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PREGNANCY AND GINGIVITIES

Fact Sheet by Academy of General Dentistry

 Women with periodontal disease are at three to five times greater 
risk of preterm birth than those who are periodontally healthy.

Pregnancy and Oral Health Drug Safety and
Pregnancy Tumors Who can I talk to?
Gingivitis affects on my Baby’s Health Prevention
Dental Treatment during Pregnancy News Update

Mothers with gum disease have six times greater risk of delivering preterm, low-birth-weight babies!  *

If mothers had untreated tooth decay, their children had four times the risk of decay compared with children of other mothers. If mothers consumed large amounts of sugar, their children had four times the risk of tooth decay compared with children of mothers with low sugar consumption.

Pregnant women who receive treatment for their periodontal disease can REDUCE their risk of giving birth to low birth-weight or pre-term babies.^

Periodontal Therapy and Birth Weight

Gum Disease in Pregnancy causes low birth rate babies and premature deliveryAmong Time Magazine’s 2005 top medical stories, was news about mom’s dental health and birth weight. Pregnant women will want to include a periodontal evaluation as part of prenatal care. Researchers found that periodontal treatment significantly reduced the risk of having a pre-term birth or low birth weight infant, according to a study published in the Journal of Periodontology. Periodontal therapy reduced pre-term birth and low birth weight infant rates by 68% in women with pregnancy-associated gingivitis.  Smart Practice News 1/-06

Will pregnancy affect my oral health?  

Most women will experience some form of gingivitis, which tends to surface most frequently in the second trimester~:

Gingivitis occurs in 60% to 75% of pregnant women

     Expectant mothers (and women who take some oral contraceptives) experience-elevated levels of the hormones estrogen and progesterone.  This causes the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as “pregnancy gingivitis” 65 to 70% of all pregnant women developed gingivitis during this time! Symptoms include;

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 swollen, red gums 

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 bleeding of the gums when you brush.

     Pregnancy gingivitis usually starts around the second month of pregnancy and decreases during the ninth month.  If you already have gingivitis, it will most likely get worse during pregnancy especially without treatment. Only half of most pregnancy women go to receive dental care. Remember that the bacteria in plaque (not hormones) are what cause gingivitis and it is an infection of the gum tissue. 

Gums infected with periodontal disease are toxic reservoirs of disease causing bacteria.  The toxins produced by the bacteria  attack the gums, ligaments, and bone surrounding the teeth to produce infected pockets that are similar to large infected wounds in your mouth.  The infected pockets provide access the your bloodstream allowing bacteria to travel throughout your body.

Your body reacts to the infections in your gums by producing prostaglandins, a natural fatty acid that's involved with inflammation control an smooth muscle contraction.  During your pregnancy the level of prostaglandins gradually increases, peaking when you go into labor.  One theory is that, if extra prostaglandins are produced as a reaction to the bacterial infection in your gums, your body may interpret it as a signal to go into labor and your baby can be born to early or too small.

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What are “pregnancy tumors”?

     Pregnancy tumors (pyogenic granuloma) are inflammatory, benign growths that develop on the gums as part of an exaggerated response to the irritants that cause periodontal disease. These "tumors" are rare, usually painless and develop on your gums in response to plaque.  Although they are not cancerous, they should be treated.  Pregnancy tumors usually subside shortly after childbirth.  

Gingivitis is most common during the second to eighth months of pregnancy.

Could gingivitis affect my baby’s health?

New research suggests a link between pre-term, low birth weight babies and gingivitis.  Excessive bacteria, which cause gingivitis, can enter the bloodstream through your mouth (gums).  If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called “prostaglandins”, which cause uterine contractions that induce premature labor. ***

Should I receive dental treatment while I’m pregnant?

    Good oral health care is vital during your pregnancy.  Continue with your regular dental cleaning and check ups to avoid oral infections that can affect the fetus, such as gingivitis and periodontal disease

    Dentists recommend that major dental treatments that aren’t urgent be postponed until after your child is born.  The first trimester, the stage of pregnancy in which most of the baby’s organs are formed, is the most crucial to your baby’s development, so it is best to have procedures performed during the second trimester to minimize any potential risk.

    Dental work is not recommended during the third trimester because the dental chair tends to be too uncomfortable for the mother.  If you lie back, the chair may cut off circulation by placing pressure on the vein that returns blood to the heart from the lower part of the body.  

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If I do need treatment, what drugs are safe?

     Be extremely cautious of all drugs during pregnancy.  If you have gingivitis or periodontal disease, your dentist may want to treat you more often to achieve healthy gums and a healthy baby.

