Effect of pregnancy on periodontal and dental health

Bi-directional relationship between pregnancy and periodontal disease

During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.

Massive pregnancy gingival enlargement: A rare case

Gingival enlargement related to pregnancy is sometimes seen in the oral cavity. Pregnancy is a physiological state that brings full of changes in a woman's life. The metabolism and immunology of the body are modified by progesterone and estrogen as well as other local factors, these sex hormones may modify the oral mucosa and may lead to various periodontal diseases. A case of female patient 23 yrs of age reported during 8^th month of pregnancy with a localised gingival enlargement affecting the buccal aspect of left maxillary central incisor upto canine. The hormonal changes occurring during pregnancy may be associated with generalized or localised gingival enlargement and the presence of local factors may accentuate the gingival response. Rarely the enlargement becomes maasive and protrude out extraorally.

Association between parity and dentition status among Japanese women: Japan public health center-based oral health study

BACKGROUND

Several studies have shown that parity is associated with oral health problems such as tooth loss and dental caries. In Japan, however, no studies have examined the association. The purpose of this study was to determine whether parity is related to dentition status, including the number of teeth present, dental caries and filled teeth, and the posterior occlusion, in a Japanese population by comparing women with men.

METHODS

A total of 1,211 subjects, who participated both in the Japan Public Health Center-Based (JPHC) Study Cohort I in 1990 and the dental survey in 2005, were used for the study. Information on parity or number of children was collected from a self-completed questionnaire administered in 1990 for the JPHC Study Cohort I, and health behaviors and clinical dentition status were obtained from the dental survey in 2005. The association between parity or number of children and dentition status was analyzed, by both unadjusted-for and adjusted-for socio-demographic and health behavioral factors, using a generalized linear regression model.

RESULTS

Parity is significantly related to the number of teeth present and n-FTUs (Functional Tooth Units of natural teeth), regardless of socio-demographic and health behavioral factors, in female subjects. The values of these variables had a significantly decreasing trend with the rise of parity: numbers of teeth present (p for trend = 0.046) and n-FTUs (p for trend = 0.026). No relationships between the number of children and dentition status were found in male subjects.

CONCLUSION

Higher-parity women are more likely to lose teeth, especially posterior occluding relations. These results suggest that measures to narrow the discrepancy by parity should be taken for promoting women's oral health. Delivery of appropriate information and messages to pregnant women as well as enlightenment of oral health professionals about dental management of pregnant women may be an effective strategy.

Periodontal disease awareness among pregnant women in the central and eastern regions of Saudi Arabia

AIM

The purpose of this study was to assess the knowledge and awareness regarding periodontal disease and its effects on pregnancy among pregnant women in the central and eastern regions of Saudi Arabia.

METHODS

In this cross-sectional survey, self-administered, structured questionnaires were distributed to 300 pregnant women who were chosen randomly from attendees of maternity health care centers in the central and eastern regions of Saudi Arabia. The questions were developed from literature reviews of articles. The questionnaire addressed personal and sociodemographic variables, periodontal health awareness, and knowledge of pregnant women. The questionnaire was translated into Arabic and was pretested during the pilot study on a random sample of 50 pregnant women. Data were analyzed by χ(2) -tests, with the level of significance set at P < 0.05.

RESULTS

An overall response rate of 81% was obtained. Approximately 53% had a higher level of education, but only 21% knew how to define dental plaque and 30% knew its harmful effects. Almost 73% stated that gum disease could be prevented through toothbrushing and flossing. Approximately 97% of the respondents knew the negative effect of smoking, while only 12% knew there was a possible relationship between periodontal disease and adverse pregnancy outcomes.

CONCLUSION

The results of this cross-sectional study found that there is limited knowledge and awareness about periodontal disease and its possible effects on pregnancy among pregnant women attending maternal health care centers in the central and eastern regions of Saudi Arabia.

Harmonious functional and aesthetic correction of severe localised pregnancy-induced gingival enlargement associated with capillary haemangioma

Gingival enlargement is a clinical condition that has been widely studied and is directly associated with specific local or systemic conditions. Pregnancy has been presented to increase susceptibility to gingival inflammation. Sex hormones are believed to be a risk factor for periodontitis because of their ability to proliferate specific periodontal microorganisms and affect host immunological response, but it is unclear whether pregnancy gingivitis exposes or proceeds to periodontitis. In this case report, the patient reported with severe localised enlarged gingival mass which initiated when she was pregnant. After parturition, gingival enlargement was persisting and causing functional and aesthetic problem. Enlargement did not resolve even after non-surgical therapy; therefore, surgical excision of the entire enlarged gingival mass was preformed. Histopathological examination revealed capillary haemangioma. No evidence of malignancy was seen. No recurrence was seen even after 2 years of follow-up.

Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome: a systematic review

OBJECTIVE

To confirm effectiveness of nonsurgical periodontal treatment during pregnancy on pregnancy outcome in terms of preterm birth and low birth weight (LBW).

METHOD

We searched for Randomized controlled trials in MEDLINE, CINAHL and EMBASE. from January 2000 to October 2012. References of included studies were hand searched. Studies which measured incidence of either preterm labor (PTL), LBW or both were included. Information on study design, population, risk of bias, periodontal parameters, time and type of periodontal treatment given and pregnancy outcome were abstracted independently by three reviewers.

RESULTS

Total thirteen studies were included. Five studies had low risk of bias. Conclusive results could not be obtained for incidence of PTL or LBW because of heterogeneity in results due to various reasons, but all studies which assessed PTL and LBW combined showed significant difference in incidence of same in group which received non surgical periodontal treatment.

