|In the course of practice we frequently
consult with obstetricians, gynecologists and other physicians regarding the status of our
female patients undergoing periodontal treatment. We have recently written to area
physicians updating them on information related to periodontal diseases in women. This
article will serve to highlight some of the recent developments between periodontal
diseases and pregnancy.
We are all aware of the
increase in bleeding tendencies in the gingival of pregnant patients. Many physicians
under the Impression that this increase in bleeding is simply due to increased vascularity
of the oral mucosa. The major cause, however, of gingival bleeding is periodontal
infections (gingivitis or periodontitis) exacerbated by the influence of hormonal changes
on the tissues and on the pathogenic bacteria which may be present. For example, one major
periodontal pathogen, Prevotella intermedia, has been shown to respond to changes in
hormone levels since the bacterium see the hormones as a growth factor.
A study has recently been published highlighting an
additional association between periodontitis and pre-term low birth weight deliveries. In
the October issue of a special supplement of the "Journal of Periodontology", a
study titled "Periodontal Infection as a Risk Factor for Pre-Term Low Birth
Weight" was published. An association between maternal periodontal disease and
pre-term low birth weight was established.
The American Academy of Periodontology notes, "This
study is one of the first of its kind to suggest maternal periodontal disease as a
possible risk factor for pre-term low birth weight. More studies are needed both to
substantiate these results as well as to determine whether or not intercepting maternal
periodontal disease will reduce the risk of pre-term delivery."
We concur with the Academy's recommendation that any
infection during pregnancy should be treated seriously. Periodontitis is a chronic
infection of the oral cavity that can worsen without treatment, especially during
pregnancy. Bleeding gums can no longer be considered a "normal" development
Early diagnosis and conservative periodontal management can control
this process and limit complications both during and after pregnancy. There is no need to
avoid periodontal management during pregnancy since this can be done in a safe and
supportive environment. Close consultation between physician and dentist is essential in
determining the best plan of treatment. Care may range from a pre-conception risk
assessment evaluation to treatment provided prior to, during or after pregnancy.
Ferris, GM, Alteration in Female Sex Hormones: Their Effect on Oral
Tissues and Dental Treatment. Compend. Contin. Educ. Dent. 1993; 14/12 : 1558-1570.
Offenbacher, et al., Periodontal Infections as Risk Factors
for Low Birth Weight. J. Periodontal, 1996; 67 (10-Supplement) : 1103-1113.