Oral Health in Pregnancy
Pregnancy-associated gingivitis
1. Description of the disease or condition
* A sex steroid hormone gingival disease
* Exaggerated inflammatory response of the gingiva to dental plaque biofilm and hormone changes usually occuring during the second and third trimesters of pregnancy.
* Most common oral disease in pregnancy.
2. Distinguishing diagnostic factors
* Response to even small amounts of biofilm
* Gingival tissue appear dark red/fiery red, edematous at the marginal gingiva and
interdental papillae, with loss of tissue resiliency.
* Tissues may be smooth and shiny, bleed easily, and display increase of probing depths.
These chages occur earlier and more frequently in the anterior than in the posterior areas.
* In some cases, a gingival papilla can react so strongly to plaque bioflim that a large,
localized overgrowth of gingival tissue called a pregnancy-associated pyogenic granuloma
(pregnacy tumor), may form on the interdental gingiva or on the gingival margin.
The figure below shows a pregnancy-associated granuloma, a mushroom-like mass of the gingiva that bleeds easily if disturbed.
1. Description of the disease or condition
* A sex steroid hormone gingival disease
* Exaggerated inflammatory response of the gingiva to dental plaque biofilm and hormone changes usually occuring during the second and third trimesters of pregnancy.
* Most common oral disease in pregnancy.
2. Distinguishing diagnostic factors
* Response to even small amounts of biofilm
* Gingival tissue appear dark red/fiery red, edematous at the marginal gingiva and
interdental papillae, with loss of tissue resiliency.
* Tissues may be smooth and shiny, bleed easily, and display increase of probing depths.
These chages occur earlier and more frequently in the anterior than in the posterior areas.
* In some cases, a gingival papilla can react so strongly to plaque bioflim that a large,
localized overgrowth of gingival tissue called a pregnancy-associated pyogenic granuloma
(pregnacy tumor), may form on the interdental gingiva or on the gingival margin.
The figure below shows a pregnancy-associated granuloma, a mushroom-like mass of the gingiva that bleeds easily if disturbed.
3. Etiology of the disease or condition
* Exagerrated inflammatory response to dental plaque biofilm
* High plasma hormone levels (fluctuations in estrogen and progesterone levels)
* Decreased immune response
* Poor Oral Hygiene/Changes in oral flora/Increase in bacteria associated with periodontal
disease.
4. Pathogens assocciated with the disease or condition
* Anaerobic bacteria that proliferate in the high-progesterone environment during pregnancy (Bacteria metabolize progesterone as a nutrient)
* Tanarella and Prevotella intermedia
5. Classification of the disease or condition using the AAP Classification/
System
* Type I-A
* Plaque-Induced Gingival Diseases - modified by systemic factors
6. Prevalence of the disease or condition
* Most common oral disease in pregnancy
* 60-75%
* Approximately 1/2 of the women with preexisting gingivitis have significant exacerbation
during pregnancy.
7. Factors to include in patient education
* Oral Health Education -Every pregnant woman should be assessed for dental hygiene
habits, access to fluridated water, oral problems (e.g. caries, gingivitis) and access to
dental care.
* Counseling and early intervention by healthcare providers such as physicians,
nurses, and dentists to provide expectant mothers with the tools and resources
necessary to understand the importance of oral health care during pregnancy.
* Oral Hygiene Instructions - Thorough oral hygiene measures, including toothbrushing
and flossing are recommended.
* Oral Hygiene/Plaque Control - Patients with severe gingivitis may require professional
cleaning and need to use mouth
rinses such as chlorhexidine.
* Nutrition/Diet - Avoidance of excessive amounts of sugary snacks and drinks.
* Xylitol and chlorhexidine lower maternal oral bacterial load and reduce transmission of
bacteria to infants when used late in pregnancy and/or in the postpartum period. Both
topical agents are safe in pregnancy (U.S. Food and Drug Administration(FDA)
preganancy category B) and during breastfeeding.
* Consult a dentist
8.Treatment recommendations or corrective procedures
* Ideally, dental procedures shoulkd be scheduled during the second trimester of
pregnancy when organogenesis is complete.
* Urgent dental care can be performed at any gestational stage.
* The third timester presents presents the additional problems of positional discomfort and
the risk of vena caval compression.
* Propping a woman on her left side, repositioning often, and keeping visits brief can r
reduce problems.
* Deferring dental care until after delivery can be problematic because new mothers are
focused on the care of their newborn.
9. Maintenance recommendations
* Regular dental visits (check-up) and cleaning every six months or depends on the
severity ; especially at the second trimester when pregnancy-associated gingivitis is at
high risk.
10. Additional Information
* Pregnant mothers with periodontal disease are seven times more likely to go into preterm
labor. Prostaglandin, a chemical found in oral bacteria, may induce labor. And high levels
of prostaglandin has been found in the mouths of women with severe cases of periodontal
disease.
* Oral Bacteria Found in Amnio Fluid
* Researchers at Case Western Reserve University School of Dental Medicine and the
Department of Obstetrics and Gynecology at MetroHealth Medical Center, both in
Cleveland, used DNA fingerprinting techniques to find the first link between bacteria
found in the mouth and in the amniotic fluid of a woman in preterm labor.