CONCLUSION

Our study suggests that treatment of periodontitis during gestation improves pregnancy outcome in terms of PTLBW, a fact which may be used for health and economical benefits but better RCTs with adequate sample size are required for conclusive evidence.

Evaluation of socio-demographic variables affecting the periodontal health of pregnant women in Chandigarh, India

Background:

The literature is replete with reports that pregnant women have an increased level of periodontal disease as compared with non-pregnant women of the same age. There are many studies correlating the effect of periodontal disease on the adverse pregnancy outcomes. The development of periodontal diseases during pregnancy can be influenced by factors such as preexisting oral conditions, general health, and socio-cultural background. There is very little data studying the effect of socio-demographic factors on the periodontal health of pregnant women. This study evaluated the periodontal status of a sample of pregnant women of Chandigarh and adjoining areas. The study also investigated the relationship between these variables and a series of demographic and clinical variables.

Materials and Methods:

The participants were 190 pregnant women attending Gynecology and Obstetrics outpatient department of Government Medical College and Hospital, Chandigarh. The participants were examined for their periodontal health and various socio-demographic variables were recorded on performas designed for the purpose of study. Statistical analysis was done.

Results:

The results revealed that the mean bleeding index scores and probing depth increased with statistical significance when the socio-economic status was lower (P<0.05). No significant differences were found in bleeding index scores and mean probing depth among different categories of profession, education, place of residence, and trimester of pregnancy (P>0.1). The plaque index was not significantly associated with the socio-economic status, profession, place of residence, and trimester of pregnancy (P>0.1).

Conclusion:

In the population of pregnant women investigated under this study, the clinical and socio-demographic characteristics showed non-significant correlation except socio-economic status which showed statistically significant correlation with bleeding on probing and pocket depth. Further studies may be required in Indian population to determine the association of periodontal diseases in pregnant women with socio-demographic variables.

Effect of pregnancy on gingival inflammation in systemically healthy women: a systematic review

AIM

To obtain an overall quantitative estimate of the association between pregnancy and gingival inflammation.

MATERIAL AND METHODS

Medline and EMBASE databases were searched through August 2011. Prospective cohort or cross-sectional studies assessing the effect of pregnancy on gingival inflammation evaluated by the gingival index (GI) and/or bleeding on probing were included. Meta-analyses were performed if possible.

RESULTS

Forty-four articles representing 33 studies (14 cohort and 19 cross-sectional) were included. Meta-analyses, performed whenever possible, revealed (1) a significantly lower GI in pregnant women in the first term compared with those in their second or third term of pregnancy; (2) a lower mean GI score in post-partum women compared with women in their second [WMD = 0.143; 95% CI (0.031; 0.255); p = 0.012] or third term [WMD = 0.256; 95% CI (0.151; 0.360); p < 0.001] of pregnancy, when considering cohort studies; (3) Non-pregnant women had lower mean GI values than women in their second or third term of pregnancy. Small changes in plaque levels were reported.

CONCLUSION

Despite the limited number of studies included in the meta-analyses, the present systematic review confirms the existence of a significant increase in GI throughout pregnancy and between pregnant versus post-partum or non-pregnant women, without a concomitant increase in plaque levels.

Assessment of angiogenic markers and female sex hormone receptors in pregnancy tumor of the gingiva

PURPOSE

Oral pregnancy tumors (OPTs) arise on the inflamed gingiva of women after the first trimester of pregnancy. The expression of angiogenic markers and female hormone receptors was assessed.

MATERIALS AND METHODS

Immunohistochemistry was used to analyze the expression of estrogen and progesterone receptors and the expression of angiogenic factors, such as vascular endothelial growth factor (VEGF) and its receptor, fibroblast growth factor (FGF), and hypoxia inducible factors 1α and 3α (HIF1α and HIF3α). Experimental groups included 9 OPTs, 10 oral pyogenic granulomas from nonpregnant women of the same age, and 9 oral pyogenic granulomas from postmenopausal women.

RESULTS

VEGF expression in stromal histiocytes and endothelial cells of small vessels was positively correlated in the OPT group (P < .05 by χ(2) test). VEGF receptor also was overexpressed in stromal histiocytes and endothelial cells of OPTs compared with oral pyogenic granulomas from nonpregnant and postmenopausal women (P < .005 by χ(2) test). No correlation was detected among estrogen and progesterone receptors, FGF and HIF1α and HIF3α (ER and PgR respectively) in the 3 experimental groups.

CONCLUSIONS

VEGF-associated angiogenesis is most likely involved in the pathogenesis of the lesion. These results imply that local inhibition of VEGF activity could be an adjuvant therapeutic approach for OPTs to control hemorrhage, which can be massive at the surgical excision of such lesions during pregnancy.

Sex/Gender differences in tooth loss and edentulism: historical perspectives, biological factors, and sociologic reasons

This review highlights what is known regarding differences in tooth loss by sex/gender, and describes: gender-related tooth ablation (the deliberate removal of anterior teeth during life) found in skulls from history and prehistory; potential mediators of the relationship between sex/gender and tooth loss; the current epidemiology of gender differences in tooth loss (limited to North America); and risk factors for tooth loss in the general population and in women.

Oral health and dental care during pregnancy

Current research shows that women tend to receive less dental care than usual when they are pregnant. In 2012, the first national consensus statement on oral health care during pregnancy was issued, emphasizing both the importance and safety of routine dental care for pregnant women. This article reviews the current recommendations for perinatal oral health care and common oral manifestations during pregnancy. Periodontal disease and its association with preterm birth and low birth weight are also discussed, as is the role played by dental intervention in these adverse outcomes.

