 2023	PMID 37620920｜https://pubmed.ncbi.nlm.nih.gov/37620920/

FAQ

Q1. Can I see a dentist while pregnant, and can a tooth be taken out?: **At guideline level the answer is yes: a study appraising 7 guideline documents with AGREE-II [Fn10] states that the message these guidelines convey consistently is that preventive, diagnostic, restorative and periodontal procedures and tooth extractions are safe throughout pregnancy [Fn9], and that dental emergency treatments can be provided at any time during pregnancy [Fn11].** The direct population-level evidence comes from a prospective comparative cohort study: 210 pregnancies exposed to dental local anaesthetics during pregnancy (53% of them in the first trimester) compared with 794 unexposed pregnancies [Fn19], with no statistically significant difference in the rate of major anomalies (4.8% versus 3.3%) [Fn20]; the procedures reported most frequently in that study included tooth extraction (31%) [Fn21], and the authors concluded that there seems to be no reason to prevent pregnant women from receiving dental treatment and local anaesthetics [Fn22]. What has to be noted is that the exposed group in that study was 210 pregnancies, **a sample size insufficient to detect rare outcomes**. Whether a procedure is actually carried out, and when, has to be assessed individually by the dentist together with the obstetric care team.; Q1. 妊娠中に歯科にかかれますか。抜歯はできますか？ — **ガイドラインのレベルでの答えは「できる」です：AGREE-II で 7 件のガイドライン文書を評価した研究 [Fn10] は、これらのガイドラインが一致して伝えているメッセージが、予防的、診断的、修復的および歯周の処置ならびに抜歯が妊娠期を通じて安全であること [Fn9]、そして歯科の救急処置は妊娠期のいかなる時期にも提供できること [Fn11] だと指摘しています。** 直接の集団レベルのエビデンスは、一つの前向き比較コホート研究に由来します：妊娠期に歯科の局所麻酔に曝露した 210 件（53% が妊娠初期に発生）と、曝露しなかった 794 件を比較し [Fn19]、重大奇形の率に統計学的な有意差はありませんでした（4.8% 対 3.3%）[Fn20]。この研究で報告頻度が高かった処置には抜歯（31%）が含まれ [Fn21]、著者の結論は、妊婦が歯科治療と局所麻酔を受けることを妨げる理由はないように思われる、というものです [Fn22]。注意すべきなのは、この研究の曝露群が 210 件であり、**まれなアウトカムを検出するにはサンプルサイズが不足している**ことです。実際に処置するかどうか、いつ処置するかは、歯科医師が産科ケアチームとともに個別に評価する必要があります。; Q1. Can I see a dentist while pregnant, and can a tooth be taken out? — **At guideline level the answer is yes: a study appraising 7 guideline documents with AGREE-II [Fn10] states that the message these guidelines convey consistently is that preventive, diagnostic, restorative and periodontal procedures and tooth extractions are safe throughout pregnancy [Fn9], and that dental emergency treatments can be provided at any time during pregnancy [Fn11].** The direct population-level evidence comes from a prospective comparative cohort study: 210 pregnancies exposed to dental local anaesthetics during pregnancy (53% of them in the first trimester) compared with 794 unexposed pregnancies [Fn19], with no statistically significant difference in the rate of major anomalies (4.8% versus 3.3%) [Fn20]; the procedures reported most frequently in that study included tooth extraction (31%) [Fn21], and the authors concluded that there seems to be no reason to prevent pregnant women from receiving dental treatment and local anaesthetics [Fn22]. What has to be noted is that the exposed group in that study was 210 pregnancies, **a sample size insufficient to detect rare outcomes**. Whether a procedure is actually carried out, and when, has to be assessed individually by the dentist together with the obstetric care team.
Q2. My gums keep bleeding during pregnancy — is that normal? Does it need treatment?: **It is very common, but common does not mean it needs no treatment: the increase in gingival inflammation caused by hormonal changes in pregnancy is undisputed in the literature [Fn1], the pooled prevalence of bleeding on probing is 67% [Fn5], and it increases as pregnancy progresses [Fn6].** In the same meta-analysis, the pooled prevalence of periodontitis in pregnancy was 40% [Fn4], while the index at the level of structural destruction (attachment loss ≥4 mm) was 24% [Fn5] — that is, the proportion that "bleeds" is far higher than the proportion in which "destruction has occurred". Swollen, red and bleeding gums are precisely the starting signs of periodontal disease [Fn3], so this is a signal that needs to be seen, not a normal state that can be ignored. As for whether treatment improves obstetric outcomes, the direction of the evidence is supportive but the significance becomes more conservative as study quality rises [Fn35][Fn36][Fn39], and this article makes no promise about obstetric outcomes. For how to handle swollen, painful gums in the moment, see canonical card KM-DENTAL-05 (in production).; Q2. 妊娠中、歯肉からずっと出血しています。正常ですか。対処は必要ですか？ — **とてもよくあることですが、よくあることは対処が不要という意味ではありません：妊娠期のホルモン変化が歯肉の炎症を増加させることは文献上で議論の余地がなく [Fn1]、プロービング時出血の統合有病率は 67% [Fn5]、妊娠の進行とともに増加します [Fn6]。** 同じメタアナリシスでは、妊娠期の歯周炎の統合有病率は 40% [Fn4]、構造の破壊のレベルの指標（アタッチメントロス ≥4 mm）は 24% でした [Fn5]——つまり「出血する」割合は、「すでに破壊が起きている」割合よりはるかに高いということです。歯肉の腫れ、発赤、出血はまさに歯周疾患の出発点となる徴候であり [Fn3]、ですから診てもらう必要のあるサインであって、無視してよい常態ではありません。治療が産科アウトカムを改善しうるかについては、エビデンスの方向は支持していますが、有意性は研究の質が上がるにつれて保守的な方向へ転じており [Fn35][Fn36][Fn39]、本記事は産科アウトカムについていかなる約束もしません。歯肉が腫れて痛むときの対応は、正典カード KM-DENTAL-05（作成中）を参照してください。