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 during pregnancy.

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.

References:

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.