Periodontal Disease in Pregnancy: The Influence of General Factors and Inflammatory Mediators

Periodontal Disease in Pregnancy: The Influence of General Factors and Inflammatory Mediators

 

Periodontal disease elicits a severe inflammatory reaction which contributes to the destruction of periodontal structures.  There are multiple factors that play a role in periodontal disease onset and progression. Periodontal disease has been associated with adverse pregnancy outcomes, better understanding these associations may lead to better preventive measures and fewer adverse pregnancy outcomes. In a study published in 2019 in the journal Oral Health and Preventive Dentistry the authors aimed to “determine the influence of plaque and progesterone on periodontitis in pregnant women and their relationship with inflammatory mediators.”1

 

This was a longitudinal, observational study with 60 women participating between the ages of 18-42. All participants were between 32 and 35 weeks of pregnancy. Exclusion criteria included, risk of preterm delivery, twin pregnancies, and pathology prior to pregnancy (i.e., uterine malformations, cervical incompetence). Participants were examined and observed between the 32nd and 35th week of pregnancy and between weeks 6 and 7 postpartum. Examinations were done by the same examiner. The examiner collected personal information such as, demographic and medical data, tobacco use and oral hygiene habits. Periodontal parameters that were recorded included plaque index, bleeding on probing, periodontal probing depth, and clinical attachment loss. Inflammatory indicators recorded included basal levels of CRP, IL-6, and TNF-α. 

 

The highest peak of periodontal inflammation during pregnancy has been reported to occur during the third trimester of pregnancy. In this study, during the third trimester of pregnancy, 18.3% of the women presented with moderate periodontal disease. Additionally, 23% had a BOP index >30%. Previous studies have proven an increase in progesterone could intensify gingival response to biofilm leading to clinical periodontal changes. Previous studies show women that begin their pregnancy with gingivitis have a prevalence of 36 to 100% of gingivitis during pregnancy. However, gingivitis prevalence among women with good oral hygiene habits that manage plaque well have a 0.03% prevalence of gingivitis throughout their entire pregnancy. 

 

A positive correlation of CRP was found with PPD and BOP, while IL-6 and TNF-α showed no correlation with periodontal parameters. The levels of CRP dramatically decreased after childbirth even in the absence of periodontal treatment indicating an increase in progesterone could alter the immune response causing an increase in CRP levels and gingival inflammation. 

 

The authors conclude by stating, “The present results demonstrate a correlation between CRP and periodontal disease during pregnancy, together with a postpartum improvement in BOP and PPD, with no changes in PI and without any periodontal treatment which could alter the amount of periodontopathogens. Thus, progesterone seems to be mainly responsible for worsening of the periodontal condition in pregnant women, since its dramatic reduction postpartum is associated with significant periodontal improvement.”

 

As a rule, how often do you recommend pregnant patients have recare appointments? Does this study change your mind regarding the intervals of recare appointments for pregnant patients? Do you discuss the reasons for increased risk of gingivitis and periodontal disease with pregnant patients? Do the results of this study influence your narrative when discussing oral health risks with pregnant patients?

 

1. Gil L, Mínguez I, Caffesse R, Llambés F. Periodontal Disease in Pregnancy: The Influence of General Factors and Inflammatory Mediators. Oral Health Prev Dent. 2019;17(1):69-73. doi:10.3290/j.ohpd.a41981