Effect of pregnancy on periodontal and dental health

Multicenter Cross-Sectional Study of Oral Health and Hygiene Practices Among Pregnant Women

Background: Hormonal, vascular, and behavioral changes during pregnancy can negatively impact a woman's oral health, resulting in conditions such as gingivitis, dental sensitivity, and caries. Although oral health is critical during pregnancy, it remains frequently overlooked. In this study, the oral health status and hygiene practices of pregnant women attending two university hospitals in southern Italy were evaluated. Methods: A cross-sectional cohort study was conducted with 72 pregnant women. Data were collected through an anonymous questionnaire that evaluated oral hygiene habits, dental visits, and oral pathologies, followed by a clinical examination. The examination included the assessment of the Decayed, Missing, Filled Teeth (DMFT) index and the Oral Hygiene Index (OHI) scores. Results: Among the participants, 61% were in their 9th month of pregnancy. The mean DMFT score was 7.9, and the mean OHI score was 3.6. Only 19.4% of participants had visited a dentist in the past 6 months, while 97.2% reported brushing their teeth just once per day. Gingival bleeding was reported by 72.2% of the women, and 38.9% experienced dental sensitivity, with both conditions worsening during pregnancy. Conclusions: The need for greater oral hygiene education and regular dental care during pregnancy is highlighted in this study. Integrating oral health maintenance into prenatal care programs is essential for preventing pregnancy-related oral diseases and promoting maternal and fetal well-being.

Are educational tools in oral health programs for pregnant women effective in improving the oral status of mothers and babies? A systematic review

OBJECTIVE

To analyze, through a systematic review, the effectiveness of educational tools (ETs) in Oral Health Programs (OHPs) for pregnant women in improving their oral status and that of their babies.

METHOD

Searches were carried out in 5 electronic databases. Randomized (RCTs) and non-randomized clinical trials (CTs) were selected that included pregnant women exposed or not to ETs in OHPs, whose oral health status, in the pre- or postnatal period, or of their babies were verified. The types of ETs, outcomes, and results were extracted. Bias risk was assessed by ROBINS-I and RoB 2.0; and the certainty of the evidence (CE) by GRADE.

RESULTS

A total of nine studies were included. Most used more than one ET (n = 8), with verbal guidance used in all (n = 9). Mothers showed a reduction in biofilm (n = 3), caries (n = 4) and periodontitis (n = 4). All studies with babies (n = 3) were successful in preventing caries. RCTs (n = 3) were classified as low risk of bias (n = 1), with concerns (n = 1) and high risk of bias (n = 1). CTs (n = 6) presented risk of bias as low (n = 2), serious (n = 1) and critical (n = 3). Studies about caries in babies showed high CE, and those who evaluated caries and periodontal parameters/biofilm in the mother had moderate and low CE, respectively.

CONCLUSION

ETs as a strategy of OHPs for pregnant women can be effective in preventing caries in themselves and in their babies. However, despite the improvement of the mothers' oral hygiene and gingival condition, the CE was low considering this parameter.

Periodontal Evaluation for a New Alkasite Restorative Material in Noncarious Cervical Lesions: A Randomized-Controlled Clinical Trial

OBJECTIVES

This study aims to evaluate the periodontal condition adjacent to Cention N (CN) restorations applied for noncarious cervical lesions (NCCL) compared with resin-modified glass ionomer cement (RM-GIC) restorations in terms of plaque accumulation, attachment loss, and gingival inflammation.

MATERIALS AND METHODS

This is a double-blind split-mouth three-armed randomized-controlled clinical trial. The study arms are RM-GIC (FUJI II LC), CN + adhesive system, and CN + retentive groove. The study included 25 restorations per arm. Follow-ups were performed at 1 week, 3, 6, and 9 months after the application of the restorations. The periodontal condition was evaluated using the plaque index (PI), the bleeding on probing index (BOP), and the probing depth (PD). Appropriate tests were used to perform statistical analyses (α = 0.05).

RESULTS

There was no significant difference between Cention N and RM-GIC regarding the studied variables. However, after the application of the restorations, it was noted that the PI and the PD mean values increased. The average increase after 9 months was 0.06 and 0.34 for PI and PD, respectively, with that of PD being significant. It was also noted that the percentage of positive BOP sites increased at the 1-week follow-up for all study groups and afterward dropped to near preintervention values at the 3-month and later follow-ups.

CONCLUSIONS

The two ion-releasing materials Cention N and RM-GIC have a comparable and clinically acceptable effect on the gingival tissue when restoring NCCLs. The combined effect of the gingival retraction cord and the rubber dam clamp on the periodontal tissues might be more important to consider, especially in relation to the probing depth. Future long-term studies are needed to evaluate the effect of Cention N on the subgingival biofilm in comparison with nonion-releasing restorative materials, and subsequently, its effect on gingival inflammation.

CLINICAL TRIAL REGISTRATION

This clinical trial was registered in clinicaltrial.gov clinical registry under protocol #NCT05593159.

The unrevealed links: periodontal health, human milk composition, and infant gut microbiome dynamics

AIM

This review aims to identify the mechanistic relationships related to periodontal diseases and its possible association with changes in human milk composition and the composition and function of infants' gut microbiome.

BACKGROUND

Maternal health conditions, especially inflammatory, are associated with altered human milk composition. It is not known whether maternal oral inflammatory diseases, including periodontal diseases, deleteriously affect human milk composition.

METHODS

A narrative review was conducted according to SANRA, the Scale for the Assessment of Narrative Review Articles, guidelines. PubMed, Google Scholar, and Cochrane database of systematic reviews were searched from September 2019 up to December 2023 using keywords such as breast/human milk, maternal health/infections, and periodontal diseases. Reference lists of relevant articles were also screened. Our primary outcome of interest was human milk composition (i.e., any changes in macronutrients, immunological components, etc.). Secondary outcomes included changes in human milk microbiome and subsequent changes in the infant gut microbiome. Outcomes were synthesized using a narrative approach where the existing evidence and current literature were summarized. No risk of bias assessment of the studies was performed in this review.

FINDINGS

The search yielded no studies investigating the relationship between periodontal diseases in nursing mothers and changes in human milk composition. However, a dose-response relationship exists between the severity of periodontal diseases and the risk of adverse pregnancy outcomes such as preterm birth. Mastitis and diabetes affected milk lipids. Immunoglobulin A (sIgA) was increased in mastitis, whereas reduced concentrations were reported in diabetes. Potential biological pathways through which periodontal diseases can negatively affect human milk composition include the systemic dissemination of inflammatory cytokines like IL-6, PGE2, and tumor necrosis factor (TNF)-β that can be up-regulated by bacterial by-products. This biological plausibility needs to be investigated, given the potentially negative impact on the quality of human milk that could be caused by periodontal inflammation.

Impact of Hormones and Lifestyle on Oral Health During Pregnancy: A Prospective Observational Regression-Based Study

Background and Objectives: This study explores the impact of hormonal fluctuations during pregnancy and lifestyle factors on stomatognathic system (SS) health. The aim is to determine how pregnancy-related hormonal changes and oral hygiene behaviors affect the onset of stomatognathic issues, such as gingival inflammation (GI) and dental erosion (DE). Materials and Methods: A prospective, observational study was conducted with 100 pregnant women, divided into two groups: Group A (60 women with significant stomatognathic alterations) and Group B (40 women without such alterations). Multiple regression analysis was used to evaluate the influence of hormonal levels, oral hygiene habits, and vomiting episodes on stomatognathic health. Results: Age and socioeconomic status showed no significant association with stomatognathic health (p > 0.05). In contrast, elevated levels of estrogen (p = 0.001) and progesterone (p = 0.003) were significantly linked to the severity of stomatognathic changes. Oral hygiene habits also had a statistically significant impact (p = 0.02), while vomiting frequency was not an important factor (p > 0.05). Conclusions: Hormonal changes during pregnancy, particularly increased estrogen and progesterone levels, are key predictors of stomatognathic health. These findings suggest that while oral hygiene is important, hormonal fluctuations play a dominant role in influencing stomatognathic system (SS) health during pregnancy.

