Periodontal Disease and Adverse Pregnancy Outcomes
While the exact mechanism has not been clearly defined, there has been mounting evidence that there is a positive relationship between chronic periodontal disease and adverse pregnancy outcomes. Such include pre-eclampsia, where the maternal blood pressure increases and protenuria during the period of gestation; and premature and low birth weight (LBW). These conditions pose a risk both to the mother and especially the baby; since the latter is likely to be born with poor development of the lungs with a good proportion ending up in the neonanatal intensive care unit (NICU) (Yiorgos et al, 2006).
Periodontal disease has a prevalence of over 23% among women aged 30 and 54; and it involves invasion of the gingival crevices by bacteria, in particular, Porphyromonas gingivalis, Tannerella forsythia, and Eikenella corrodens (AAP). These organize themselves into a bacterial biofilm and produce many factors that trigger an immune response from the body aimed at eliminating the infection; but which also results in further destruction of the periodontal tissue. The bacterial is also thought to be able to enter into the bloodstream and/or shed these factors therein; resulting in a systemic rather than a local response (Yiorgos et al, 2006).
As mentioned before, the exact mechanism that links periodontal disease with adverse outcomes of pregnancy are yet to be established; however, it is thought that the outcomes are a result of exposure of the fetus to the bacteria and/or its factors, inflammatory response of the fetus and that of the mother (Yiorgos et al, 2006).
Periodontal Disease and Smoking
Smoking is an important risk factor for the occurrence of periodontal disease; in fact, it has been estimated that about 50% of all cases of periodontal disease may be attributed to smoking. These adverse effects have also been extended past cigarettes to include other forms of tobacco consumption such as cigars (AAP).
Smoking increases the rate and possibility of formation of calculus; since it is loaded with bacteria, plaque (if not removed by a dentist) results in the destruction of the tooth below the gum line; resulting in the recession of the line and exposure of periodontal pockets to infection and periodontal disease. This process is augmented by other effects of smoking including deepening of pockets between the teeth and gingival; and loss of the osteoid support of teeth.
Periodontal Disease and Hormones
The subject of hormones and periodontal disease is more important in women than in men; this is because the latter has a more-or-less stable hormonal profile post-puberty than the latter; this is due to the normal reproductive cycle in women and the accompanying hormonal fluctuations, and the changes experienced during menopause (AAP).
The onset of puberty in women is often accompanied by an increase in the blood flow to the gums as a result of the commencement of production of reproductive hormones; this may result in increased occurrence of sensitivity and irritation; this increases the risk of development of periodontal disease.
Also important to oral health is the period of menstruation; a condition known as menstruation gingivitis may occur and is characterized by the development of mild lesions on various oral surfaces. In the absence of proper oral hygiene, these may progress to periodontal disease. Pregnancy also comes with a similar condition, known as pregnancy gingivitis; which may lead to periodontal disease with the accompanying risk of adverse pregnancy outcomes.
Finally, the onset of menopause may be accompanied by gingivostomatitis; and the associated loss of bone density may affect the integrity of the support structure of teeth. Hormone Replacement Therapy (HRT) aimed at reversing or preventing menopausal osteoporosis may also have some positive effects on the oral health of these women (AAP).
References
- American Academy of Periodontology (AAP)
- Periodontitis Associated with Preeclampsia in Pregnant Women. 2006.
- Gum Disease and Pregnancy Problems.
- Tobacco Use and Periodontal Disease.
- Study Shows Yet Another Reason Why Quitters Are Winners. 2006.
- Protecting Oral Health throughout Your Life.
- Yiorgos A. Bobetsis, Silvana P. Barros and Steven Offenbacher (2006): Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc, Vol. 137, No suppl_2, 7S-13S