In Reply

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In Reply:
We thank Drs. McLeod and Samelson for their letter and agree wholeheartedly with the points raised. Pregnancy is a unique time during which most women are both insured and regularly accessing medical care. This presents an opportunity to address not only reproductive health but also health maintenance and preventive care more broadly.
Among reproductive-age women, the prevalence of tobacco use is 19.2%. More than half of the same population is overweight or obese. Nearly 10% of women aged 22–30 have never had a Pap test, and this number has increased in recent years.1–3 These are just few examples of a very long list.
We completely agree that pregnant women should be advised to have a dental visit and examination, preferably in the first trimester as feasible. We agree that “Maternal education on oral health and dental hygiene as well as early referrals to dentists can make a critical difference. Equally important is health care provider education on the safety of virtually all dental procedures during pregnancy. Identifying dentists willing to care for women insured by government-sponsored programs is also critical, because lack of health care providers is another stumbling block to care.” There is also low-quality evidence that maternal treatment of periodontal disease is associated with a significant decrease in the incidence of low-birth-weight neonates.4
As Drs. McLeod and Samelson point out, this case also demonstrates the potential harms of acetaminophen, a mainstay of analgesia for pregnant women.5 However, given the relative contraindication to nonsteroidal anti-inflammatory drugs in pregnancy, as well as the national opioid crisis, we would advocate that avoidance of acetaminophen in pregnancy is not the solution. Given the potential for harm with overuse of acetaminophen, patients should be explicitly instructed on how to use this medication within the therapeutic window in pregnancy, with a maximum of 4 g per day.
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