Discovering medical conditions associated with periodontitis using linked electronic health records

AIM

To use linked electronic medical and dental records to discover associations between periodontitis and medical conditions independent of a priori hypotheses.

MATERIALS AND METHODS

This case-control study included 2475 patients who underwent dental treatment at the College of Dental Medicine at Columbia University and medical treatment at NewYork-Presbyterian Hospital. Our cases are patients who received periodontal treatment and our controls are patients who received dental maintenance but no periodontal treatment. Chi-square analysis was performed for medical treatment codes and logistic regression was used to adjust for confounders.

RESULTS

Our method replicated several important periodontitis associations in a largely Hispanic population, including diabetes mellitus type I (OR = 1.6, 95% CI 1.30-1.99, p < 0.001) and type II (OR = 1.4, 95% CI 1.22-1.67, p < 0.001), hypertension (OR = 1.2, 95% CI 1.10-1.37, p < 0.001), hypercholesterolaemia (OR = 1.2, 95% CI 1.07-1.38, p = 0.004), hyperlipidaemia (OR = 1.2, 95% CI 1.06-1.43, p = 0.008) and conditions pertaining to pregnancy and childbirth (OR = 2.9, 95% CI: 1.32-7.21, p = 0.014). We also found a previously unreported association with benign prostatic hyperplasia (OR = 1.5, 95% CI 1.05-2.10, p = 0.026) after adjusting for age, gender, ethnicity, hypertension, diabetes, obesity, lipid and circulatory system conditions, alcohol and tobacco abuse.

CONCLUSIONS

This study contributes a high-throughput method for associating periodontitis with systemic diseases using linked electronic records.

Active and passive smoking and prevalence of periodontal disease in young Japanese women

BACKGROUND AND OBJECTIVE

Studies reporting on the association between smoking and periodontal disease have mostly focused on active smoking. The purpose of this study was to examine the relationships between active smoking and exposure to second-hand smoke at home and at work and the prevalence of periodontal disease among young Japanese women.

MATERIAL AND METHODS

Study subjects were 1167 postpartum women with a mean age of 31.5 years. Information on smoking and potential confounding factors was obtained through a self-administered questionnaire. Partial-mouth recording was used to determine probing pocket depth at six sites per tooth for six teeth in the mouth. Periodontal disease was defined as positive if a woman had at least one tooth with a probing pocket depth of 3.5 mm or deeper. Adjustment was made for age, region of residence, household income, education, toothbrushing frequency and use of an interdental brush.

RESULTS

Compared with never smoking, ever smoking was independently positively associated with the prevalence of periodontal disease: the adjusted odds ratio was 1.56 (95% confidence interval: 1.02-2.36). There was a marginally significant positive dose-response relationship between pack-years of smoking and the prevalence of periodontal disease (p for linear trend = 0.08). No material associations were observed between second-hand smoke exposure at home or at work and periodontal disease.

CONCLUSION

Our findings suggest that active smoking, but not passive smoking, might be associated with an increased prevalence of periodontal disease among young women in Japan.

Comparison of aerobic conjunctival bacterial flora in pregnant, reproductive-aged and postmenopausal women

AIM

To evaluate the effect of hormonal status on aerobic conjunctival flora in women.

METHODS

One hundred fifty-eight women [reproductive-aged (n=55), pregnant (n=51), and postmenopausal (n=52)] who admitted to outpatient clinic of Obstetrics and Gynecology Department of Denizli State Hospital were enrolled. Age, body-mass index (BMI), obstetric history, cigarette smoking, drug usage, presence of systemic disease, and intraocular pressure (IOP) were recorded for each patient. The samples were taken from the lower fornix with two culture swabs and directly incubated in culture containing 5% sheep blood, eosin-methylene blue and chocolate agar. The other swab specimen was Gram stained. All growths and microscopic results were analyzed.

RESULTS

The coagulase-negative Staphylococcus was the predominant organism isolated in the conjunctival samples in both three groups. The aerobic microorganism growth rate for all isolated aerobic organisms revealed no significant change in the three groups (P >0.05). The conjunctival culture positivity rates were similar in the three groups (49% in reproductive-aged, 57% in pregnant and 58% in postmenopausal women) (P >0.05). Age, IOP, BMI, gravidity, parity, cigarette smoking, drug usage, and presence of systemic diseases did not have an effect on culture positivity in three groups.

CONCLUSION

Results of this study showed that conjunctival aerobic flora and bacterial colonization did not differ between reproductive-aged, pregnant and postmenopausal women.

Expression of IL-1β, IL-6, TNF-α, and iNOS in pregnant women with periodontal disease

Periodontal disease is one of the most prevalent oral diseases. An association between this disease and pregnancy has been suggested, but available findings are controversial. We evaluated the expression levels of interleukins (IL-1β and IL-6), tumor necrosis factor-alpha (TNF-α), and inducible nitric oxide synthase (iNOS) in pregnant women with and without periodontal disease in comparison with non-pregnant women with and without periodontal disease since studies have suggested a relationship between periodontitis and the expression levels of these genes. The women in the sample were distributed into four groups: pregnant and non-pregnant women, with or without periodontal disease, a total of 32 women. The periodontal condition was evaluated according to the probing depth, clinical attachment level and bleeding on probing. Analysis of gene expression was performed by real-time PCR. Comparisons were made of the level of gene expression among the four groups. Expression of IL-1β in the non-pregnant women with periodontal disease was 12.6 times higher than in the non-pregnant women without periodontal disease (P < 0.01), while expression of TNF-α in the non-pregnant women without periodontal disease was 3.5 times higher than in the pregnant women with periodontal disease (P < 0.05). Despite these differences, our overall findings indicate no differences in the expression levels of the cytokines IL-1β, IL-6, TNF-α, and iNOS in pregnant women with and without periodontal disease in comparison with expression of the same genes in non-pregnant women with and without periodontal disease, suggesting that periodontal disease is not influenced by pregnancy.