The effects of pregnancy on oral health, salivary ph and flow rate

BACKGROUND

The frequent occurrence of dental caries and periodontal diseases in women during pregnancy may be due to many factors, such as salivary variables. The aim of this study was to evaluate the effects of pregnancy on salivary pH, flow rate, the DMFT index, and CPI sores.

METHODS

A total of 198 volunteers (pregnant in different trimesters and non- pregnant) were included for the present observational cross-sectional study. Data about sociodemographic characteristics and dental and systemic health conditions were recorded. Unstimulated saliva samples were collected for 5 min via the spitting method. The pH of the saliva was measured by a portable pH meter. The salivary flow rate was determined by the weight measurement method. The DMFT index and CPI were determined. The statistical evaluation was performed using Robust ve Poisson Regression analyses (p < 0.05).

RESULTS

It was determined that there was a gradually significant decrease in the Ph value from the first trimester to the third trimester during pregnancy, which was lower than the control group. (p < 0.001) The flow rate of pregnants in their third trimester was lower than that of first trimester (p = 0.017). The CPI scores of pregnant women were significantly greater than that of non-pregnants (p = 0.042), while the DMFTs were similar among all groups.

CONCLUSION

Our findings indicate that pregnancy leads to a notable reduction in unstimulated salivary pH and flow rate, which also has a detrimental impact on periodontal health.

TRIAL REGISTRATION

Clinical Trials-ID: NCT06343337; Registration Date: 04.01.2024.

Severe Deep Fascial Spaces Infections with Pregnancy: A Retrospective Study

Background: Odontogenic infections are common and self-limiting in most cases, but, they can lead to severe consequences and considerable morbidity and can even be fetal in spite of modern medical therapy. Patients and Methods: Retrospective study included data of pregnant patients with deep fascial space infections, done in Oral & Maxillofacial Surgery Department, Faculty of Dentistry. Alexandria University, and Oral & Maxillofacial Surgery Department, King Fahd Specialist Hospital, Burayda, Qassim, Saudi Arabia, from June2017 to Dec2022. Data were analyzed to study incidence, etiology, pattern, treatment modalities, outcomes, complications, and effects on pregnancy. Results: Thirty-eight pregnant patients, with a mean age of 30.8 ± 6.21 years, were included. The mean age of pregnancy was 24.5 ± 4.3 weeks. Diabetes mellitus was identified in seven cases (18.42%) and combined with hypertension in one case (2.63%) and with valvular heart disease in another one. The commonest affected single space was the submandibular space that occurred in six cases (15.8%). Canine space was the second single commonly involved one which occurred in five patients (13.2%). Complications occurred in 11 patients. Unesthetic scar occurred in three patients (7.9%). Trismus was observed in two patients (5.3%). Recurrent abscess was found in one case. Complications affecting the developing fetus and considered the most serious occurred in four patients: two cases of preterm labor and two cases of abortion. Conclusion: These infections may lead to serious outcomes and may have irreversible effects on the pregnancy and the developing fetus. Urgent intervention with multidisciplinary team to provide adequate care.

Determination of the Microbial Shift in the Gingival Sulcus of Women during Each Trimester of Pregnancy: A Cross-Sectional Study

Background and Objectives: This study aims to identify types of bacterial species in women visiting obstetrics/gynecology centers in Riyadh City, Saudi Arabia, during different pregnancy trimesters. Materials and Methods: This cross-sectional study was conducted among pregnant and nonpregnant women seeking care at Alyamamah Hospital, obstetrics/gynecology center, Riyadh, Saudi Arabia. A total of 110 [pregnant = 90 and nonpregnant = 20] individuals were recruited based on inclusion/exclusion criteria. Personal data, plaque index (PI), and gingival index (GI) were recorded. Bacterial samples were collected using sterile absorbent paper points from the gingival sulcus of pregnant females during the first, second, and third trimesters and compared to a control group of nonpregnant females. Thioglycolate broth containing the absorbent paper points was incubated at 37 °C for 24-48 h. After growth, the microorganisms were subjected to a Gram stain. The VITEK 2 system and conventional methods were used to identify various types of bacterial species from the gingival sulcus of pregnant and nonpregnant women. Chi-square tests and nonparametric tests were applied to the data. Results: The bacterial characterization indicated that Actinomyces naeslundii (AN) was the most predominant bacteria found in the study participants, followed by Lactobacillus fermentum (LF) (23.6%), Veillonella (VL) (10%), and unidentified organisms (9.1%). When the presence of subgingival bacterial species was compared between pregnant and nonpregnant women, a statistically significant difference was observed (p < 0.001). LF was the predominant bacteria in 9 nonpregnant women (45%) and 8 pregnant women in the first pregnancy trimester (44.4%). However, during the second (17 women: 48.6%) and third pregnancy (17 women: 45.9%) trimesters, AN becomes the predominant bacteria. A statistically significant difference was observed when the prevalence of various bacterial species was compared across the three pregnancy trimesters (p = 0.010). The plaque and gingival scores of pregnant and nonpregnant women showed no significant difference. Conclusions: In different trimesters of pregnancy, pregnant women's gingival crevices showed significant microbial changes without affecting gingival inflammation.

Consideration of hormonal changes for orthodontic treatment during pregnancy and lactation - a review

Hormonal changes in pregnant and lactating women significantly affect bone metabolism and overall stress levels, positioning them as a unique group within the orthodontic population. Fluctuations in estrogen, progesterone, prolactin, and other hormones are closely linked to bone remodeling and the periodontal tissue's response to inflammation caused by dental plaque. Hormones such as thyrotropin, leptin, and melatonin also play crucial roles in pregnancy and bone remodeling, with potential implications for orthodontic tooth movement. Additionally, adverse personal behaviors and changes in dietary habits worsen periodontal conditions and complicate periodontal maintenance during orthodontic treatment. Notably, applying orthodontic force during pregnancy and lactation may trigger stress responses in the endocrine system, altering hormone levels. However, these changes do not appear to adversely affect the mother or fetus. This review comprehensively examines the interaction between hormone levels and orthodontic tooth movement in pregnant and lactating women, offering insights to guide clinical practice.

Temporal pattern of dental caries at the western flank of the Central Plateau of Iran, c. 2700 BCE - 1600 CE

OBJECTIVE

To analyze the overall frequency and inter-tooth patterns of caries in three populations from ancient cemeteries located along the western border of the Central Iranian Plateau as a means to explore whether the populations of Iran had greater access to fermentable sugars after the establishment of the great empires.

MATERIALS

Dental collections from Kafarved-Varzaneh (Early Bronze Age, MNI=66), Estark-Joshaqan (Iron Age, MNI=57), Tappeh Poustchi (Timurid and Safavid Period, MNI=34), together with comparative data from NE Syria.