   Although dental anesthetics such as Novocain or lidocaine can enter the placenta, which filters out most drugs, the doses used in most dental procedures are considered safe. 

    If you need to have dental work done during your pregnancy, research has shown that some acceptable antibiotics include penicillin, amoxicillin, and clindamycin but avoid tetracycline, which can cause discoloration of your child’s temporary and permanent teeth.

    Products containing acteaminophen, such as Tylenol, are approved, but you should be wary of other over-the-counter medications such as aspirin or ibuprofen.  Avoid using narcotics for dental pain until after your child is born.  

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Who can I talk to?

    If you have any concerns about treatment or medications, make sure to ask your dentist or physician before receiving treatment.  Most dental procedures are safe during pregnancy.  

Prevention

  You can prevent gingivitis by keeping your teeth clean, especially near your gumline and:

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Brush your teeth at least twice a day and after meals when possible.

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Floss daily

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If you suffer from morning sickness, repeatedly rinse our mouth with water and brush your teeth as often as possible to neutralize the acid caused by vomiting.

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If brushing your teeth causes morning sickness, rinse your mouth with water, brush without toothpaste and follow with anti-plaque fluoride mouthwash.

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Eat a well-balanced diet with plenty of vitamin C and B12.

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See you dentist  for help in controlling plaque and preventing gingivitis.  Also schedule routine exams and cleaning to maintain good dental health.

   Remember, the healthier your mouth is, the healthier and happier your pregnancy and baby will be.

News Update

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

Periodontitis Linked to Preeclampsia

 Recent study published in the February issue of the Journal of Periodontology has verified a positive association between periodontitis and an increased risk of developing preeclampsia during pregnancy. Preeclampsia is a hypertensive disorder that effects between five and eight percent of all pregnancies, and usually occurs during the late part of the second or early part of the third trimester.(1) The study also shows that periodontitis is a risk factor for low birth weight babies among preeclamptic mothers, versus those who did not have the condition.
Swelling, headaches, changes in vision, and sudden weight gain are recognized as important symptoms of preeclampsia, but many women with rapidly advancing disease often report few symptoms. Proper prenatal care is essential to diagnose and treat preeclampsia, which, along with other hypertensive disorders, is estimated to
cause 76,000 maternal and infant deaths each year.(1) For more information on preeclampsia please visit www.preeclampsia.org.

1.What is preeclampsia? Bellevue, Wash., Preeclampsia Foundation;2005. Available at: "www.preeclampsia.org/about.asp". Accessed
February 13, 2006.
2. Contreras A, Herrera JA, Soto JE, et al. Periodontitis isassociated with preeclampsia in pregnant women. Journal ofPeriodontology 2006; 77:182-8.
 

Research Presented Today Provides Further Evidence on the Importance of Good Oral Health in Pregnant Women

Periodontal Disease and Preterm Birth

Periodontitis Is Associated With Preeclampsia in Pregnant Women

Recent investigations have demonstrated a positive association between periodontitis and pregnancy complications. The purpose of this study was to determine the effect of periodontitis and the subgingival microbial composition on preeclampsia. A case-control study was carried out in Cali, Colombia that
included 130 preeclamptic and 243 non-preeclamptic women between 26 to 36 weeks of pregnancy. Sociodemographic data, obstetric risk factors, periodontal status, and subgingival microbial composition
were determined in both groups. Preeclampsia was defined as blood pressure ˇÝ140/90 mm Hg, and ˇÝ2+ proteinuria, confirmed by 0.3 g proteinuria/24 hours of urine specimens.

Results: A total of 83 out of 130 preeclamptic women and 89 out of 243 controls  had chronic periodontitis  The average newborn birth weight from preeclamptic mothers was 2.453 g, whereas in controls was 2.981 g (P <0.001). Two red complex microorganisms, Porphyromonas gingivalis and Tannerella forsythensis, and the green
complex microorganism Eikenella corrodens were more prevalent in the preeclamptic group than in controls (P <0.01).
Chronic periodontal disease and the presence of P. gingivalis, T. forsythensis, and E. corrodens were significantly
associated with preeclampsia in pregnant women.


