Dr Muhammad HaseebDepartment of Periodontology,

Fatima Memorial Hospital College of Medicine and Dentistry.

Outcome:Understand the effects of pregnancy on oral

healthUnderstand the oral manifestations which

can arise during pregnancyUnderstand the importance of Oral health

and its effects on systemic healthUnderstand the rationale behind some

common beliefsUnderstand the importance of referring the

patient to a dentist

Systemic changes in Pregnancy

Increased progesterone levelsIncreased estrogen levelsCD4:CD8 ratio may be decreasedLow response of lymphocytes

Mukherjee PM, Almas K. Orthodontic considerations for gingival health during pregnancy: a review. Int J Dent Hygiene 8, 2010; 3–9

Changes in Oral cavityAlteration in micro flora (Prevotella

intermedia, Porphyromonas gingivalis, Tannerella sp. dominates) in pregnancy

Increased gingival crevicular fluidPregnancy gingivitisPregnancy granuloma/epulis/tumorPeriodontal disease and Tooth mobilityTooth surface loss

Old wives tales about pregnancy

The baby extracts calcium from the tooth of mother !!!

You lose a tooth for every pregnancy !!!

Gums always bleed in pregnancy !!!

Rationale behind the talesThere is increased tendency of vomiting in

pregnancy which causes stomach acid to erode the tooth surface

With lack of maintenance of oral hygiene, the periodontal condition gets worsen and leads to increased mobility of teeth

Gums bleed because of pregnancy gingivitis

Pregnancy Gingivitis

Clinical Features:Inflammation of gingivaIncreased swelling of gingivaBleeding from gums while brushing or spitting

Pathophysiology:Primary cause is dental plaque, pregnancy

makes it hypersensitive to plaque irritation

Pregnancy Gingivitis

Pregnancy gingivitis

A 20 year old pregnant woman (7th Month) presents with gingival hyperplasia on buccal and lingual sides.

Treatment for Pregnancy gingivitis

Oral hygiene instructionsScaling and root planingCurettage

Significance of each trimester

1st Trimester:Severity of Gingivitis increases from 2nd month

2nd Trimester:Considered safest for the elective dental

procedures3rd Trimester:

Gingival swelling again gets increased in third trimester

Pregnancy GranulomaPedunculatedUsually originates from inter dental papilla

(part of the gum between two teeth)Highly vascularizedCompromise estheticsMay compromise mastication or speech

PregnancyGranulomaA 28 years old woman in her 8th month of pregnancy presents with a pregnancy granuloma , hanging in the palatal surface between the central incisors

Diagnosis ???

This patient is not pregnant

Diagnosis ???

He is a man, cant be pregnant !

Diagnosis ???

This 20 years old lady is not pregnant

Diagnosis

Pyogenic Granuloma It is an over growth of soft tissues due to

irritation, physical trauma or hormonal factors

Pregnancy granuloma is a type of pyogenic granuloma

Treatment for Pregnancy Granuloma

Remove the irritating source (plaque/calculus)

Regresses after pregnancyShould better be removed if it is

compromising mastication or speechExcision

Surgical Electrocautery

Potential problems with excisionProfuse bleeding if surgically excisedChance of recurrence

Possible Effects of Periodontitis on pregnancy outcome

Pre-term Low birth

Birth Weight Clothier  B, Stringer  M, Jeffcoat  MK.  Periodontal disease and

pregnancy outcomes: exposure, risk and intervention.  Best Pract Res Clin Obstet Gynaecol.  2007;21(3):451–466

Preterm birth and low birth weightPreterm birth refers to the delivery of new

born before 37th week of gestationLow birth weight refers a weight equal or

less than 2500 gramsRate of preterm birth varies with country to

country. (1 in 8 births in USA)Preterm birth is one of the most common

reason for infant mortality

MacDormann MF, Mathews TJ. Behind international rankings of infant mortality: how the United States compares with Europe. Int J Health Serv. 2010;40(4):577-88.

Does Periodontal treatment decrease the chances of low birth weight ?

Sadatmansouri S, Sedighpoor N, Aghaloo M. Effects of periodontal treatment phase I on birth term and birth weight. J Indian Soc Pedod

Prev Dent 2006;24:23-6

A Common Misbelief !Usually women tend to believe that any

dental procedures can harm their pregnancy

One American study showed that women seek dental treatment less during pregnancy period, specially getting a radiograph

Peilei Jiang, Eric P. Bargman, Nancy A. Garrett, et al. A Comparison of Dental Service Use Among Commercially Insured Women in Minnesota Before, During and After

Pregnancy. J Am Dent Assoc. 2008 Sep;139(9):1173-80.

The truth !American Dental Association recommends that

all dental procedures are safe and can be carried out in pregnancy

Periodontal scaling and prophylaxis is considered safe in all trimesters.

ADA endorses at least 2 dental visits during pregnancy

According to the American Academy of Family Physicians, you would need 50,000 dental x-ray examinations to reach the 5-rad cumulative dose to the fetus.

Recommendations for Family Physicians/Specialists

Examine the oral cavity of every pregnant patient

Educate the patient on maintaining good oral health

Refer to the dental surgeons specially periodontists for tooth cleaning (scaling)

Take Home Message !

Timely referral to the dentist will save complications like preterm birth and low birth weight babies of your patients which will eventually benefit your practice

Prevention of preterm birth and low birth weight will reduce the financial burden on part of government and the individual