METHODS

Frequencies of dental caries per tooth categories, location and size of carious lesions are analyzed using Smith's Mean Measure of Divergence, Correspondence Analysis, χ2 and Kruskal-Wallis tests.

RESULTS

There are minimal differences in overall frequencies of carious lesions at Iranian sites, regardless of the chronology, but notable differences at Syrian sites. The inter-tooth pattern at the Iron Age cemetery in Estark appears distinctly different than the other Iranian sites and the comparative samples from Syria.

CONCLUSIONS

Divergent subsistence strategies may be linked with different inter-tooth patterns since people buried at Estark were mobile herders, while the other cemeteries were used by settled farmers.

SIGNIFICANCE

This comprehensive research on dental caries in three chronologically diverse populations in Iran sheds light on the association between dental caries and subsistence strategies, and introduces the Smith's Mean Measure of Divergence to explore inter-tooth carious patterns, which may prove useful to other researchers seeking to understand the relationships between subsistence, diet, and the presence of carious lesions.

LIMITATIONS

The studied sample size is relatively small and therefore its temporal/regional distribution produces low-resolution results.

SUGGESTIONS FOR FURTHER RESEARCH

More systematic research on the patterns of dental caries is necessary to produce more fine-grained reconstructions of diet and subsistence in Iran and around the globe.

Assessment of Oral Health Status and Pregnancy Outcomes Among Women in Saudi Arabia

Purpose

Pregnant women witness many changes in the body as well as in the oral cavity with many factors influencing these changes. This study evaluated the relationship between oral health status, perceptions, and pregnancy outcomes.

Methods

A cross sectional study design was implemented to recruit a convenience sample of women attending Obstetrics and gynecology department in public hospitals in East and capital city of Saudi Arabia. To collect data, a validated self-administered questionnaire in English and Arabic was used. The questionnaire covered background information, perceived oral health status, and dental visits.

Results

About 64.4% of the 481 women recruited had dental problems, 49.7% reported deterioration in their oral health during pregnancy, and 17.5% reported adverse pregnancy outcomes. Only 40.7% of pregnant women rated their oral health as good, and only 22% visited a dentist during their pregnancy. Dentists were the most common source of oral health information (44.1%), followed by social media (38.9%). Dental problems during pregnancy were significantly associated with adverse outcomes (P=0.007). Oral health perceptions of pregnant women, not visiting the dentist during pregnancy, and gingival problems were also significantly associated with adverse pregnancy outcomes (P=0.001). Those with fair to poor oral health were twice as likely to experience adverse pregnancy outcome. Those who intended to visit the dentist during their pregnancy but did not do so, as well as those who did not visit the dentist at all were 12 and 9 times more likely to experience adverse pregnancy outcomes respectively.

Conclusion

Dental complaints during pregnancy, oral health perceptions, and a lack of dental visits were all linked to increased likelihood of adverse pregnancy outcomes. There is a need for interprofessional collaboration to dispel myths and encourage oral health care and regular dental visits during pregnancy.

Clinical Use of Paraprobiotics for Pregnant Women with Periodontitis: Randomized Clinical Trial

Periodontal disease is very common in pregnant women. Paraprobiotics are a subset of probiotics. They can be defined as inactivated microbial cells providing health benefits to the host and are considered particularly safe. The aim of this study was to compare the periodontal health of pregnant women and puerperae after 6 months of home use of paraprobiotics. A total of 30 pregnant women were enrolled and divided into two groups: the test group, who had to use a paraprobiotic-based toothpaste (Biorepair Peribioma Pro, Coswell S.p.A., Funo di Argelato, BO, Italy) and mousse (Mousse Mouthwash Biorepair Peribioma, Coswell S.p.A.) twice a day, and the control group, who had to use only the paraprobiotic-based toothpaste. The time frames of the study were: 1 month (T1), 3 months (T2) and 6 months (T3), and data were collected during pregnancy and in the period immediately following delivery. The following indices were evaluated at T0, T1, T2 and T3: clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), plaque control record (PCR), modified marginal gingival index (mMGI), papillary marginal gingival index (PMGI) and recessions (R). All data were subjected to statistical analysis. PCR decreased significantly from T0 to T1 in the control group and from T0 to T2 and from T0 to T3 in the test group. BOP tended to decrease in both groups, but a significant reduction was observed only in the test group. CAL, PPD, PMGI and mMGI tended to decrease gradually in both groups without significant differences between or within groups. The combination of the paraprobiotic-based toothpaste and the paraprobiotic-based mousse significantly reduced BoP and plaque control over time, although there were no significant differences with the use of the paraprobiotic-based toothpaste alone. In addition, the combination of the two products promoted a trend towards the better stabilization of recessions.

Maternal and child oral health barriers and solutions: Case studies from South Africa, Brazil, and Indonesia

The World Federation of Public Health Associations (WFPHA) has introduced a maternal oral health framework and launched its Global Maternal and Child Oral Health Initiative, advocating for maternal and child health as a strategic entry point for oral health to be integrated into primary healthcare systems. This article delves into maternal oral health initiatives in South Africa, Brazil, and Indonesia, exploring challenges and proposing context-specific solutions aligned with the WFPHA maternal oral health framework and its Global Maternal and Child Oral Health Initiative. The apartheid legacy in South Africa has led to the gross health inequalities, including oral health disparities characterized by maldistribution of dental facilities and dental professionals in the public sector. The proposed objectives focus on effective leadership, human resource capacity building, and integration of maternal and child oral health policy into existing health policies. Brazil faces challenges in reaching pregnant women, especially pregnant teens, due to workforce shortages. Brazil's Oral Health National Program mandates all pregnant women undergo at least one dental appointment, but a shortage of oral health teams persists and impedes timely access to dental care during pregnancy. Dental students' outreach to vulnerable pregnant teens can enhance the future oral health workforce's sensitivity to maternal oral health matters. In Indonesia, the Antenatal Care Innovative (iANC) Project has introduced a co-training model for midwives and oral health professionals addressing oral health needs of mothers and their spouses and fostering a comprehensive understanding of the interplay between oral health and maternal well-being. These country cases demonstrate the importance of tailored policies, health promotion, and care delivery interventions in maternal oral health. All cases highlight the importance of workforce training and distribution, fostering cross-disciplinary collaboration and future oral health workforce who can promote health beyond treatment delivery.

Exploring the Perception and Awareness of Dental Students and Interns in Managing and Treating Pregnant Patients

Background Undergraduate dental students and interns express reluctance to deal with pregnant women in the dental office due to the fear of medical consequences on the fetus. This study aims to explore the knowledge, attitudes, and practices of dental students and interns regarding the dental considerations of pregnant women in three dental schools in Saudi Arabia. Methodology This cross-sectional study was performed between October and December 2023 and targeted the clinical academic years of dental students and interns at three dental schools in Saudi Arabia, namely, Taibah University, Umm Al-Qura University, and Qassim University. Using the convenience sampling method, 223 students were invited to respond to a questionnaire constructed from previously published studies and reviewed by experts in the field. It consisted of 15 questions divided into four sections. Descriptive analysis and chi-square test were conducted to assess the difference between the different sociodemographic groups and students' educational levels with the significance level set at p-values <0.05. Results Overall, 223 complete responses were received, with a response rate of 97%. Demographics included 99 (44.40%) males and 124 (55.60%) females, with a reasonable distribution across academic years. Knowledge assessment findings revealed that 114 (51%) participants acquired adequate knowledge. Regarding participants' attitudes, 112 (50%) found the curriculum-centered information sufficient. In addition, 173 (77.6%) participants chose lectures/books as their preferred source of information. Almost 138 (61.9%) participants did not feel confident in managing pregnant women. The chi-square test revealed that educational level significantly impacts the knowledge and practice of the participants, regardless of their gender (p < 0.05). Conclusions Both students and dental interns showed adequate-to-good levels of knowledge and attitude. Both need more exposure to clinical situations with pregnant women during their undergraduate dental training programs to boost their confidence level and enhance their readiness to practice dental procedures with such a group of patients after graduation.