A. Contreras, et al.Journal of Periodontology 2006, Vol. 77, No. 2, Pages 182-188
 

Oral Bacteria May Predict Pregnancy Outcomes
Researchers from New York University found that certain bacteria from the mouth may be related to preterm delivery and low birthweight according to a study in the Journal of Periodontology. Previously it was reported that periodontal disease may be a factor in the occurrence of preterm low birthweight babies. Now it is believed that bacteria commonly found in dental plaque biofilms may also be related. Researchers evaluated bacterial levels in the saliva of 297 women in their third trimester of pregnancy. They found that a high salivary level of the bacteria called Actinomyces naeslundii Genospecies2 (A. naeslundii gsp2) is associated with low birthweight and preterm delivery, while higher levels of the bacteria Lactobacillus casei (L. casei) during pregnancy positively affected the birthweight. To view an abstract or learn more visit www.perio.org 4/05

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Perio & preterm birth

Why chronic periodontitis may induce an inflammatory response with premature pregnancy termination is unclear.  This study studied amniotic fluid cytokines and periodontitis variables in early-stage pregnancy.

A periodontal examination and collection of amniotic fluid was performed (weeks 1520) of pregnancy in 36 women at risk for pregnancy complications. Cytokine levels in amniotic fluid were studied in relation to other study variables.

Pregnant women with findings of elevated amniotic fluid levels of PGE2, IL-6 and IL-8 in the 1520 weeks of pregnancy and with periodontitis are at high risk for premature birth. The implication of this is that periodontitis can induce a primary host response in the chorioamnion leading to preterm birth.


[Orhun  O et al., Periodontitis, a marker of risk in pregnancy for preterm birth  Journal Of Clinical Periodontology 2005;32(1):45.]

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Periodontal disease as a risk factor for adverse pregnancy outcomes.   

Periodontal diseases is a  risk factors for adverse pregnancy outcomes such as prematurity and low birth weight.  A number of studies have shown that bacteria is related to preterm and/or low birth weight (PT/LBW), which continues to be a significant cause of infant morbidity and mortality. MAIN RESULTS:  Several studies implicated periodontal disease as a risk factor for PT/LBW  Periodontal disease may be a risk factor for PT/LBW. Preliminary evidence to date suggests that periodontal intervention may reduce adverse pregnancy outcomes.

Ann Periodontol. 2003 Dec; 8(1): 70-8 Scannapieco FA, Bush RB, Paju

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Premature Births: Know the Facts and Stats

 Recent studies have shown that women with periodontal disease are at three to five times greater risk of preterm birth than those who are periodontally healthy.

bulletPremature (or preterm) babies are born too soon - before 37 completed weeks of gestation.
bulletIn 2001, the preterm birth rate was 11.9%, reflecting more than 476,000 newborns and the highest rate ever reported for the U.S. This represents 1 in 8 babies in the U.S. born prematurely.
bulletThe rate of preterm birth increased 27% between 1981 and 2001 from 9.4% to 11.9%.
bulletOn an average day in the U.S., 1,305 babies are born preterm (before 37 weeks), 213 are born very preterm (before 32 weeks).
bulletWomen with periodontal disease are at three to five times greater risk of preterm birth than those who are periodontally healthy.
bulletAmong racial/ethnic subgroups, preterm birth rates were highest among infants born to black mothers (17.5%) in 2001.
bulletMajor risk factors associated with increasing rates of preterm delivery include multiple births, advanced maternal age, induced deliveries and additional factors as yet unknown.
bulletPreterm labor/delivery is the number one obstetrical challenge in the U.S.
bulletIn 2000 prematurity/low birthweight was the leading cause of neonatal mortality in the U.S., accounting for 23% of deaths in the first month of life.
bulletPreterm birth is a leading challenge in pediatrics, accounting for substantial long-term disabilities such as mental retardation, cerebral palsy, vision and hearing problems, and chronic lung disease.
bulletCauses of nearly half of all preterm births are unknown.
bulletPreterm labor can happen to any pregnant woman.

ADHA 12/03

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Scaling and root planing may reduce preterm birth risk: study Pregnant women with periodontitis may be able to reduce their risk of preterm birth by undergoing scaling and root planing, ideally in the second trimester, according to recent study results published in the Journal of Periodontology. The results come from a study of 366 pregnant women with advanced gum disease.  Women who were less than 35 weeks pregnant showed as much as an 84 percent reduction in premature births following the scaling and root planing. However, the use of the antibiotic therapy did not improve pregnancy outcomes. It is recommend that all women who are thinking of becoming pregnant or who are pregnant receive a full periodontal exam and diagnosis. Women who are already pregnant when periodontal disease is detected are ideally treated with scaling and root planing in the second trimester, which is a pragmatic protocol according to most OB-GYN specialists." http://www.ada.org/ Periodontal Disease and Preterm Birth: Results of a Pilot Intervention Study - Marjorie K. Jeffcoat, John C. Hauth, Nico C. Geurs, Michael S. Reddy, Suzanne P. Cliver, Pamela M. Hodgkins, and Robert L. Goldenberg  J Periodontol 2003;74:1214-1218.W. *Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, and Offenbacher S: Periodontal disease associated with risk of preeclampsia. Obstet Gynecol 101:227-231, 2003.