The activity of salivary aldehyde dehydrogenase during the menstrual cycle and pregnancy

OBJECTIVE

The aim of the present study was to describe the changes in the activity of ALDH3A1 in saliva in relation to the menstrual cycle and pregnancy. We also measured major salivary antioxidants, salivary peroxidase (SPO) activity and uric acid (UA) concentration.

DESIGN

Fasting saliva samples were collected from 63 women with uncomplicated pregnancies and from 39 healthy women of reproductive age, but not pregnant. Saliva samples were also collected from 10 healthy women with regular menstrual cycles in the early follicular, the mid-cycle and the mid-luteal phase during one menstrual cycle. SPO and ALDH3A1 activity was determined fluorimetrically, whereas UA concentration photometrically.

RESULTS

The ALDH3A1 did not vary significantly among phases of menstrual cycle. However, the enzyme activity decreased with the length of pregnancy and in the third trimester is significantly lower than that in the saliva of non-pregnant women.

CONCLUSIONS

Lower concentration of UA and in the third trimester the activity of ALDH3A1 in saliva of pregnant women could be a risk factor of, e.g. oral pathologies.

V, Vanitha B. Variations in the oral anaerobic microbial flora in relation to pregnancy

INTRODUCTION

Pregnancy gingivitis is a major oral infection. Periodontium acts as a reservoir of inflammatory mediators and sub gingival biofilms of bacteria.

AIM

To evaluate the anaerobic oral microbial flora in pregnant women before delivery and after delivery by comparing them with control group.

MATERIAL AND METHODS

The study group included fifteen cases of pregnant women before and after delivery and healthy non-pregnant women of same age as control group. Sub gingival plaque samples were collected with the help of dentists. The samples were inoculated immediately into Thioglycollate broth (MV010), transported to the laboratory, inoculated on to selective media for anaerobes (Hi-media laboratories) incubated anaerobically (Gas pack).

RESULTS

Prevotella, Tanerella forsythia, Porphyromonas gingivalis and Fusobacterium nucleatum, Veillonella, Peptostreptococcus were isolated.

DISCUSSION

The anaerobic bacteria in pregnant women were Prevotella, Tanerella forsythia and Porphyromonas gingivalis. Viellonella and Peptostreptococcus were seen in control group and after delivery. Research suggests that periodontal pathogens may travel the blood stream from the oral cavity to the placenta.

CONCLUSION

Pregnancy has significant effect on periodontal tissue. There is a significant alteration of bacterial flora during and after pregnancy. Oral health has to become a part of antenatal care /check up.

Dental neglect and adverse birth outcomes: a validation and observational study

OBJECTIVES

The objectives of this study were to validate the Indian translation of the Dental Neglect Scale (DNS) among a sample of parturient Indian women and to investigate dental neglect as a possible risk indicator in adverse birth outcomes.

SUBJECTS AND METHODS

Three hundred and sixteen parturient women were administered the DNS and the Modified Dental Beliefs Scale (MDBS) and were also clinically examined for oral health status. Information regarding socio-economic status, weeks of gestation and birth weight was also collected. A gestation period of less than 37 weeks was considered as preterm and a birth weight of less than 2500 gm as 'low birth weight'.

RESULTS

The Indian version of the DNS was found to be reliable (Cronbach's Alpha = 0.72) and valid for assessing dental neglect among the women. Factor analysis of the DNS revealed a two-factor structure accounting for 56% variance. Dental neglect was higher among those with poorer oral health status, lower socio-economic and educational status. Multinomial logistic regression showed high dental neglect and negative dental beliefs and not poor oral health, as significant risk indicators for occurrence of adverse birth outcomes.

CONCLUSION

The finding of an association of adverse birth outcomes with dental neglect and beliefs, but not with poor oral health could be due to the influence of other more important general factors which had a direct bearing on birth outcomes. There is a need for further research to assess the role of behavioural factors like dental neglect as risk indicators for adverse birth outcomes.

Change of periodontal disease status during and after pregnancy

BACKGROUND

This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy.

METHODS

A follow-up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty-nine females who were previously enrolled in a case-control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status.

RESULTS

Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy.

CONCLUSIONS

Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.

Interventions with vitamins B6, B12 and C in pregnancy

The water-soluble vitamins B6, B12 and C play important roles in maternal health as well as fetal development and physiology during gestation. This systematic review evaluates the risks and benefits of interventions with vitamins B6, B12 and C during pregnancy on maternal, neonatal and child health and nutrition outcomes. Relevant publications were identified by searching PubMed, Popline and Web of Science databases. Meta-analyses were conducted for outcomes where results from at least three controlled trials were available. Potential benefits of vitamin B6 supplementation were reduction in nausea and vomiting, improvement in dental health, and treatment of some cases of anaemia. In meta-analysis based on three small studies, vitamin B6 supplementation had a significant positive effect on birthweight (d = 217 g [95% confidence interval (CI) 130, 304]). Interventions with vitamin C alone or combined with vitamin E did not systematically reduce the incidence of pre-eclampsia, premature rupture of membranes, or other adverse pregnancy outcomes. In meta-analyses, vitamins C and E increased the risk of pregnancy-related hypertension (relative risk 1.10 [95% CI 1.02, 1.19]). Effects of vitamin B6 or C intervention on other neonatal outcomes, including preterm birth, low birthweight, and perinatal morbidity and mortality, were not significant. Data on child health outcomes were lacking. Despite the prevalence of vitamin B12 deficiency amongst populations with limited intake of animal source foods, no intervention trials have evaluated vitamin B12 supplementation before or during pregnancy. In conclusion, existing evidence does not justify vitamin C supplementation during pregnancy. Additional studies are needed to confirm positive effects of vitamin B6 supplementation on infant birthweight and other outcomes. While vitamin B12 supplementation may reduce the incidence of neural tube defects in the offspring based on theoretical considerations, research is needed to support this hypothesis.

