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Understanding the importance of Gum Health in Pregnancy

Nearly 40 to 60% of pregnant women suffer from periodontal diseases. Read the article for more details.

Pregnant woman

Pregnant women are more susceptible to periodontal diseases

During pregnancy, women undergo hormonal changes and during this period, the gingiva becomes excessively sensitive to irritations. 1

Nearly 40 to 60% of pregnant women suffer from periodontal diseases. Pregnancy-related gingivitis usually starts in the second month of gestation and reaches the highest level in the eighth month. 1,2

Oral conditions that are commonly seen during Pregnancy3,4

During pregnancy, alteration in hormones affects the gum health in several ways.1,2

  • Gingivitis may be caused due to hormonal changes that exaggerate the response to bacteria in the gum tissue
  • Dental caries is caused due to changes in diet such as increased cravings, acidity in the mouth due to vomiting, dry mouth or poor oral hygiene stemming from nausea and vomiting.
  • Pyogenic granuloma can be caused due to hormonal changes.
  • Tooth erosion can be caused due to frequent vomiting because of morning sickness
Figure 1: Factors that can aggravate periodontal diseases during pregnancy

Figure 1: Factors that can aggravate periodontal diseases during pregnancy

Periodontal disease and its impact on adverse pregnancy outcomes

During pregnancy, due to hormonal changes, there is an increase in vascular permeability that facilitates entrance of periodontal pathogens/ by-products (Treponema denticola, Porphyromonas gingivalis etc) into the blood circulation and translocation to the placenta.

The presence of bacteria/by-products in the placenta and the foetal compartment stimulates a foetal immune and inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of pro-inflammatory cytokines. This results in tissue damage and can demonstrate an increased risk for perinatal mortality or morbidity 5,6

Overview of 23 systematic reviews conducted through 2016 concluded that associations exist between periodontitis and pre-term birth, low birthweight babies, and low birthweight babies born prematurely

Figure 2: Potential biological mechanisms of periodontal disease inducing adverse pregnancy outcome

Figure 2: Potential biological mechanisms of periodontal disease inducing adverse pregnancy outcome5

Management of gum disease during pregnancy

Oral health management in pregnant patients is a very important aspect.

  • It is recommended to assess the patient’s current dental health status and then to educate the patient  about the expected changes during pregnancy and measures that can be helpful to avoid pain and distress. 2,7
  • The dental examination and treatment cause no harm to the foetus (during the second and third trimester) in contrast to that if left untreated, e.g. dental decay may cause infant caries at a later stage. 2,7
  • Care should be taken so that procedures such as diagnosis, periodontal treatment, restorations and extractions cause no harm. 2,7

Pregnant women who underwent treatment for periodontal diseases showed significantly decreased incidence of adverse pregnancy outcome.9

First trimester2

In the first trimester the treatment should be limited to periodontal prophylaxis and emergency treatment only. The concern about doing procedures during the first trimester is twofold. First, the developing child is at a greatest risk which is posed by teratogens during organogenesis, and second, during the first trimester, it is known that as many as one in five pregnancies undergo spontaneous abortions.2,7

The following guidelines should be followed during this time: 2,7

  • The patients should be well educated about oral changes taking place.
  • Instructions to be given to maintain oral hygiene.
  • Avoid routine radiographs.

Second trimester2

In this trimester the organogenesis phase is complete, and procedures like emergent dentoalveolar and other electives procedures are safe to perform. 2,7

Recommendations during this stage include: 2,7  

  • Maintenance of oral hygiene and plaque control.
  • It is safe to perform scaling, polishing and curettage
  • It’s safe to perform elective procedures, i.e. root canal, extraction, restorations.

Third trimester2,7

It is safe to perform short dental procedures only during the beginning of the third trimester as there is no significant risk to the foetus.

The following measures are recommended during the third trimester: 2,7

  • Maintenance of oral hygiene and plaque control.
  • It is safe to perform scaling, polishing and curettage if necessary.
  • Radiograph use should be minimised.

Summary

Pregnancy is a very vulnerable situation with some major changes happening in the body. Care should be taken to keep the oral hygiene in check as it can even affect the pregnancy outcome. Regular brushing and consuming a healthy diet are the only way to maintain good oral health.

Patient counselling tips for managing gum health during pregnancy10

It is important for a pregnant woman with periodontal disease to keep a close eye on the health of the gums gum health.

  • It is very important to keep the teeth and gums clean and healthy during pregnancy. The best way to prevent or deal with gum problems is to practise good oral hygiene.
  • Brush the teeth carefully twice a day for 2 minutes with a toothpaste such as Pepsodent G GumCare with zinc citrate that is clinically proven to reduce gum problems  
  • Floss once a day to remove small bits of food from between the teeth. This will help to prevent the build-up of plaque.
  • Brushing is best with a small-headed toothbrush with soft filaments 
  • Avoid having sugary drinks (such as fizzy drinks or sweet tea) and sugary foods too often
  • Its best to snack on foods such as vegetables, fresh fruit or plain yoghurt, and avoid sugary or acidic foods
  • Avoid mouthwashes that contain alcohol.

 

Reference

  1. Yenen Z, et al. Oral care in pregnancy. J Turk Ger Gynecol Assoc. 2019 11 28;20(4):264-8.
  2. Kurien S, et al. Management of pregnant patient in dentistry. J Int Oral Health. 2013 Feb;5(1):88-97.
  3. Pregnancy [Internet]. Ada.org. 2019 [cited 10 June 2020]. Available from: https://www.ada.org/en/member-center/oral-health-topics/pregnancy
  4. Oral Health Care During Pregnancy and Through the Lifespan [Internet]. Acog.org. 2013 [cited 10 June 2020]. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/08/oral-health-care-during-pregnancy-and-through-the-lifespan
  5. Madianos P, et al. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. Journal of Clinical Periodontology. 2013;40:S170-S180.
  6. Suragimath G, et al. Periodontal Disease and Pregnancy Outcome. Gingival Disease - A Professional Approach for Treatment and Prevention. 2019;.
  7. Vt H, et al. Dental considerations in pregnancy-a critical review on the oral care. J Clin Diagn Res. 2013 May;7(5):948-53.
  8. Oral Health Care During Pregnancy Practice Guidance for Maryland’s Prenatal and Dental Providers [Internet]. Phpa.health.maryland.gov. 2020 [cited 11 June 2020]. Available from: https://phpa.health.maryland.gov/oralhealth/Documents/PregnancyGuidanceDocument.pdf
  9. Radnai M, et al. Benefits of Periodontal Therapy When Preterm Birth Threatens. Journal of Dental Research. 2009;88(3):280-284.
  10. Teeth and gums in pregnancy -Your pregnancy and baby guide [Internet]. www.nhs.uk/. 2019 [cited 10 June 2020]. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/teeth-and-gums-pregnant/

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