According to www.sciencedaily.com, the presence of the bacteria Bergeyella was found
in a mother's mouth and in her amniotic fluid. The mother went into preterm labor
at 24 weeks. The results are published in the April issue of the Journal of Clinical
Microbiology.Dimensions Dental Hygiene May 2006
Author:
Douglass, A.B., Douglass, J.M., Silk, H., & Silk, M. Oral Health during pregnancy. American Family Physician, 2008; 77(8):1139-1144.
Link to the journal:
http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=18481562&site=nrc-live
References:
Darby, M.L., & Walsh, M.M. Dental Hygiene Theory and Practice. 3rd ed.Canada:Saunders Elsevier; 2010.
Nield-Gehrig, J.S., & Willman, D.E. Foundations of Periodontics for the Dental Hygienist, 3rd ed, China. Wolters Kluwer Health; 2011
http://about.com/od/basicdentalcare/qt/perinatalguidelines.htm
http://www.dentalgentlecare.com/pregnancy_and_gingivitis.htm
Images:
www.google.com
Nield-Gehrig, J.S., & Willman, D.E.: Foundations of Periodontics for the Dental Hygienist, 3rd ed, 240
Video:
www.youtube.com
* Exagerrated inflammatory response to dental plaque biofilm
* High plasma hormone levels (fluctuations in estrogen and progesterone levels)
* Decreased immune response
* Poor Oral Hygiene/Changes in oral flora/Increase in bacteria associated with periodontal
disease.
4. Pathogens assocciated with the disease or condition
* Anaerobic bacteria that proliferate in the high-progesterone environment during pregnancy (Bacteria metabolize progesterone as a nutrient)
* Tanarella and Prevotella intermedia
5. Classification of the disease or condition using the AAP Classification/
System
* Type I-A
* Plaque-Induced Gingival Diseases - modified by systemic factors
6. Prevalence of the disease or condition
* Most common oral disease in pregnancy
* 60-75%
* Approximately 1/2 of the women with preexisting gingivitis have significant exacerbation
during pregnancy.
7. Factors to include in patient education
* Oral Health Education -Every pregnant woman should be assessed for dental hygiene
habits, access to fluridated water, oral problems (e.g. caries, gingivitis) and access to
dental care.
* Counseling and early intervention by healthcare providers such as physicians,
nurses, and dentists to provide expectant mothers with the tools and resources
necessary to understand the importance of oral health care during pregnancy.
* Oral Hygiene Instructions - Thorough oral hygiene measures, including toothbrushing
and flossing are recommended.
* Oral Hygiene/Plaque Control - Patients with severe gingivitis may require professional
cleaning and need to use mouth
rinses such as chlorhexidine.
* Nutrition/Diet - Avoidance of excessive amounts of sugary snacks and drinks.
* Xylitol and chlorhexidine lower maternal oral bacterial load and reduce transmission of
bacteria to infants when used late in pregnancy and/or in the postpartum period. Both
topical agents are safe in pregnancy (U.S. Food and Drug Administration(FDA)
preganancy category B) and during breastfeeding.
* Consult a dentist
8.Treatment recommendations or corrective procedures
* Ideally, dental procedures shoulkd be scheduled during the second trimester of
pregnancy when organogenesis is complete.
* Urgent dental care can be performed at any gestational stage.
* The third timester presents presents the additional problems of positional discomfort and
the risk of vena caval compression.
* Propping a woman on her left side, repositioning often, and keeping visits brief can r
reduce problems.
* Deferring dental care until after delivery can be problematic because new mothers are
focused on the care of their newborn.
9. Maintenance recommendations
* Regular dental visits (check-up) and cleaning every six months or depends on the
severity ; especially at the second trimester when pregnancy-associated gingivitis is at
high risk.
10. Additional Information
* Pregnant mothers with periodontal disease are seven times more likely to go into preterm
labor. Prostaglandin, a chemical found in oral bacteria, may induce labor. And high levels
of prostaglandin has been found in the mouths of women with severe cases of periodontal
disease.
* Oral Bacteria Found in Amnio Fluid
* Researchers at Case Western Reserve University School of Dental Medicine and the
Department of Obstetrics and Gynecology at MetroHealth Medical Center, both in
Cleveland, used DNA fingerprinting techniques to find the first link between bacteria
found in the mouth and in the amniotic fluid of a woman in preterm labor.
According to www.sciencedaily.com, the presence of the bacteria Bergeyella was found
in a mother's mouth and in her amniotic fluid. The mother went into preterm labor
at 24 weeks. The results are published in the April issue of the Journal of Clinical
Microbiology.Dimensions Dental Hygiene May 2006
Author:
Douglass, A.B., Douglass, J.M., Silk, H., & Silk, M. Oral Health during pregnancy. American Family Physician, 2008; 77(8):1139-1144.
Link to the journal:
http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=18481562&site=nrc-live
References:
Darby, M.L., & Walsh, M.M. Dental Hygiene Theory and Practice. 3rd ed.Canada:Saunders Elsevier; 2010.
Nield-Gehrig, J.S., & Willman, D.E. Foundations of Periodontics for the Dental Hygienist, 3rd ed, China. Wolters Kluwer Health; 2011
http://about.com/od/basicdentalcare/qt/perinatalguidelines.htm
http://www.dentalgentlecare.com/pregnancy_and_gingivitis.htm
Images:
www.google.com
Nield-Gehrig, J.S., & Willman, D.E.: Foundations of Periodontics for the Dental Hygienist, 3rd ed, 240
Video:
www.youtube.com