Association between early preterm birth and periodontitis according to USA and European consensus definitions

OBJECTIVE

Prospective case-control study assessing the association between maternal periodontitis according to the recently issued USA and European consensus definitions and early preterm delivery (<35 weeks gestation). Cases were women delivering between 22 and 34(6/7) weeks of gestation (n = 84) and controls were women delivering at term (≥ 37 weeks) (n = 345).

METHODS

Periodontal examination at the immediate postpartum period identified periodontitis according to both consensus definitions. A multivariate logistic model was used to assess the association between early preterm delivery and the presence of periodontitis adjusted for confounders.

RESULTS

All women had periodontitis by the European consensus definitions. When using the USA definitions, more cases had severe periodontitis than controls (34.5% vs. 17.72%); p = 0.003. After adjustment for main confounders, the association between severe (OR: 2.38; 95% CI: 1.36-4.14) periodontitis and early preterm delivery persisted. The only other independent factor associated with early preterm delivery was vaginal bleeding during pregnancy.

CONCLUSIONS

Early preterm delivery is associated with periodontitis when the USA consensus definitions are used. The European definitions revealed inadequate for the study population because of the lack of discrimination power.

Frequency and risk indicators of tooth decay among pregnant women in France: a cross-sectional analysis

INTRODUCTION

Little is known on the prevalence of tooth decay among pregnant women. Better knowledge of tooth decay risk indicators during pregnancy could help to develop follow-up protocols for women at risk, along with better prevention strategies. The aim of this study was to assess the frequency of tooth decay and the number of decayed teeth per woman in a large sample of pregnant women in France, and to study associated risk indicators.

METHODS

A secondary cross-sectional analysis of data from a French multicentre case-control study was performed. The sample was composed of 1094 at-term women of six maternity units. A dental examination was carried out within 2 to 4 days post-partum. Socio-demographic and behavioural characteristics were obtained through a standardised interview with the women. Medical characteristics were obtained from the women's medical records. Risk indicators associated with tooth decay were identified using a negative binomial hurdle model.

RESULTS

51.6% of the women had tooth decay. The mean number of decayed teeth among women having at least one was 3.1 (s.d. = 2.8). Having tooth decay was statistically associated with lower age (aOR = 1.58, 95%CI [1.03,2.45]), lower educational level (aOR = 1.53, 95%CI [1.06,2.23]) and dental plaque (aOR = 1.75, 95%CI [1.27,2.41]). The number of decayed teeth was associated with the same risk indicators and with non-French nationality and inadequate prenatal care.

DISCUSSION

The frequency of tooth decay and the number of decayed teeth among pregnant women were high. Oral health promotion programmes must continue to inform women and care providers about the importance of dental care before, during and after pregnancy. Future research should also assess the effectiveness of public policies related to oral health in target populations of pregnant women facing challenging social or economic situations.

Factors associated with the prevalence of periodontal disease in low-risk pregnant women

Objective

To evaluate the prevalence of periodontal disease (PD) among Brazilian low-risk pregnant women and its association with sociodemographic factors, habits and oral hygiene.

Method

This cross-sectional study included 334 low-risk pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. Independent variables were: age, race/color, schooling, marital status, parity, gestational age, smoking habit, alcohol and drugs consumption, use of medication, presence of any systemic diseases and BMI (body mass index). Statistical analyses provided prevalence ratios and their respective 95%CI and also a multivariate analysis.

Results

The prevalence of PD was 47% and significantly associated with higher gestational age (PR 1.40; 1.01 - 1.94 for 17-24 weeks and PR 1.52; 1.10 - 2.08 for 25-32 weeks), maternal age 25-29 years, obesity (PR 1.65; 1.02 - 2.68) and the presence of gingival bleeding on probing (OR_adj 2.01, 95%CI 1.41 - 2.88). Poor oral hygiene was associated with PD by the mean values of plaque and bleeding on probing indexes significantly greater in PD group.

Conclusions

The prevalence of PD is high and associated with gingival bleeding on probing, more advanced gestational age and obesity. A program of oral health care should be included in prenatal care for early pregnancy, especially for low-income populations.

Periodontitis-associated risk factors in pregnant women

OBJECTIVE

The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women.

METHODS

This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth ≥ 4 mm and an attachment loss ≥ 3 mm at the same site in four or more teeth. A logistic regression analysis was also performed.

RESULTS

The prevalence of periodontitis in this sample was 11%. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque.

CONCLUSION

The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene.

Self-reported oral health and hygiene habits, dental decay, and periodontal condition among pregnant European women

OBJECTIVE

To investigate the relationship among self-reported oral hygiene habits, dental decay, and periodontal condition among pregnant women.

METHOD

In a cross-sectional study, a structured questionnaire and dental examination were used to assess pregnant women's knowledge of oral health and attitudes to oral hygiene, in addition to their dental and periodontal condition. Data were collected from 337 pregnant women living in Murcia in southeast Spain.

RESULTS

The questionnaire was completed by 337 women, 282 of whom also had an oral examination. More than 57% were in their first pregnancy, their mean age was 30 years, and most (80.1%) were Spanish with a medium-high educational level. Most of the pregnant woman (84%) brushed their teeth 2 or 3 times a day, and a third (30.9%) used a mouthwash daily. The pregnant women who self-reported having good or very good dental health had a lower level of active decay (P < 0.001) and a lower periodontal index (P < 0.001).