Association between birth-related factors and periodontitis in women: Korea National Health and Nutrition Examination Survey 2013-2018

AIM

Adult women experience several changes in physiological status, such as pregnancy and childbirth, during their life cycle. This study analyses the association between birth-related factors (the number of childbirths, abortions and miscarriages) and periodontitis using data from the Korea National Health and Nutrition Examination Survey, which represents Korean adults.

MATERIALS AND METHODS

The study used data from Korea National Health and Nutrition Examination Survey VI and VII (2013-2018) and included 10,072 women 19 years or older, with no missing data on the variables assessed. Periodontitis was defined according to the Community Periodontal Index (CPI) criteria. Multiple logistic regression analysis, adjusting for age, household income, education, alcohol consumption, smoking, stress, body mass index, waist circumference, hypertension, diabetes mellitus, an oral examination within 1 year, daily tooth brushing frequency, hygiene products and self-perceived oral health as identified via logistic regression analyses, was performed to determine the association between birth-related variables and periodontitis.

RESULTS

In the crude model, the odds ratio (OR) showed a significantly increased risk of periodontitis (CPI ≥ 3) and severe periodontitis (CPI = 4) based on the number of childbirths, abortions and miscarriages (p < .05). After covariate adjustment, periodontitis (CPI ≥ 3) was associated with the number of childbirths (1: OR = 1.92; 95% confidence interval [CI]: 1.47-2.50; 2: OR = 2.03; 95% CI: 1.57-2.61; ≥3: OR = 2.11; 95% CI: 1.60-2.78). Furthermore, severe periodontitis (CPI = 4) was also associated with the number of childbirths (1: OR = 2.33; 95% CI: 1.24-4.38; 2: OR = 2.99; 95% CI: 1.62-5.52; ≥3: OR = 3.34; 95% CI: 1.79-6.21).

CONCLUSIONS

The findings of this large-scale, nationally representative study suggest that the number of childbirths is associated with the severity of periodontitis. However, the relationship between the number of abortions and miscarriages and periodontitis (CPI ≥ 3) or severe periodontitis (CPI = 4) is not significant.

The effect of dental problems on pregnancy and birth outcomes in pregnant women registered in family health centers in a city center: A prospective study

The researchers aimed to determine the effects of oral-dental health of pregnant women on their pregnancy and fetus health. In this descriptive observational study, the researchers prospectively followed up 64 pregnant women three times, who were registered in two family health centers that were selected by using a simple random sampling method. As the follow-ups progressed, an increase was determined in the DMF-S (Decayed-Missing-Filled-Surface) index and DEBRIS (Caries Surface Distribution Form) scores in the areas observed (p < 0.05). No significant relationship was found between the increased scores and the infant's birth length, weight, and birth week.

Social and Preventive Factors That Explain Oral Health among Pregnant Women in the Canton of Cuenca, Ecuador

(1) Background: pregnant women in underprivileged areas may face challenges that affect their oral health. The analysis of these issues such as toothaches or cavities, among others could be crucial for them. However, no studies have been conducted in Cuenca, Ecuador. Thus, this study aimed to create a model explaining how social factors and healthy habits impact oral health in Cuenca, Ecuador. (2) Methods: An observational study was performed using a questionnaire developed from scratch. Principal component factor analysis was performed to calculate the oral disease index based on the oral health issues reported by women during pregnancy. (3) Results: 1971 women participated in the research. In total, 88% reported at least one oral health problem, with cavities (34%) and bleeding gums (33%) as the most prevalent. The rate of preventive visits and frequent brushing were the two variables that most impacted the oral disease index. The consumption of sweets, age, and the belief that visiting the dentist harms their unborn child were also important factors. However, income, education, and ethnic background showed little to no effect. (4) Conclusions: The most beneficial determinants of oral health factors in pregnant women in Cuenca, Ecuador, are preventive dentist visits, frequent brushing, and a contained consumption of sweets. The main harmful factors are age and the misconception that dental visits can harm their unborn child. Surprisingly, income, education, and ethnic background have little effect. This study can be replicated in other countries and cultures.

Awareness of physicians and dentists in Serbia about the association between periodontitis and systemic diseases: a cross-sectional study

BACKGROUND

Strong evidence supports the association between periodontitis and certain systemic diseases. The aim of the present study was to evaluate the knowledge of a group of physicians and dentists in Serbia regarding this topic and assess their professional actions to prevent and control both periodontal and systemic diseases.

METHODS

An anonymous self-administered structured questionnaire was sent to the available e-mail addresses of randomly selected healthcare providers working in Serbia. According to the inclusion criteria, general practitioners, specialists, general dentists, and specialists working in government hospitals and private practices in various cities in Serbia were recruited in the study. The questionnaire consisted of 17 questions divided into three parts. The first part recorded the sociodemographic characteristics of participants, the second part included questions about the clinical manifestation and etiology of periodontitis, as well as knowledge of the association between periodontitis and systemic diseases, and the third part included questions about professional procedures for the prevention and control of periodontitis and systemic diseases.

RESULTS

A total of 1301 health participants, 739 (57.8%) physicians and 562 (43.2%) dentists, were included in this cross-sectional study. Most respondents (94.7%) were aware of the association between periodontitis and general health. The highest percentage of respondents associated diabetes mellitus and periodontitis. Factors significantly associated with higher knowledge were female sex (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.37-2.52; p < 0.001) and dental profession (OR, 5.86; 95% CI], 4.03-8.53; p < 0.001). Participants who had higher knowledge score were more likely to ask their patients about gum/systematic health (p < 0.001) and refer them to dentists/physicians (p < 0.001).

CONCLUSIONS

It was concluded that compared to the group of dentists, the group of physicians had less knowledge of the relationship between periodontitis and systemic diseases. The female gender was significantly associated with better knowledge. A better understanding of this topic is associated with better clinical practice.

A Randomized Controlled Clinical Trial of Prenatal Oral Hygiene Education in Pregnancy-Associated Gingivitis

INTRODUCTION

Research shows there is a significant increase in gingival inflammation during pregnancy. This study was conducted to determine if an oral health intervention (OHI), including oral hygiene education delivered by nurse-led staff and an advanced over-the-counter (OTC) oral home care regimen, improved gingival inflammation in pregnant women with moderate-to-severe gingivitis compared with a standard oral hygiene control group.

METHODS

This was a multicenter, randomized, controlled, single-masked, parallel group clinical trial conducted in obstetrics clinics of 2 medical centers. A total of 750 pregnant women between 8 and 24 weeks of pregnancy with at least 20 natural teeth and moderate-to-severe gingivitis (>30 intraoral bleeding sites) were enrolled. Participants were randomized to either the OHI group, which included oral hygiene instructions supplemented with an educational video and advanced OTC antibacterial/mechanical oral hygiene products, or the control group receiving oral hygiene instructions and standard products. Both groups received oral hygiene instructions from nurse-led staff. Experienced, masked examiners measured whole mouth gingival index (GI) and periodontal probing depths (PDs) at baseline and months 1, 2, and 3.

