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.
What is Periodontal Disease?
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.
Why Periodontal Disease Lead to More Serious Problems
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.
What is the Incidence of Periodontal Disease in Pregnancy?
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.
Why is the Presence of Periodontal Disease Important in Pregnancy?
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.
Why Is Periodontal Disease Equated with Poor Obstetrical Outcome?
- One explanation is that bacteria or infection from the mouth enter the bloodstream and eventually reach the placental membranes causing inflammation and damage resulting in preeclampsia or labor.
- Other explanations behind the results are that the specific bacteria and toxins identified in periodontal disease (Treponema denticola, Campylobacter rectus, Porphyromonas gingivalis to name a few) cause elevations in "inflammatory factors" or cytokines in the maternal blood (tumor necrosis factor-alpha, interleukin-8 (IL-8) and IL-1B) and it is these factors that have been found to increase the substances that stimulate the uterus to contract, such as prostaglandins (PGE-2), which cause the induction of labor.
- Supporting this theory is the finding that blood from pregnant moms who have an increase in antibodies (reactive substances) to some of these bacteria found in the mouth have also been found to have a higher incidence of preterm birth and low birth weight infants. These same elevated antibodies have been found in amniotic fluid and in fetal cord blood samples of infants delivered preterm or of low birth weight.
- Studies have shown that treatment for periodontal disease, through plaque control, scaling, and daily antibacterial rinsing reduced the risk of preterm births. Some studies however, have not been as consistent.
Periodontal Disease Relates to Other Conditions in Life
After pregnancy, chronic exposure to these inflammatory blood substances from bacteria in the mouth may cause a three to four times greater risk later in life to cardiovascular disease, atherosclerosis, stroke, and diabetes compared to the general population. The mechanism is believed to be due to bacteria, toxins and platelets sticking together, along with circulating inflammatory factors which cause clots to form.
Children exposed to these inflammatory factors may also have added risk of cardiovascular disease and diabetes later in life. Other diseases associated with these inflammatory mediators include Crohn's disease and Alzheimer's disease as adults.
Periodontal disease is a curable problem. Treatment may not only help save your teeth, but will support the prevention of perinatal mortality and morbidity. If mothers are educated to realize that there might be a link between preventing periodontal disease and improving the health and well-being of their infant, not to mention their own health, more women will seek preventative dental care during pregnancy.
Studies that are more conclusive with controls for socioeconomic status, smoking and study size have yet to be performed. However, even if the associations with these other factors are found not to be a factor in getting the disease, treating periodontal disease in pregnancy is safe and effective and, at the very least, may prevent unpleasant symptoms and appearance. It may also prevent the need for costly treatment and potential tooth loss later in life.
You may want to stick the photo of the gingivitic horse on your refrigerator as a reminder to always take good care of your teeth, especially while you are pregnant. Please share this article with everyone you know who is pregnant or may get pregnant.
Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.
Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.