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Pregnancy and Oral Health

Everything You Always Wanted To Know — But Never Knew To Ask

By Dr. Enrique Bimstein and Dr. Joseph Katz

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Pregnant woman flossing teeth.

Healthy Mouth, Healthy Body

The key to oral health is largely oral hygiene. Periodontal (gum) disease is caused by the accumulation and development of a bio-film between the gums and teeth known as dental bacterial plaque. If removed daily by gentle effective brushing with a soft multi-tufted toothbrush, and by flossing to remove plaque from the protected areas between the teeth, the gum tissues will stay pink, inflammation free and healthy. Daily brushing with fluoride toothpaste will also strengthen teeth against decay. It is also vitally important to maintain oral and dental health by visiting your dentist regularly during pregnancy.

Pregnancy, Hormones and Periodontal (Gum) Disease

Normal female hormones, of which progesterone is one, are elevated during pregnancy and also in women who are taking certain birth control pills containing high levels of progesterone. In the presence of periodontal disease, progesterone stimulates the production of substances called prostaglandins, which cause inflammation of the blood vessels in the gum tissues.

Warning signs of periodontal (gum) disease include swelling, redness, bleeding and sensitivity of the gum tissues, common in pregnancy and known as pregnancy gingivitis (gingival – gum tissue, itis – inflammation of). The tiny blood vessels of the gum tissues become dilated (widened) in response to the elevated hormone levels of pregnancy and therefore more susceptible to the effects of plaque bacteria and their toxins. Gingivitis is especially common during the second to eighth months of pregnancy.

Occasionally, overgrowths of gum tissue called “pregnancy tumors” appear on the gums during the second trimester. Tumor means nothing more than swelling or growth; pregnancy tumors are benign and not cancerous. They are usually found between the teeth and are believed to be related to excess dental bacterial plaque. They bleed easily and are characterized by a red, raw-looking mulberry-like surface. They are often surgically removed after the baby is born if they do not resolve themselves.

Periodontal Disease and Preterm Delivery, Low Birth Weight Babies

In the United States about 10% of all newborns are low birth weight babies. Maternal risk factors for LBW, PTD babies include age, low socio-economic status, obesity, alcohol and tobacco use, diabetes, hypertension (high blood pressure), and genito-urinary tract infection (genito – reproductive, urinary – kidney function, tract – pathway).

Early gum disease unchecked, can progress to destructive periodontitis, an inflammation and infection of the supporting structures of the teeth. This can result in the loss of tooth supporting bone and ultimately the teeth themselves. A variety of studies support a positive link between preterm delivery and the presence of periodontal (gum) disease in the pregnant women. Although the exact mechanism underlying this association is still unclear, evidence is accumulating suggesting that plaque bacteria can invade the placental tissues and trigger inflammatory responses, which will result in release of substances into the bloodstream that may result in preterm delivery. There is also a positive correlation between the severity of periodontal (gum) disease and the possibility of an increased rate of pre-eclampsia (high blood pressure during pregnancy) suggesting that periodontal disease may cause stress to the blood vessels of the mother, placenta, and fetus.

“Interventional” studies, literally done to intervene and treat disease during pregnancy, have shown that treating periodontal disease with basic periodontal therapy results in significantly decreased levels of prostaglandins — the substances that cause inflammation. Basic periodontal therapy includes oral hygiene instruction, scaling, root planing (deep cleaning with local anesthesia) and prophylaxis (polishing). Regular treatment throughout pregnancy for those women who are susceptible to periodontal (gum) disease will help maintain oral health.

Practice Prevention for the Future Oral Health of Your Child

Important new information has come to light regarding both parents and other caregivers. Their oral health may have a significant influence on the development of dental caries (decay) in their children since the bacteria responsible for tooth decay may be easily transmitted to the child by kissing, and other habits that can transmit saliva. Therefore, maintaining oral health of parents and other caregivers will reduce the possibility of children developing oral disease. In addition, professional topical application of fluoride directly to the teeth of children provided in the dental office has the potential to prevent tooth decay.



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