RESULTS

Participants enrolled in this study presented with moderate-to-severe gingivitis at baseline. Both the OHI and control groups exhibited significant reductions in GI (P < .001) and PD (P < .03) from baseline that persisted throughout the study period. The OHI group exhibited modest, yet statistically greater, reductions in GI (P ≤ .044) compared with the control at all time points. The reduction in PD directionally favored the OHI group, but between-group differences were small (<0.03 mm) and not statistically significant (P > .18).

DISCUSSION

Significant gingivitis was prevalent among participants in this study and identifies an opportunity to improve gingival health during pregnancy by providing oral health education during the course of prenatal care when coupled with an advanced OTC oral hygiene regimen.

The role of oral and prenatal healthcare providers in the promotion of oral health for pregnant women

BACKGROUND

Hormonal alterations and lowered immunity during pregnancy aggravated by poor oral hygiene increase the risk of pregnant women of developing oral diseases. We conducted this cross-sectional study to examine the role of oral and prenatal health providers in promoting dental care for pregnant women attending primary healthcare centers (PHCs) in Saudi Arabia.

METHODS

An online questionnaire was sent to a random sample of women who attended PHCs in Jeddah, during 2018-2019. From a total of 1350 women who responded to our questionnaire, 515 women reported having a dental visit before pregnancy. These women comprised our study sample. Bivariate analyses and multiple logistic regression models were conducted to examine associations between oral practices of dental and prenatal health providers (exposures) and women's utilization of dental care during pregnancy (outcome). Covariates included age, education (< 12 years of education, 12 years of education, and > 12 years of education), family income (≤ 5,000, 5,001-7,000, 7,001-10,000, and > 10,000 Saudi Riyals), health insurance (yes/no), nationality (Saudi Arabian/non-Saudi Arabian), and presence of dental problems, such as toothache, dental caries, gingival inflammation, and the need for dental extractions.

RESULTS

Only 30.0% of women were informed by a dentist during their dental visit before pregnancy about the importance of visiting a dentist during pregnancy. About 37.0% of women were asked about oral health, 34.4% were informed about the importance of dental care during pregnancy, and 33.2% had their mouths inspected by prenatal health providers. Women informed by dentists about the importance of dental visits during pregnancy were twice as likely (Odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.63-3.60) to visit a dentist during pregnancy. Women who were referred to dentists, had their mouth inspected, or were advised to visit a dentist during pregnancy by prenatal providers were 4.29 (95% CI: 2.67-6.88), 3.79 (95% CI: 2.47-5.82), and 3.37 (95% CI: 2.16-5.27) times as likely to visit a dentist during pregnancy.

CONCLUSION

The partaking of oral and prenatal healthcare providers in evidence-based oral health promotion practices, antenatal-dental collaboration, and closing the referral loop increase pregnant women's access to and utilization of preventive and treatment dental services.

The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response

Periodontal disease has been suggested to be linked to adverse pregnancy outcomes such as preterm birth, low birth weight, and preeclampsia. Adverse pregnancy outcomes are a significant public health issue with important clinical and societal repercussions. This article systematically reviews the available epidemiological studies involving the relationship between periodontal disease and adverse pregnancy outcomes over the past 15 years, and finds a weak but independent association between adverse pregnancy outcomes and periodontal disease. The bidirectional association and the potential mechanisms are then explored, focusing on three possible mechanisms: inflammatory reaction, oral microorganisms and immune response. Specifically, elevated systemic inflammation and increased periodontal pathogens with their toxic products, along with a relatively suppressed immune system may lead to the disruption of homeostasis within fetal-placental unit and thus induce adverse pregnancy outcomes. This review also explains the possible mechanisms around why women are more susceptible to periodontal disease. In conclusion, pregnant women are more likely to develop periodontal disease due to hormonal changes, and periodontal disease has also been suspected to increase the incidence of adverse pregnancy outcomes. Therefore, in order to lessen the risk of adverse pregnancy outcomes, both obstetricians and dentists should pay attention to the development of periodontal diseases among women during pregnancy.

Antibacterial Effect of Zirconia Nanoparticles on Polyethyl Methacrylate Resin for Provisional Crowns

Objective

Mid-to-long term use of provisional crowns in the oral cavity is associated with bacterial adhesion and biofilm formation, thus necessitating provisional crowns exhibiting antibacterial properties to prevent the occurrence of gingivitis and periodontal disease. This study aimed to evaluate the antibacterial effect of zirconia nanoparticle-containing polyethyl methacrylate (PEMA) resin for provisional restorations.

Methods

Zirconia nanoparticles were added to the monomer of PEMA resin for provisional restorations, and the mixture was stirred for 2 h using a magnetic stirrer. Disk-shaped specimens were prepared by mixing the polymer with the nanoparticle solution. The control group contained pure PEMA resin samples, and the experimental groups Group Z2, Group Z4, and Group Z8 included PEMA resin specimens containing 2, 4, and 8% w/v zirconia nanoparticles, respectively. After analyzing the sample surfaces, the antibacterial effect of the specimens was evaluated using Streptococcus mutans. Statistical analysis was performed using Tukey's test and Mann-Whitney U-test, according to the normality result in the Shapiro-Wilk test.

Results

FE-SEM and EDX analyses revealed the successful addition of zirconia nanoparticles. Results showed no significant difference in the measured values for surface roughness and contact angle between the experimental and control groups; however, adhesion and biofilm thickness of S. mutans were significantly decreased in Group Z2, Group Z4, and Group Z8 compared to the control group (P < 0.05, P < 0.01, P < 0.01, respectively).

Conclusion

The addition of zirconia nanoparticles can lower the incidence of adhesion and biofilm thickness of S. mutans on PEMA resin used for provisional crowns. Thus, incorporating zirconia nanoparticles in repair materials for provisional crowns and PEMA resin can produce an antibacterial effect and prevent gingivitis, periodontal disease, and dental caries.

Longitudinal Dynamics of HPV16 Antibodies in Saliva and Serum among Pregnant Women

Oral infections with high-risk (hr)HPV genotypes are associated with a subset of head and neck squamous cell carcinomas. Oral hrHPV infections may result from having oral sex, but also from horizontal infection from mouth to mouth. In such cases, saliva can serve as a vehicle for HPV transmission. Still, the prevalence and dynamics of salivary HPV antibodies in healthy non-vaccinated individuals are poorly known and the role of the salivary antibodies in protection from oral HPV infection is unclear. We used an ELISA assay to evaluate the dynamics and correlation of oral HPV16 infection and HPV16L1 and E7 specific antibody levels in saliva and serum samples among 39 women, 13 of which had persistent oral HPV16 infection. The women were mothers-to-be, sampled before delivery and followed up for 36 months postpartum. HPV16L1 IgG and sIgA antibodies were regularly detected in saliva. Antibody levels in serum remained stable during the 36-month follow-up, while antibody levels in saliva fluctuated. There was considerable individual variation in salivary HPV16L1 antibody levels, and some women had persistent oral HPV16 infection but no salivary antibodies. No differences in salivary HPV16L1 levels were found between the women with persistent or transient oral HPV16 infection.

