by Dr. Michele Brown OB/GYN
I'm terribly sorry if anyone is offended by this photo of a horse with a bad set of choppers, but because a whopping 30% of pregnant women get periodontal disease, I simply couldn't risk losing your attention. As they say, you can lead a horse to water, but you can't make it brush its teeth.
While periodontal disease may seem like a boring and unglamorous topic to be discussing, it's so important that I even decided to post two articles in a row about proper dental care during pregnancy. (Read part one)
Last week article focused on dental changes, good oral hygiene and recommended dental health guidelines. This week's will concentrate on the specific risks of periodontal disease. It's not a pretty picture but please read all the way to the end to make sure you understand what you can do to stay out of the 30% and prevent this ugly and damaging syndrome.
Periodontal disease begins as gingivitis, or inflammation of the soft tissue that supports the teeth. This inflammation is caused by a specific oral bacteria named gram negative anaerobic bacteria. In combination with the elevated hormones during pregnancy that increase blood volume and capillary fragility, these bacteria give rise to redness, increased sensitivity, bleeding and pain. Left untreated, these conditions can predispose a pregnant woman to more serious problems down the road.
If left untreated, the inflammation previously described can lead to the formation of pockets around the teeth. Within these pockets potential deep infections can occur and as pregnancy progresses, pocket depth has been shown to increase.
These pockets are actually the separation of the teeth from the gums and, if left untreated, these teeth can separate from the surrounding supporting structure, named the periodontal ligament and cementum. This separation can eventually lead to the loss of the affected teeth.
Approximately one third of all pregnant women have periodontal disease. Although the disease is measured differently in varying studies it is generally defined as 15 or more tooth sites with greater than 4 mm loss of attachment when probing.
Periodontal disease has been associated with preterm delivery (before 37 weeks), low birth weight (less than 2500 grams), poor obstetrical outcomes, pregnancy loss, late miscarriage and preeclampsia, especially in populations comprised of people who have very limited access to dental care. Preterm birth rate has been reported to be 11.2% in women without periodontal disease compared to 28.6% in women with moderate to severe disease (Offenbacher, 2006).
Similarly, progression of periodontal disease is also associated with a higher risk of preterm birth (6.4% vs 1.8% by same author). Most studies confirm these findings although some fail to show this association.