Periodontal disease and adverse pregnancy outcomes
Oral Pathology

Author: Laura Cereser
Date: 06/01/2014


Puberty , Menstruation and Periodontal Disease.

During puberty in women increases the production of sex hormones such as estrogen and progesterone. In particular, in the premenstrual period elevated hormone levels can cause increased sensitivity to bacteria and gingival inflammation. The gums swell, become reddened , may be painful and bleeding: it’s a gingivitis , which is manifested even in women with good oral hygiene and with little plaque. Due to the periodicity of the menstrual phenomenon, if the woman is more susceptible to these problems or she already has periodontitis, she should consult the dentist in advance and periodically, even a week before menstruation, for a checkup and for a basic therapy, that is the removal of plaque and tartar above and subgingival, and the reinforcement of hygienic home education with the aid of pharmacological products.
The diagnosis and treatment of periodontal problems become more complex if during her fertile life the woman has an early-onset or aggressive periodontal disease. It is based on a genetic predisposition. With the recurrence of the menstrual cycle, if periodontitis is not diagnosed and treated, you can have a significant loss of gum tissue and bone, that can cause tooth loss, as well as present an unsightly smile.

Women, pregnancy and periodontal disease.

The biggest problems for gums are manifested during pregnancy and periodontitis may be a risk for the pregnancy outcomes.
The body needs energy and resources for motherhood. An example of disease is a remarkable gingivitis which usually appears already from the second to the third month of gestation and its gravity increases during the eighth month. In this period episodes of gingival abscesses may occur with the formation of a kind of "pocket" of the gum, pus-filled, or you can have the formation of gum "excrescences" that are called epulis gravidarum. These formations of cells proliferation of the gum should not be frightening, because they have no neoplastic origin and may be reversible or easily removed surgically.
The causes of these clinical manifestations are mainly hormonal alterations and / or stress, vitamin and immune defenses deficiencies, that naturally occur in a period in which the woman's body is concentrated on the function of motherhood. However, the main cause is always bacterial plaque, which must be removed beforehand and subsequently controlled with strict oral hygiene methods: either by proper brushing technique, and with the help of other means such as dental floss, toothbrush floss, dental toothpick, simple tools for the control of the formation of bacterial plaque in the spaces between a tooth and the other. Indeed, there isn’t an increase in the plaque, but a change in its composition due to increased levels of estradiol and progesterone (respectively 30 and 10 times compared to the menstrual cycle) that would work as growth factors for some bacteria as the B . Melaninogenicus and P. Intermedia that change the state of gingival health.
It’s also recommended in these periods the use of products for the chemical control of plaque. Of course the best one are the Chlorhexidine mouthwash, the most effective antiplaque substance, or rinses based on Triclosan. It's also recommended the use of mouthwash with fluoride and supplementation with vitamin C and B-carotene which stimulate the defense properties and gingival healing.

And if the woman already has parodontal disease before pregnancy?

This can be a serious problem because motherhood promotes the progression of periodontitis with increased inflammation and bleeding and loss of alveolar bone. We can establish with a test easy to perform if the woman is genetically predisposed to periodontitis , since the concomitant pregnancy leads to aggressive periodontitis with permanent consequences in terms of lost gum and bone in the future. Scientific studies prove that the presence of periodontal infection is one of the major risk factors for the fetus, in fact, the transmission of the infection and its products from mother to child , greatly increases the premature birth , the low weight , and a high risk of mortality. It is one of the biggest problems for public health of the most socially advanced countries . Along with other factors , such as smoking and alcohol, periodontal infection entered fully among the risk factors for pregnancy. For those who have periodontitis the chance to have an immature baby with low weight is almost eight times more. It’s therefore essential an early diagnosis of periodontitis before pregnancy, which should ideally be carried out by a specialist periodontist before the planning of a pregnancy.
During pregnancy, if there are signs of gingival pain you must promptly contact the dentist to treat periodontal infection. In this cases woman must be careful in recognizing symptoms such as bleeding and redness of the gum, the dental mobility, the excessive presence of plaque and tartar. Moreover, in this context, today the role of the gynecologist or primary care physician is crucial as a "first detector" of periodontal disease and for directing the patient to the specialist.

The mechanism would be the result of the production of toxins by bacteria and mediation of substances produced by the mother such as prostaglandins and interleukin. A high level of these substances in the oral cavity and consequently in the genitourinary tract may stimulate the event of childbirth earlier than expected. The antigens of the mother can bypass the placenta and cause chorionamniosite: utero-placental inflammatory disease associated with most cases of premature delivery, even in the absence of infections of the genitourinary tract. This disease causes the PT (preterm delivery prior to 37 weeks), LBW (low birth weight <2500 g), IUGR (intrauterine growth restriction).

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