with gum disease have six times greater risk of delivering preterm, low-birth-weight
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
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
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
pregnancy affect my oral health?
Most women will
experience some form of gingivitis, which tends to surface most
frequently in the second trimester~:
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;
swollen, red gums
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
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.
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.
is most common during the second to eighth months of pregnancy.
gingivitis affect my
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
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.
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.
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.
You can prevent gingivitis by keeping your teeth clean, especially near your
your teeth at least twice a day and after meals when possible.
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
brushing your teeth causes morning sickness, rinse your mouth with water,
brush without toothpaste and follow with anti-plaque fluoride mouthwash.
a well-balanced diet with plenty of vitamin C
you dentist for help in controlling
plaque and preventing gingivitis. Also schedule routine
exams and cleaning to maintain good dental
Remember, the healthier your mouth is, the healthier and happier your
pregnancy and baby will be.
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
Linked to Preeclampsia
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.
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".
February 13, 2006.
2. Contreras A, Herrera JA, Soto JE, et al. Periodontitis isassociated
with preeclampsia in pregnant women. Journal ofPeriodontology 2006;
Presented Today Provides Further Evidence on the Importance of Good Oral
Health in Pregnant Women
Periodontal Disease and Preterm Birth
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
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,
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
Perio & preterm
Why chronic periodontitis may induce an inflammatory
response with premature pregnancy termination is unclear. This
study studied amniotic fluid cytokines and periodontitis variables in
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
Periodontal disease as
a risk factor for adverse pregnancy outcomes.
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
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.
|Premature (or preterm) babies
are born too soon - before 37 completed weeks of gestation.
|In 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.
|The rate of preterm birth
increased 27% between 1981 and 2001 from 9.4% to 11.9%.
|On an average day in the U.S.,
1,305 babies are born preterm (before 37 weeks), 213 are born very
preterm (before 32 weeks).
|Women with periodontal disease
are at three to five times greater risk of preterm birth than those
who are periodontally healthy.
|Among racial/ethnic subgroups,
preterm birth rates were highest among infants born to black mothers
(17.5%) in 2001.
|Major risk factors associated
with increasing rates of preterm delivery include multiple births,
advanced maternal age, induced deliveries and additional factors as
|Preterm labor/delivery is the
number one obstetrical challenge in the U.S.
|In 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.
|Preterm 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.
|Causes of nearly half of all
preterm births are unknown.
|Preterm labor can happen to any
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.
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
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
status of pregnant women and its relationship with socio-demographic and
D. Q. Taani et al Journal of Oral
Rehabilitation Volume 30 Issue 4 Page 440 - April 2003
treatment can reduce risk of some pregnancy complications.
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
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
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
"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,
Examined Between Gum Disease and Early Births
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!
is advised that expectant mothers increase their level of oral hygiene
and seek regular professional care during their pregnancies.
~Dentalnotes pg 3 Fall
"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
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
Mouth-Body Connection, Pregnancy by American
Academy of Periodontology
MCN Am J Matern Child Nurs 2002
Maternal and Child Oral Health Resources.
Dental Health Needs Women's Health Index