CONCLUSION

In the present study, there was a significant correlation between a high level of self-reported oral health in pregnant women and low levels of dental decay and low periodontal indexes.

Periodontal diseases as an emerging potential risk factor for adverse pregnancy outcomes: A review of concepts

Preterm birth is the leading perinatal problem with subsequent morbidity and mortality in developed as well as developing nations. Among the various possible environmental, genetic, demographic, psychosocial and obstetric risk factors responsible for premature labor, poor oral health with periodontal infection has also emerged as a potential and modifiable risk factor for preterm low birth weight babies. The infected periodontium is regarded as a reservoir for periodontopathic bacteria, mainly gram negative anaerobes that serve as a source of endotoxins and lipopolysaccharides, proinflammatory cytokines and prostaglandins that enhance uterine muscle contraction leading to preterm low birth weight. Also, the progression of periodontal disease during pregnancy appears to increase the fetal growth restriction, irrespective of baseline periodontal disease status. Thus, identification and treatment of periodontal disease should be considered an important intervention strategy as a part of prenatal care to reduce adverse pregnancy outcomes.

Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis

OBJECTIVE

To examine whether treatment of periodontal disease with scaling and root planing during pregnancy is associated with a reduction in the preterm birth rate.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

Cochrane Central Trials Registry, ISI Web of Science, Medline, and reference lists of relevant studies to July 2010; hand searches in key journals.

STUDY SELECTION

Randomised controlled trials including pregnant women with documented periodontal disease randomised to either treatment with scaling and root planing or no treatment.

DATA EXTRACTION

Data were extracted by two independent investigators, and a consensus was reached with the involvement a third. Methodological quality of the studies was assessed with the Cochrane's risk of bias tool, and trials were considered either high or low quality. The primary outcome was preterm birth (<37 weeks). Secondary outcomes were low birthweight infants (<2500 g), spontaneous abortions/stillbirths, and overall adverse pregnancy outcome (preterm birth <37 weeks and spontaneous abortions/stillbirths).

RESULTS

11 trials (with 6558 women) were included. Five trials were considered to be of high methodological quality (low risk of bias), whereas the rest were low quality (high or unclear risk of bias). Results among low and high quality trials were consistently diverse; low quality trials supported a beneficial effect of treatment, and high quality trials provided clear evidence that no such effect exists. Among high quality studies, treatment had no significant effect on the overall rate of preterm birth (odds ratio 1.15, 95% confidence interval 0.95 to 1.40; P=0.15). Furthermore, treatment did not reduce the rate of low birthweight infants (odds ratio 1.07, 0.85 to 1.36; P=0.55), spontaneous abortions/stillbirths (0.79, 0.51 to 1.22; P=0.28), or overall adverse pregnancy outcome (preterm births <37 weeks and spontaneous abortions/stillbirths) (1.09, 0.91 to 1.30; P=0.34).

CONCLUSION

Treatment of periodontal disease with scaling and root planing cannot be considered to be an efficient way of reducing the incidence of preterm birth. Women may be advised to have periodical dental examinations during pregnancy to test their dental status and may have treatment for periodontal disease. However, they should be told that such treatment during pregnancy is unlikely to reduce the risk of preterm birth or low birthweight infants.

Relation of salivary antioxidant status and cytokine levels to clinical parameters of oral health in pregnant women with diabetes

OBJECTIVE

Both pregnancy and diabetes are thought to predispose to the impairment of oral health. As saliva contributes to oral homeostasis, we have characterised its properties and flow rate in pregnant women with or without diabetes.

DESIGN

Unstimulated whole mixed saliva was collected from 63 women in the first trimester of pregnancy and analysed for the concentration of selected antioxidants, cytokines, and growth factors.

RESULTS

Pregnant women with diabetes were found to have markedly increased indexes of caries activity, plaque formation, gingival and periodontal status, as well as increased salivary antioxidant capacity and pro-inflammatory cytokine levels. These changes were more pronounced in patients with long-term disease and systemic diabetic complications, but only partly correlated with the level of blood glycated haemoglobin. Of the cytokines examined, salivary VEGF and HGF concentrations in diabetic pregnant women correlated in a positive and negative manner, respectively, with the prevalence of caries. Moreover, VEGF levels in this group correlated inversely with the probing depth and clinical attachment levels. All such associations did not occur in healthy individuals. In contrast, the salivary pH and flow rate correlated inversely with several parameters of caries and plaque formation irrespectively of whether the pregnant women were diabetic or not.

CONCLUSIONS

Diabetes in pregnant women significantly changes saliva properties, which may contribute to accelerated deterioration of the oral status in this population.

Most pregnant women in California do not receive dental care: findings from a population-based study

OBJECTIVES

We examined the prevalence of dental care during pregnancy and reasons for lack of care.

METHODS

Using a population-based survey of 21,732 postpartum women in California during 2002-2007, we calculated prevalence of dental problems, receipt of care, and reasons for non-receipt of care. We used logistic regression to estimate odds of non-receipt of care by maternal characteristics.

RESULTS

Overall, 65% of women had no dental visit during pregnancy; 52% reported a dental problem prenatally, with 62% of those women not receiving care. After adjustment, factors associated with non-receipt of care included non-European American race/ethnicity, lack of a college degree, lack of private prenatal insurance, no first-trimester prenatal insurance coverage, lower income, language other than English spoken at home, and no usual source of pre-pregnancy medical care. The primary reason stated for non-receipt of dental care was lack of perceived need, followed by financial barriers.