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This study concluded that symptoms of inflammation of gum tissue are irritated during pregnancy and are related to increased age, lower level of education and non-employment. Therefore periodontal preventive programs are very important for pregnant women.

The periodontal status of pregnant women and its relationship with socio-demographic and clinical variables Journal of Oral Rehabilitation, April 2003, vol. 30, no. 4, pp. 440-445

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 The periodontal status of pregnant women and its relationship with socio-demographic and clinical variables.

This study

D. Q. Taani et al Journal of Oral Rehabilitation Volume 30 Issue 4 Page 440 - April 2003

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Periodontal treatment can reduce risk of some pregnancy complications.

 Pregnant women who receive treatment for their periodontal disease can reduce their risk of giving birth to a low birth-weight or pre- term baby. In a study of 400 pregnant women aged 18 to 35 with advanced periodontal disease, half of the subjects were given periodontal treatment before the end of the second trimester while the other half were treated after giving birth.    Treatment included scaling and root planing, instruction in good oral hygiene habits and antimicrobial mouth rinse for daily use.  Of the women who received treatment during pregnancy, 2 percent gave birth to either a low birth-weight or pre-term infant. By comparison, 10 percent of the women who received treatment after birth had either a low birth-weight or pre-term baby
The study results are consistent in establishing a link between advanced gum disease 
and pre-term deliveries when bacteria from the mother's mouth travel through the bloodstream to the placenta and fetus, possibly stimulating pre-term labor
.  
University of Chile were published in the August issue of the Journal of Periodontology. Document address: http://www.ada.org/prof/pubs/daily/0209/0912peri.html

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Infections in Pregnancy can cause Stillbirth

 Approximately 9% to 15% of stillbirths are caused by infections. Infection may be especially important as a cause of stillbirth occurring early in pregnancy. Recognized causes include syphilis, toxoplasmosis, parvovirus B-19, chorioamnionitis, and Listeria monocytogenes. Other organisms that are "purported to cause" stillbirth include the genital mycoplasmas, Chlamydia trachomatis, HIV, group B streptococci, and others.  Infection is an important cause of stillbirth. 
Gibbs RS. The origins of stillbirth: infectious diseases; .Semin Perinatol 2002 Feb;26(1):75-8
   

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"Don't forget to floss" -- it's the dentist's often-ignored advice, but new research indicates that for pregnant women, the development of their child may be at stake. In a study presented at the International Association for Dental Research by researchers with the University of North Carolina found that pregnant women with moderate-to-severe gum disease were at greater risk of delivering low birth weight babies.

   In looking at the periodontal exams of 850 pregnant women before their 26th week of pregnancy and then again within 48 hours of delivery, the researchers found that women with gum disease that was moderate to severe had rates of low birth weight and fetal growth restriction that were as much as six to 10 times higher than those with no gum disease.And even those with mild gum disease had some risk of fetal growth deficiencies

 

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Link Examined Between Gum Disease and Early Births

In a study of 1,313 pregnant women, researchers at the University of Alabama found that women with severe periodontal disease, in their second trimester of pregnancy tended to give birth anywhere from 3 to 8 weeks before their due dates!

It is advised that expectant mothers increase their level of oral hygiene and seek regular professional care during their pregnancies.

~Dentalnotes pg 3 Fall 2004
 "Periodontal Therapy May Reduce the Risk of Preterm Low Birth Weight in Women With Periodontal Disease: A Randomized Controlled Trial" by Lopez et al. J Periodontology 2002;73:911-924.  I think the results showed pre term low weight births were reduced 67% by having periodontal treatment before 28 weeks of gestation.
Dentistry Today April 2001 pg 41
*J.A.D.A.  Periodontal Infections and Preterm Birth, Vol. 132, July 2001 pg 875-880
**Oral Health During Pregnancy, Gaffield, Gilbert, Malvitz, Romaguera, JADA Vol 132, July 2001 pg 1009-1016.
^ Journal of Periodontology August 2002.

September 14, 2007

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Visit: The Mouth-Body Connection, Pregnancy by American Academy of Periodontology
MCN Am J Matern Child Nurs 2002 September/October;27(5):275-280
National Maternal and Child Oral Health Resources.

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