; Q2. My gums keep bleeding during pregnancy — is that normal? Does it need treatment? — **It is very common, but common does not mean it needs no treatment: the increase in gingival inflammation caused by hormonal changes in pregnancy is undisputed in the literature [Fn1], the pooled prevalence of bleeding on probing is 67% [Fn5], and it increases as pregnancy progresses [Fn6].** In the same meta-analysis, the pooled prevalence of periodontitis in pregnancy was 40% [Fn4], while the index at the level of structural destruction (attachment loss ≥4 mm) was 24% [Fn5] — that is, the proportion that "bleeds" is far higher than the proportion in which "destruction has occurred". Swollen, red and bleeding gums are precisely the starting signs of periodontal disease [Fn3], so this is a signal that needs to be seen, not a normal state that can be ignored. As for whether treatment improves obstetric outcomes, the direction of the evidence is supportive but the significance becomes more conservative as study quality rises [Fn35][Fn36][Fn39], and this article makes no promise about obstetric outcomes. For how to handle swollen, painful gums in the moment, see canonical card KM-DENTAL-05 (in production).
Q3. How exactly should an older person's denture be cleaned?: **The methodological conclusion is clear: the combined use of chemical and mechanical cleaning is significantly more effective than a single cleaning approach [Fn66], and the same conclusion holds in another systematic review [Fn68].** The everyday wording on the official health education page is: brush them every day with a denture care product [Fn63], and take them out at night and put them in water or a denture-cleansing liquid [Fn64]. What has to be known alongside this: denture stomatitis is very common among wearers (worldwide prevalence in the range of 20–67%) [Fn71], its causes include continuous wearing of dentures and a Candida biofilm facilitated by poor oral hygiene [Fn72], and the literature recommends monitoring for its appearance [Fn73]; and there is indeed a gap between wearers' actual cleaning frequency and the recommended guidelines [Fn70]. This passage is a compilation of literature at the level of method and involves no brand; whether it applies has to be assessed by a dentist. For other questions about dentures see canonical cards KM-DENTAL-13 and KM-DENTAL-31 (both in production) and the domain article P07.; Q3. 高齢の家族の入れ歯は、結局どう洗えばよいですか？ — **方法論のうえでは結論は明確です：化学的な清掃法と機械的な清掃法を併用することが、単一の清掃法より有意に有効です [Fn66]。この結論は、別のシステマティックレビューでも同様に成り立ちます [Fn68]。** 公的な口腔保健情報のページの日常的な記述は、義歯用のケア製品で毎日ブラッシングする [Fn63]、夜は外して水または義歯洗浄液に浸ける [Fn64]、というものです。あわせて知っておくべきことは：義歯性口内炎は装着者によく見られ（世界の有病率の範囲は 20–67%）[Fn71]、その原因には義歯を装着し続けることと、不良な口腔衛生によって促進されるカンジダのバイオフィルムが含まれ [Fn72]、文献はその出現をモニタリングすることを推奨していること [Fn73]；そして装着者の実際の清掃の頻度と、推奨されるガイドラインのあいだには確かに隔たりがあること [Fn70] です。本項は方法のレベルの文献の整理であり、いかなるブランドにも触れません；適用できるかどうかは歯科医師の評価によります。義歯のその他の問いは、正典カード KM-DENTAL-13、KM-DENTAL-31（いずれも作成中）および領域記事 P07 を参照してください。; Q3. How exactly should an older person's denture be cleaned? — **The methodological conclusion is clear: the combined use of chemical and mechanical cleaning is significantly more effective than a single cleaning approach [Fn66], and the same conclusion holds in another systematic review [Fn68].** The everyday wording on the official health education page is: brush them every day with a denture care product [Fn63], and take them out at night and put them in water or a denture-cleansing liquid [Fn64]. What has to be known alongside this: denture stomatitis is very common among wearers (worldwide prevalence in the range of 20–67%) [Fn71], its causes include continuous wearing of dentures and a Candida biofilm facilitated by poor oral hygiene [Fn72], and the literature recommends monitoring for its appearance [Fn73]; and there is indeed a gap between wearers' actual cleaning frequency and the recommended guidelines [Fn70]. This passage is a compilation of literature at the level of method and involves no brand; whether it applies has to be assessed by a dentist. For other questions about dentures see canonical cards KM-DENTAL-13 and KM-DENTAL-31 (both in production) and the domain article P07.

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km 編輯部・《The Complete Guide to Oral Care in Pregnancy and Special Populations: a domain map from physiological background through the grading of care capacity to the pathway for seeking care｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/post/reports/dental-pillar-special-populations-evidence

更新 2026-08-13T14:17:35.375Z · server-rendered · four-language · IDAEO 知識庫

The Complete Guide to Oral Care in Pregnancy and Special Populations: a domain map from physiological background through the grading of care capacity to the pathway for seeking care｜證據鏈

The Complete Guide to Oral Care in Pregnancy and Special Populations: a domain map from physiological background through the grading of care capacity to the pathway for seeking care｜證據鏈

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