Why is oral health important during pregnancy?
The mouth is one of the main areas involved in the physiological and hormonal changes that take place during pregnancy. Gingival inflammation tends to increase during pregnancy, even when proper oral-hygiene to remove plaque is performed. Pregnant women can be affected by pregnancy gingivitis, granuloma gravidarium (pregnancy tumour), and periodontitis.
What are the implications of these diseases?
Pregnancy gingivitis does not usually imply irreversible damage to the periodontium (the bone, connective tissue, and gum surrounding and supporting a tooth) and inflammation usually disappears in the months following delivery. Granuloma gravidarium lesions that do not cause significant functional or aesthetic problems should not be removed during pregnancy – they may recur or they may resolve spontaneously after delivery. While no specific type of periodontitis is related to pregnancy, periodontitis is a potential risk factor for adverse pregnancy outcomes and gestational diabetes mellitus.
Does periodontal treatment during pregnancy reduce the risk of adverse pregnancy outcomes?
Research shows that while non-surgical periodontal therapy during the second trimester is safe, it does not reduce the incidence of adverse pregnancy outcomes. However, periodontal therapy may reduce rates of adverse pregnancy outcomes in women who are at high risk of pregnancy complications or who have a better response to periodontal treatment. The main role of periodontal treatment during pregnancy is to improve the periodontal and overall health of the pregnant woman. Nonsurgical periodontal therapy improves the periodontal status of most pregnant women with periodontal disease – but falls short of eliminating gingival inflammation.
So, when is the best time for a pregnant woman to receive periodontal treatment?
In terms of affecting adverse pregnancy outcomes, it may be more effective to provide periodontal intervention before conception. During pregnancy, it is preferable to receive periodontal treatment during the second trimester
What are the reasons why periodontal disease might play a role in adverse pregnancy complications?
Clinical studies suggest that bacteria from the mouth colonise the foetus and the placenta, with blood as the most likely vehicle of transmission. Specific micro-organisms associated with periodontitis have been associated with adverse pregnancy outcomes, but little is known about their exact role. It is not yet known why some women with periodontal inflammation develop adverse pregnancy outcomes and others do not, and further studies are needed to understand the complex biological processes involved.
What kind of adverse pregnancy outcomes are associated with periodontitis?
Studies have shown associations between periodontal disease and three forms of adverse pregnancy outcome: low birth weight, preterm birth, and pre-eclampsia (defined as high maternal blood pressure and significant proteinuria, or presence of excess proteins in the urine), as well as with gestational diabetes.