Assessment of Periodontal Disease status in Pregnant Women and Related Demographic Factors in arak, Iran

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Hormonal Fluctuations and Periodontal Status in Postmenopausal Women

Introduction. While the short-term effects of hormonal events on gingival inflammation have been well described, their long-term effects on the periodontium have received less attention. Our investigation was aimed at evaluating the correlation between hormonal fluctuations and periodontal status in postmenopausal women from the profile of the Rafsanjan Cohort Study. Material and Methods. We used the data obtained from the profile of the Rafsanjan Cohort Study (RCS) as a part of the prospective epidemiological research studies in Iran (PERSIAN). The RCS includes 10,000 participants aged 35–70 years old. Among this population, the periodontal status data of 4143 women were available. Of these 4,143, the postmenopausal women were included in the study, and those who had a history of gingival treatment during the past 6 months were excluded from the study. Finally, 928 postmenopausal women were included in the present study. Periodontal status was assessed by measuring the clinical attachment loss, pocket depth, and bleeding on probing (BOP). Univariate and multivariate regression analyses were applied using three different models. Results. The results showed that 53.2% of postmenopausal women had periodontitis. There were significant differences between the participants with and without periodontitis in brushing frequency and educational status $\left(P<0.05\right)$ . After adjusting for all potential confounders, no correlation was found between hormonal fluctuations and periodontal status. Conclusion. There was no correlation between hormonal fluctuations and periodontal status.

A Healthier Smile in the Past? Dental Caries and Diet in Early Neolithic Farming Communities from Central Germany

Dental health is closely linked to an individual's health and diet. This bioarcheological study presents dental caries and stable isotope data obtained from prehistoric individuals (n = 101) from three Early Neolithic sites (c. 5500-4800 BCE) in central Germany. Dental caries and ante-mortem tooth loss (AMTL) were recorded and related to life history traits such as biological sex and age at death. Further, we correlate evidence on caries to carbon and nitrogen isotope data obtained from 83 individuals to assess the relationship between diet and caries. In 68.3% of the adults, carious lesions were present, with 10.3% of teeth affected. If AMTL is considered, the values increase by about 3%. The prevalence of subadults (18.4%) was significantly lower, with 1.8% carious teeth. The number of carious teeth correlated significantly with age but not sex. The isotopic data indicated an omnivorous terrestrial diet composed of domestic plants and animal derived protein but did not correlate with the prevalence of carious lesions. The combined evidence from caries and isotope analysis suggests a prevalence of starchy foods such as cereals in the diet of these early farmers, which aligns well with observations from other Early Neolithic sites but contrasts to Late Neolithic and Early Bronze Age populations in Germany.

Exogenous progesterone short-termly affects the periodontal environment in perimenopausal women

OBJECTIVE

This study aimed to evaluate the effects of exogenous progesterone in the periodontal environment of perimenopausal women.

METHODS

Either with or without periodontitis, 100 perimenopausal women received 3 months of progesterone treatment, as well as age-matched 100 perimenopausal and 100 postmenopausal women without treatments were enrolled (N = 50). The gingival index (GI), probing depth (PD), clinical attachment level (CAL), and tooth mobility (TM), as well the gingival crevicular fluid (GCF) levels of IL-6 and TNF-α were analyzed.

RESULTS

Periodontitis showed higher GI, PD, and CAL than non-periodontitis at perimenopausal and postmenopausal periods. In women without periodontitis, the GI and PD, and the GCF levels of IL-6 and TNF-α were increased by 3 months of progesterone treatment, but recovered from the 6^th month in the absence of progesterone. In women with periodontitis, only the PD was short-termly increased by progesterone treatment. For those without progesterone treatment, the GI, PD, and TM were not significantly different between perimenopausal and postmenopausal women either with periodontitis or not.

CONCLUSIONS

Exogenous progesterone short-termly exacerbated the inflammation and PD in perimenopausal women without periodontitis, and the PD in those with periodontitis.

Relationship between DMFT index and number of pregnancies: a cross-sectional study on enrollment phase of the Tabari Cohort Study

Background

People of all age and gender groups are at risk of dental diseases; however, some groups, such as pregnant women, are more vulnerable than others due to their specific physiological situations. The protection of maternal and fetal is critical. Therefore, the present study intended to investigate the relationship between the Decayed, Missing, and Filled Teeth (DMFT) index and the number of pregnancies.

Methods

The present cross-sectional study was performed using the Tabari Cohort Study (T.C.S.) data. Data of 5,496 women enrolled in the T.C.S. were included in the study. After obtaining the approval of the Ethics Committee, the related data on the variables of age, age at the first pregnancy, number of pregnancies, total number of teeth at the time of examination, number of DMFT, employment status, socioeconomic status, educational level, residence location, body mass index, and the status of diabetes mellitus, hypertension, and cardiovascular diseases were extracted. Finally, data analysis was performed in the STATA software (version 14).

Results

The mean DMFT index in women with 1, 2, 3, 4, 5, 6, and more than six pregnancies were obtained at 12.74 ± 7.11, 13.09 ± 7.06, 14.80 ± 7.81, 17.07 ± 8.11, 19.82 ± 9.02, 22.89 ± 8.98, and 26.17 ± 8.01, respectively (P < 0.001). Using the multivariate linear regression and adjusting the effect of potential confounding variables, it was found that the DMFT index increased by 34% for each unit increase in the number of pregnancies (β = 0.34, P < 0.001).

Conclusions

According to our results, there was a significant relationship between the DMFT index and the number of pregnancies. The DMFT index was increased with an increased number of pregnancies. Therefore, oral healthcare promotion should receive special attention in healthcare planning and related policies by raising awareness and providing easy access to dental services for women of childbearing age, especially pregnant women.

Assessment of Oral Microbiome Changes in Healthy and COVID-19-Affected Pregnant Women: A Narrative Review

During pregnancy, there are several metabolic changes and an alteration in the composition of microorganisms that inhabit the oral cavity, with an increase in pathogenic bacteria that promote the onset of gingival diseases. This review is based on research in reference to the PICO model (Problem/Intervention/Comparison/Outcome), related to changes in the oral microbiome of pregnant women and possible oral consequences in patients with COVID-19. The results showed a growth of some pathogenic bacteria in pregnant women, including Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum, and the selective growth of the Prevotella intermedia, Porphyromonas gingivalis and Tannerella species, probably due to the fact that these bacteria use progesterone as a source of nutrition. These same bacteria are implicated in the development of periodontal disease. Periodontal pockets have bidirectional interactions between the oral cavity and the systemic circulatory system through the peripheral gingival blood vessels. The affinity of the SARS-CoV-2 virus to specific membrane receptors is now clear, and could involve the internal and external epithelial lining or the fibroblasts of the periodontal ligament. According to the results of the present review, the control of oral microbiome changes during pregnancy would be welcomed. The use of probiotics could help clinicians manage pregnant patients, reducing inflammatory indexes. Future studies should focus not only on changes in the level of the oral microbiome in pregnancy or the correlation between periodontal disease and COVID-19, but also on oral changes induced by both clinical situations.

Periodontal Disease and Vitamin D Deficiency in Pregnant Women: Which Correlation with Preterm and Low-Weight Birth?