CONCLUSIONS

Most pregnant women in this study received insufficient dental care. Odds were elevated not only among the poorest, least educated mothers, but also among those with moderate incomes or some college education. The need for dental care during pregnancy must be promoted widely among both the public and providers, and financial barriers to dental care should be addressed.

Parity & untreated dental caries in US women

While parity (number of children) reportedly is related to tooth loss, the relationship between parity and dental caries has not been extensively investigated. We used path analysis to test a theoretical model that specified that parity influences dental caries levels through dental care, psycho- social factors, and dental health damaging behaviors in 2635 women selected from the NHANES III dataset. We found that while increased parity was not associated with a greater level of total caries (DFS), parity was related to untreated dental caries (DS). The mechanisms by which parity is related to caries, however, remain undefined. Further investigation is warranted to determine if disparities in dental caries among women are due to differences in parity and the likely changes that parallel these reproductive choices.

Periodontal disease, oxidative stress, and risk for preeclampsia

BACKGROUND

Maternal periodontal infection is associated with an increased risk for preeclampsia. Periodontal infection is also associated with increased oxidative stress. Our objective was to determine the relationship among maternal periodontal disease, maternal oxidative stress, and the development of preeclampsia.

METHODS

A secondary analysis of prospectively collected data from the Oral Conditions and Pregnancy Study was performed. A cohort of healthy women enrolled at <26 weeks of gestation underwent an oral examination, serum sampling, and delivery follow-up. A periodontal infection was categorized by clinical parameters as healthy or mild or moderate/severe periodontal infection. Preeclampsia was defined by the American Congress of Obstetricians and Gynecologists criteria as blood pressure >140/90 mmHg and >or=1+ proteinuria on a catheterized specimen. Maternal blood was assayed for 8-isoprostane concentrations using an enzyme-linked immunosorbent assay and stratified as elevated (>or=75th percentile) or not elevated (<75th percentile). Odds ratios (ORs) for preeclampsia were calculated and stratified by periodontal disease and the level of 8-isoprostane concentration.

RESULTS

A total of 34 (4.3%) of 791 women developed preeclampsia. Women with an 8-isoprostane concentration >or=75th percentile at enrollment were more likely to develop preeclampsia compared to women with an 8-isoprostane concentration <75th percentile (38.2% versus 24.4%, respectively; P = 0.07; OR: 1.91; 95% confidence interval [CI]: 0.94 to 3.90). Among women with moderate/severe periodontal disease, an elevated 8-isoprostane concentration (>or=75th percentile) did not significantly increase the likelihood for preeclampsia (adjusted OR: 2.08; 95% CI: 0.65 to 6.60).

CONCLUSIONS

Women with oxidative stress early in pregnancy, as measured by an 8-isoprostane concentration >or=75th percentile, were at an increased risk for developing preeclampsia. The presence of periodontal disease did not appear to modify this risk.

Women's attitudes to and perceptions of oral health and dental care during pregnancy

AIMS

To assess pregnant women's opinions on and perceptions of oral health and their relationship to oral hygiene and dental care practices.

METHODS

Questionnaire survey on perceived oral health, oral hygiene and utilization of dental services among 649 nulliparae attending for antenatal care at all public antenatal clinics in Adelaide, South Australia.

RESULTS

Women rated their general health significantly better than their oral health (P<0.001) and attributed more importance to healthy teeth for their baby than for themselves (P<0.001). Only 35% had dental care during pregnancy; 35% had no dental visit for at least two years and 27% reported cost as a major deterrent. Eighteen percent had experienced gingival bleeding before pregnancy and 41% during pregnancy. Gingival bleeding outside pregnancy was clearly related to perceived oral health (P<0.001), but this was less so for bleeding during pregnancy. The latter was not related to age, level of education, employment, marital status, or smoking habits. Only 38% of women with gingival bleeding in pregnancy had a dental care visit in pregnancy and 28% considered their oral health as very good.

CONCLUSIONS

Many pregnant women do not perceive gingival bleeding as indicating inflammatory disease and seek no professional help for it. Maternity care providers need to devote more attention to oral health in antenatal clinics and antenatal education.

Factors associated with dental visit and barriers to utilisation of oral health care services in a sample of antenatal mothers in Hospital Universiti Sains Malaysia

BACKGROUND

The aims of this study were to determine factors associated with dental visit and to describe barriers to utilisation of oral health care services among antenatal mothers attending the Obstetric and Gynaecology Specialist clinic in Hospital Universiti Sains Malaysia.

METHODS

A structured, self-administered questionnaire was used obtain information on the variables of interest pertaining to the current pregnancy from 124 antenatal mothers.

RESULTS

The majority of the mothers claimed that their oral health status was good (67.0%) or very good (2.4%). On the contrary, most of them admitted of having had at least one oral health problem (59.7%) including cavitated (43.5%) and painful teeth (15.3%), bleeding gum (21.0%), and bad breath (10.5%). However, only 29% of the mothers visited dentist during the current pregnancy. Factors associated with the mothers' dental visit were exposure to oral health education before the pregnancy and awareness of relationship between poor maternal oral health and adverse pregnancy outcomes with odds ratio of 4.06 (95% CI: 1.67-9.78) and 3.57 (95% CI: 1.30-9.77) respectively. Common excuses given by most mothers include perceptions of not having any oral health problems (65.9%), long waiting time at the clinic (71.6%), and no immediate treatment given by the dentist (64.8%).

CONCLUSIONS

Utilisation of oral health care services among antenatal mothers was low. Mothers who reported dental visit were more likely to be those who had received oral health education before the current pregnancy and knew of the association between poor maternal oral health and adverse pregnancy outcomes. Dissatisfaction with the services rendered and perceptions of not having any oral health problems were the main barriers.

