Periodontal Disease and Pregnant Women

Medscape reports on women and oral health. In a recent article, it was stated that studies have shown a possible link between oral inflammation and pregnancy complications and preterm, low-birth weight babies. Various biological immune markers present in the blood as a result of periodontal infection may serve as a risk factor for premature labor.

Several risk factors are documented relating to the high incidence of preterm delivery (<37 weeks) of low-birthweight (<2,500-g) babies. Prostaglandins are produced and released during inflammation. Specifically, prostaglandin E2 (PGE2) is involved in bone resorption and in stimulating the uterus to contract during pregnancy. Both inflammation and progesterone significantly increase the formation of prostaglandins in the gingival tissue of pregnant women. Thus, it has been postulated that women with periodontal disease who give birth to preterm, low-birthweight babies versus normal-birthweight babies have significantly increased PGE2 levels. These prostaglandins found in the serum originate in the fluid of the underlying gingival tissues and flow out into the pocket between the tooth and the gingiva.[16] Additionally, four bacteria types (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Bacteroides forsythus, and Treponema denticola) were detected at higher levels in mothers of preterm, low-birthweight babies than in mothers who delivered normal-birthweight babies. Given these data, pharmacists and other health care professionals should stress to their patients the role of oral health in preventing pregnancy complications.

Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis.

Hormones and Periodontal Diseases

Medscape also provides information about hormones and periodontal disease. Extensive research suggests a relationship between periodontal diseases, such as gingivitis and periodontitis, and puberty, menstruation, pregnancy, oral contraceptive use, and menopause.

Gingival diseases can be increased by systemic factors, such as sex hormones. Elevated levels of hormones cause an exaggerated response to dental plaque on the teeth and gums, resulting in gingival inflammation. Unique to gingival diseases associated with sex hormones is that the gingival inflammation is elicited by relatively small amounts of dental plaque.

The same gingival changes seen during pregnancy will also be seen in women taking oral contraceptives. Gingival changes include inflammation and enlargement with increased amount of fluid flow into the tissue. As with pregnancy-associated gingivitis, gingival inflammation in women on oral contraceptives occurs in the presence of very little plaque. The most profound gingival changes are seen in the first few months after starting the contraceptive. If the condition worsens, a different formulation may be tried. Once the woman discontinues the contraceptive, the gingival condition will reverse.

Since the inception of oral contraceptives, the newer formulations contain lower concentrations of hormones. Unfortunately, most of the clinical studies investigating oral contraceptive use were performed in the 1960s. One more recent report suggests that because of the lower concentrations in the current oral contraceptive formulations, the inflammatory response of the gingiva to dental plaque was not affected in the study participants, so no gingival changes were found. More research is needed to evaluate these current formulations.

Phenytoin, calcium channel blockers (especially Nifedipine) and Cyclosporine are widely reported in the literature to cause gingival enlargement. Of particular importance due to the large number of fertile women is the fact that oral contraceptive use is also reported to cause gingival disease.

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