Periodontal disease seems to be correlated with low vitamin D serum levels, preterm birth (PTB) and low birth weight (LBW), although the literature still lacks a consensus. This study aimed to investigate this correlation in a cohort of pregnant women over 20 weeks of gestation from the University Hospital “Maggiore della Carità”, Novara, Italy. We assessed serum levels of vitamin D and oral health status through the following indexes: Oral Hygiene Index (OHI), Plaque Control Record (PCR), Gingival Bleeding Index (GBI), and Community Periodontal Index of Treatment Needs (CPTIN). Moreover, we assessed the number of PTB and LBW among the newborns. Out of 121 pregnant women recruited, 72 (mean age 29.91 ± 3.64 years) were included. There was a statistically significant correlation between preterm and OHI > 3 (p = 0.033), and between LBW and OHI > 3 (p = 0.005) and CPITN = 3 (p = 0.027). Both pregnant women with vitamin D deficiency ((25-hydroxy-vitamin D) < 30 ng/mL) and PTB plus LBW newborns were significantly correlated (p < 0.05) with poor levels of all oral health status indexes during pregnancy. Furthermore, these conditions (women with hypovitaminosis D and combination of PTB and LBW) were shown to be significantly correlated (p < 0.001). Taken together, our findings reported a high prevalence of PTB and LBW with poor oral health and vitamin D deficiency in pregnant women.

Self-reported periodontitis and fecundability in a population of pregnancy planners

STUDY QUESTION

Is a history of periodontitis among women associated with reduced fecundability?

SUMMARY ANSWER

A history of periodontitis, as assessed by three different self-reported measures, may be associated with reduced fecundability.

WHAT IS KNOWN ALREADY

Periodontitis is a chronic inflammatory condition affecting the hard and soft tissues surrounding the teeth. Few studies have evaluated the association between periodontitis and time to pregnancy, and findings are mixed. It is hypothesized that periodontitis may adversely affect time to pregnancy.

STUDY DESIGN, SIZE, DURATION

We conducted a prospective cohort study of 2764 female pregnancy planners residing in North America (March 2015-June 2020).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Eligible participants had been attempting pregnancy for six or fewer menstrual cycles at enrollment and were not using fertility treatment. Women answered questions about their oral health. Pregnancy was ascertained via bi-monthly follow-up questionnaires. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs) for three different measures indicative of a history of periodontitis: ever diagnosed with periodontitis (N = 265), ever received treatment for periodontitis (N = 299), and ever had an adult tooth become loose on its own (N = 83). We adjusted for potential confounders and precision variables. Women at risk of misclassification of periodontitis diagnosis due to pregnancy-related gingivitis were reclassified in a sensitivity analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

All three indices of periodontitis may be associated with reduced fecundability. FRs were 0.89 (95% CI 0.75-1.06) comparing women with and without a previous periodontitis diagnosis, 0.79 (95% CI 0.67-0.94) comparing women with and without previous periodontitis treatment, and 0.71 (95% CI 0.44-1.16) comparing women with and without a tooth that became loose. After reclassification of pregnancy-related gingivitis in the sensitivity analysis, the FR for periodontitis diagnosis was 0.83 (95% CI 0.68-1.00). Weaker FRs were observed among parous women as compared with nulliparous women for periodontitis diagnosis and tooth becoming loose, but not for periodontitis treatment.

LIMITATIONS, REASONS FOR CAUTION

Though we used validated self-report measures of periodontitis, clinical confirmation is the gold standard. These questions may be functioning as markers of different levels of periodontitis severity, but we were unable to measure disease severity in this population. Finally, we cannot eliminate the possibility of unmeasured confounding.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first preconception prospective cohort study to evaluate the association between self-reported periodontitis and fecundability. Our results indicate that periodontitis may be associated with lower fecundability.

STUDY FUNDING/COMPETING INTEREST(S)

This work was partially funded by R01HD086742/Eunice Kennedy Shriver National Institute of Child Health and Human Development and R21HD072326/Eunice Kennedy Shriver National Institute of Child Health and Human Development. PRESTO has received in-kind donations from Swiss Precision Diagnostics, Sandstone Diagnostics, FertilityFriend.com, and Kindara.com for primary data collection. L.A.W. is a fibroid consultant for AbbVie, Inc. J.C.B., S.W., J.Y., K.J.R., E.E.H., and B.H. have no conflicts of interest to disclose.

TRIAL REGISTRATION NUMBER

N/A.

Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.

Regulation of matrix metalloproteinases-8, -9 and endogenous tissue inhibitor-1 in oral biofluids during pregnancy and postpartum

OBJECTIVE

During pregnancy, mothers undergoe considerable physiological changes affecting the whole body including periodontal tissues. Susceptibility to gingival inflammation during pregnancy could be mediated by modulation of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Therefore, the aim of this study was to investigate salivary and gingival crevicular fluid (GCF) levels of MMPs and TIMPs during the second and third trimester of pregnancy and postpartum.

DESIGN

Saliva and GCF samples were collected from 96 pregnant women (PW) before and after giving birth. The sixty matched non-pregnant women (N-PW) were recruited as a control group and full-mouth periodontal examination was performed. The levels of MMP-8, MMP-9 and TIMP-1 were determined by immunofluorometric and enzyme-linked immunosorbent assays.

RESULTS

The PW group exhibited significantly higher levels of MMP-8 and MMP-9 in their saliva than the N-PW group while corresponding salivary TIMP-1 levels were significantly lower in NPW compared to the postpartum stage. This resulted in significantly higher MMP-8/TIMP-1 and MMP-9/TIMP-1ratio in the saliva from PW before and after birth than in that from N-PW. MMP-8, MMP-9 and TIMP-1 levels were higher in GCF from PW and postpartum than in that from N-PW.

CONCLUSIONS

MMP-8 and MMP-9 levels in saliva and GCF reflect inflammatory burden during pregnancy. They could be used for monitoring the inflammatory state of gingival tissues during pregnancy.

Association between parity and tooth loss among northern Nigerian Hausa women

BACKGROUND

Female reproduction is associated with physiological, metabolic, and nutritional demands that can negatively affect health and are possibly cumulative when parity is high. While it is probable that maternal oral health is similarly affected, available evidence is based on fairly low parity populations and likely confounders affecting oral health status were not considered.

AIM

To determine the relationship between parity and tooth loss in a population with many high parity women. Contributions of age, reproductive and socioeconomic parameters, and oral health practices were considered.

MATERIALS AND METHODS

This was a cross-sectional study involving 612 Hausa women of all parity levels aged 13-65 years. Women with ≥5 children were considered high parity. Sociodemographic status and oral health practices were collected using a structured interviewer-administered questionnaire. All teeth present, (excluding third molars) and missing teeth were noted, with inquiries regarding tooth loss etiology. Associations with tooth loss were evaluated through correlations, ANOVA, post hoc analyses and Student's t tests. Effect sizes were used to interpret the magnitude of differences. Multiple regression (negative binomial model) was used to investigate predictors of tooth loss.

RESULTS

Hausa women had a low prevalence of tooth loss, despite poor oral hygiene, and limited dental care. Older, middle SES, and higher parity women experienced significantly more tooth loss. Additionally, increased duration of reproductively active years was significantly related to fewer remaining teeth.

CONCLUSION

Higher parity was related to greater tooth loss in Hausa women. Women with ≥5 children experienced more loss than lower parity age mates.

Prevalence of myths regarding oral health among pregnant women in North India

OBJECTIVES

To study the prevalence of myths regarding oral health care in pregnant women in North Indian population.

METHODS

This cross-sectional study used a self-administered closed-ended questionnaire to assess oral healthcare related beliefs and practices in 400 pregnant women who reported for prenatal checkup in a tertiary healthcare centre in North India. The questionnaire included questions to elicit information on socio-demographic factors, beliefs and practices of oral hygiene during pregnancy, attitude towards dental problems occurring during pregnancy and the reasons associated with a specific belief. Prevalence of various myths was observed, and its associations with various socio-demographic factors, adverse pregnancy outcomes and dental symptoms were analysed.