Factors associated with dental visit and barriers to utilisation of oral health care services in a sample of antenatal mothers in Hospital Universiti Sains Malaysia

BACKGROUND

The aims of this study were to determine factors associated with dental visit and to describe barriers to utilisation of oral health care services among antenatal mothers attending the Obstetric and Gynaecology Specialist clinic in Hospital Universiti Sains Malaysia.

METHODS

A structured, self-administered questionnaire was used obtain information on the variables of interest pertaining to the current pregnancy from 124 antenatal mothers.

RESULTS

The majority of the mothers claimed that their oral health status was good (67.0%) or very good (2.4%). On the contrary, most of them admitted of having had at least one oral health problem (59.7%) including cavitated (43.5%) and painful teeth (15.3%), bleeding gum (21.0%), and bad breath (10.5%). However, only 29% of the mothers visited dentist during the current pregnancy. Factors associated with the mothers' dental visit were exposure to oral health education before the pregnancy and awareness of relationship between poor maternal oral health and adverse pregnancy outcomes with odds ratio of 4.06 (95% CI: 1.67-9.78) and 3.57 (95% CI: 1.30-9.77) respectively. Common excuses given by most mothers include perceptions of not having any oral health problems (65.9%), long waiting time at the clinic (71.6%), and no immediate treatment given by the dentist (64.8%).

CONCLUSIONS

Utilisation of oral health care services among antenatal mothers was low. Mothers who reported dental visit were more likely to be those who had received oral health education before the current pregnancy and knew of the association between poor maternal oral health and adverse pregnancy outcomes. Dissatisfaction with the services rendered and perceptions of not having any oral health problems were the main barriers.

Oral health among antenatal care attendees in Calabar, Nigeria

The objective of this study is to determine the oral health habits, awareness, oral health education and treatment needs among pregnant women who attend the antenatal clinics at the University of Calabar Teaching Hospital, Calabar, Nigeria. A total of 252 women at different stages of pregnancy responded to an interviewer-administered structured questionnaire. Of those, 238 (94.4%) of the respondents used toothbrush and toothpaste for oral cleaning, while 12 (4.8%) used a combination of toothbrush/toothpaste and local chewing sticks. Two (0.8%) adhered to the use of chewing sticks only. A total of 34 (13.5%) respondents were aware of and used dental services while pregnant; 18 (52.9%) of those who presented with dental complaints during pregnancy had bleeding gums. Based on the level of awareness of the need to attend a dental clinic during pregnancy (26.2%) and the percentage of respondents willing to have a dental examination during pregnancy (83.3%), it is recommended that oral health education be incorporated into the antenatal counselling of pregnant women in Nigeria.

Introduction of agriculture and its effects on women's oral health

This study explores the dynamic relationship between the introduction of agriculture and its effects on women's oral health by testing the hypothesis that female reproductive physiology contributes to an oral environment more susceptible to chronic oral disease and that, in a population undergoing the foraging to farming transition, females will exhibit a higher prevalence of oral pathology than males. This is tested by comparing the presence, location, and severity of caries lesions and antemortem tooth loss across groups of reproductive aged and postreproductive females (n = 71) against corresponding groups of males (n = 71) in an Early Agricultural period (1600 B.C.-A.D. 200) skeletal sample from northwest Mexico. Caries rates did not differ by sex across age groups in the sample; however, females were found to exhibit significantly more antemortem tooth loss than males (P > 0.01). Differences were initially minimal but increased by age cohort until postreproductive females experienced a considerable amount of tooth loss, during a life stage when the accumulation of bodily insults likely contributed to dental exfoliation. Higher caries rates in females are often cited as the result of gender differences and dietary disparities in agricultural communities. In an early farming community, with diets being relatively equal, women were found to experience similar caries expression but greater tooth loss. We believe this differential pattern of oral pathology provides new evidence in support of the interpretation that women's oral health is impacted by effects relating to reproductive biology.

Periodontal disease is associated with gestational diabetes mellitus: a case-control study

BACKGROUND

Few studies have specifically examined the relationship between periodontal disease and gestational diabetes mellitus (GDM). The objective of this study was to examine whether maternal periodontal disease is associated with GDM.

METHODS

A case-control study was conducted of 53 pregnant women with GDM and 106 pregnant women without GDM at Woman's Hospital, Baton Rouge, Louisiana. The periodontal examinations were performed by a calibrated dentist who was masked to the diabetic status of the pregnant women. Periodontitis was defined as the presence of any site with a probing depth (PD) >or=4 mm or a clinical attachment loss (AL) >or=4 mm. The severity of periodontal disease was measured in quartiles of PD and clinical AL. Univariable analysis and multivariable logistic regression were used to examine the relationships between periodontal disease and GDM.

RESULTS

The percentage of periodontitis was 77.4% in women with GDM and 57.5% in women without GDM, with an odds ratio (OR) of 2.5 and a 95% confidence interval (CI) of 1.2 to 5.3. After adjusting for confounding variables of maternal age, parity, race, marital status, education, family income, smoking, alcohol consumption, systemic antibiotics during pregnancy, family history of diabetes, income, dental insurance coverage, and body mass index, the adjusted OR (95% CI) was 2.6 (1.1 to 6.1). The adjusted ORs (95% CIs) of GDM comparing the highest-to-lowest quartiles of PD and clinical AL were 3.8 (1.0 to 14.0) and 4.5 (1.2 to 16.9).

CONCLUSION

This study supports the hypothesis of an association between periodontal disease and GDM.