By Jannette Whisenhunt, RDH, BS, MEd, PhD
Several inflammatory disease processes affect the mouth. One place where inflammation can cause many problems is with pregnancy. It has been known for many years that the inflammation associated with periodontal disease can influence a pregnancy. Many studies have been done showing a correlation with periodontal disease in the mother with low-birth-weight babies. Some studies show that mothers with periodontal disease causes more low-birth-weight babies than mothers who smoke or use alcohol (Offenbacher et al.).
I don’t believe that is something that we normally think of when we think of high risk behavior during pregnancy.
The severity of the periodontal disease can affect the mother and the baby in a negative way by causing chronic inflammation in the mother and then can cause pre-term birth in the baby. When the baby cannot grow to its full potential during a pregnancy, there are many physical issues that the baby will have to deal with when it is born early. During an early birth, the lungs of the infant, for example, are not as developed as it normally would have been if it had grown to full term.
Of course, there are many other factors that can affect a child’s preterm birth, such as malnutrition and poor prenatal care or drug teratogenic effects. Periodontal disease and the bacteria produced can cause adverse effects to the gingival tissues of the mother. It is very common too for these women to have continued periodontal issues after birth of the infant (Wilkins). The increase in hormone levels (estrogen and progesterone) during a pregnancy often can cause an exaggerated adverse response to the biofilm and calculus present.
Other tissue issues can affect pregnant women - pregnancy gingivitis, pyogenic granulomas, or pregnancy tumors. These can cause an isolated enlargement of the soft tissue at the gingival margin that is reddish-purple in color. When hormones (especially progesterone) that are circulating rise during the second trimester the mother can become very sensitive to a small amount of plaque biofilm, and the tissue reacts in a negative manner and may cause these pyogenic granulomas to form (Neild-Gerhrig). The hormones tend to decrease the immune response that the mother would normally have, so they react to a smaller amount of biofilm, and it can cause increased redness and swelling.
It is very important to educate our pregnant patients to have meticulous home care during their pregnancy. This can be a problem for them too if they have had morning sickness or experienced emesis often. They may not feel like putting a toothbrush in their mouth!
Gestational diabetes is a whole other issue that can occur during high risk pregnancies. Having glycemic control of the blood sugar can become a problem during some pregnancies, further complicating gingival tissue health. Patients with diabetic issues have a higher risk of periodontal disease, and, on top of a pregnancy, it can make bad matters even worse and more difficult to control.
Pre-eclampsia is an issue that some women get when they are pregnant that causes an abrupt increase in blood pressure and a large amount of protein albumin gathers in the urine. It can cause extensive swelling in the hands and feet and face of the mother. It usually occurs during the last trimester of the pregnancy. Many times, the doctor puts the expectant mother on complete bed rest until the birth.
It is important pregnant women are eating healthy and getting enough nutrients and vitamins to keep their tissue health to a maximum. Calcium and phosphorus products for alveolar bone health should be included in their daily diets along with enough folate for strong spinal health in the infant.
We can educate our pregnant patients about many things when it comes to their new babies and how to care for their mouths once they are born. But we need to take the time to educate them while they are pregnant about their own mouths, as ell as how important their periodontal health can be for the health of their unborn child. If we can treat them while it is still pregnancy-associated gingivitis, studies have shown that it can help prevent them from having a low-birth-weight baby (Lopez). We need to focus our pregnant patients to taking excellent care of their tissues in their mouth to increase their chances of carrying their baby to full term. Happy Scaling! RDH
Jannette Whisenhunt, RDH, BS, MEd, PhD, is the Department Chair of Dental Education at Forsyth Technical Community College in Winston-Salem, N.C. Dr. Whisenhunt has taught since 1987 in the dental hygiene and dental assisting curricula. She has a love for students and served as the state student advisor for nine years and has won the student Advisor of the Year award from ADHA in the past. Her teaching interests are in oral cancer, ethics, infection control, emergencies and orofacial anatomy. Dr. Whisenhunt also has a small continuing education business where she provides CE courses for dental practices and local associations. She can be reached at [email protected].
1. Offenbacher S, Katz V, Fertik G, Collins J, et al. Periodontal Infection as a possible risk factor for preterm birth low birth weight. J Periodontol. 1996;67 (10 Suppl):1103-1113.
2. Lopez NJ, Da Silva I, Ipinza J, Guutierrez J. Periodontal Therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J PEriodontol. 2005;76 (11 Supp): 2144-2153.
3. Neild-Gehrig JS, Willmann DE. Foundations of Periodontics for the Dental Hygienist 2nd Ed. Lippincott Williams & Wilkins.
4. Wilkins E. Clinical Practice of the Dental Hygienist 11th Ed. Lippincott Williams & Wilkins, 2013, Chapter 48-The Pregnant Patient.