RESULTS

84.2% of the respondents harboured at least one oral healthcare related myth. 63.4% of respondents deferred brushing for many days after delivery. 36.6% of respondents avoided consumption of hot/cold food and drinks during pregnancy due to fear of tooth loss. 24.5% of respondents believed local anaesthesia could affect baby's developing organs, and 21.8% of the studied population believed tooth extraction might cause miscarriage. Females possessing more myths were more likely to experience severe oral health problems during pregnancy. Education was depicted as a significant negative predictor of the prevalence of myths. No significant correlation between myths prevalence and history of adverse pregnancy outcomes was found.

CONCLUSION

Neglect of oral health due to myths about oral hygiene practices and dental treatment during pregnancy is a serious concern. A very high prevalence of these myths is an obstacle to goal of optimal maternal and child health.

Oral health knowledge among a cohort of pregnant women in south India: A questionnaire survey

Aim:

To assess oral health knowledge of pregnant women visiting Government Maternity Hospital, Hyderabad.

Materials and Method:

A cross-sectional survey was carried out among 606 pregnant women aged 18–40 years old. Oral health knowledge of respondents was assessed using the 14-item self-administered questionnaire and responses were recorded on a dichotomous scale (yes/no). The data were analyzed using Statistical Package for Social Sciences (SPSS) package version 20.0.

Results:

Overall inadequate knowledge regards to oral health was observed among 55.8% pregnant women. Based on knowledge regarding tooth decay, 71.6% of study participants believed that every painful tooth has to be removed and 81% of respondents were unaware of brushing with fluoridated toothpaste prevents tooth decay. Similarly, with respect to gum disease, 77.7% of subjects were not aware of gum disease and around 49.8% unacquainted that bleeding during tooth brushing indicates gum problems. It is enriching to observe, 94.1% of respondents felt oral health is important for general health. On the other hand, a quite alarmingly high percentage (73.9%) of subjects does not know the relationship between oral health and pregnancy. Furthermore, 91.1% and 65.5% of participants were ignorant that pregnancy can increase the tendency of gums to swell or bleed and poor oral health affect their unborn baby, respectively. More than three-fourths of the study participants (84%) had never visited dentist

Conclusion:

The study highlights limited knowledge allied to oral health among pregnant women and problem-oriented dental visits indicating an urge among this group to scale up their knowledge.

Risk of preterm birth associated with maternal gingival inflammation and oral hygiene behaviours in rural Nepal: a community-based, prospective cohort study

OBJECTIVES

Observational studies have identified associations between periodontitis and adverse pregnancy outcomes, but randomised controlled trials evaluating the efficacy of periodontal therapy have yielded inconsistent results. Few studies have explored relationships between gingival inflammation and these outcomes or been conducted in rural, low-income communities, where confounding risk factors differ from other settings.

METHODS

We conducted a community-based, prospective cohort study with the aim of estimating associations between the extent of gingival inflammation in pregnant women and incidence of preterm birth in rural Nepal. Our primary exposure was gingival inflammation, defined as bleeding on probing (BOP) ≥10%, stratified by BOP <30% and BOP ≥30%. A secondary exposure, mild periodontitis, was defined as ≥2 interproximal sites with probing depth (PD) ≥4 mm (different teeth) or one site with PD ≥5 mm. Our primary outcome was preterm birth (<37 weeks gestation). We used Poisson regression to model this relationship, adjusting for potential confounders.

RESULTS

Of 1394 participants, 554 (39.7%) had gingival inflammation, 54 (3.9%) mild periodontitis and 197 (14.1%) delivered preterm. In the adjusted regression model, increasing extent of gingival inflammation was associated with a non-significant increase in risk of preterm birth (BOP ≥30% vs no BOP: adjusted relative risk (aRR) 1.37, 95% CI: 0.81 to 2.32). A secondary analysis, stratifying participants by when in pregnancy their oral health status was assessed, showed an association between gingival inflammation and preterm birth among women examined in their first trimester (BOP ≥30% vs no BOP: aRR 2.57, 95% CI: 1.11 to 5.95), but not later in pregnancy (BOP ≥30% vs no BOP: aRR 1.05, 95% CI: 0.52 to 2.11).

CONCLUSIONS

Gingival inflammation in women examined early in pregnancy and poor oral hygiene behaviours were risk factors for preterm birth. Future studies should evaluate community-based oral health interventions that specifically target gingival inflammation, delivered early in or before pregnancy, on preterm birth.

TRIAL REGISTRATION NUMBER

Nepal Oil Massage Study, NCT01177111.

Self-reported and clinical periodontal conditions in a group of Eastern European postpartum women

Periodontitis is a highly prevalent condition leading to a continuous destruction of tooth-supporting tissues. It increases the risk for various systemic diseases and adverse pregnancy outcomes. Therefore, screening for periodontitis is important. Screening measures can range from self-reported symptoms to clinical full-mouth periodontal examination. The hypothesis of our study was that self-reported parameters and clinical definition perform equally well in identifying periodontitis patients. The aim of this study was to develop, validate its internal consistency, and evaluate a self-reported instrument against periodontal clinical evaluation for diagnosis of periodontitis in a group of postpartum women, as well as to describe their periodontal status and the risk factors associated with periodontal disease. A cross-sectional study on postpartum women was conducted in a tertiary university hospital, from April 2018 to March 2019. Sociodemographic and behavioral data, periodontal clinical parameters, and self-reported periodontal perception were collected. A 16-item questionnaire was developed to obtain information about perceived periodontal alterations and oral hygiene habits. The utility of the questionnaire was tested against a periodontal diagnosis based on a full-mouth periodontal examination. The questionnaire was applied in 215 postpartum women aged 29.16±5.54 years (mean age (y) ± standard deviation) having the following periodontal status: 16 individuals without periodontal disease (7.44%), 32 individuals with gingivitis (14.88%), 19 individuals with mild periodontitis (8.84%), 132 individuals with moderate periodontitis (61.39%), and 16 individuals with severe periodontitis (7.44%). A significant association was observed between oral hygiene score, smoking status, and periodontal conditions (p<0.05). A significant association between the self-reported items related to “gum swelling”, “halitosis”, “previous periodontal diagnosis” and “previous periodontal treatment” with clinical periodontitis have been identified (p<0.05). Using self-reported questionnaires for detection of periodontal disease was ineffective in our studied population, since self-reported parameters and clinical definition do not appear to perform equally in identifying periodontitis cases. Clinical periodontal examination remains the gold standard for screening. Periodontitis was frequent in our group and the severity was significantly associated with the oral hygiene score and smoking. These results underline the necessity for periodontal clinical examination during pregnancy.

Sociodemographic Differences in Health Awareness and Oral Health in Pregnant Women

Objective The aim of this study was to determine the present oral health status of pregnant women depending on selected sociodemographic differences and deduce any resulting consequences for health prevention.

Methods The participantsʼ data of relevance to the study such as age, school leaving qualification, migration background, smoking habits or last dentist visit were recorded using a questionnaire. The subsequent dental check-up concentrated on open carious lesions, any initiated root canal treatments and missing teeth. Finally, the Periodontal Screening Index was recorded to diagnose the presence of any gingivitis or periodontitis. The subsequent biometric evaluation comprised descriptive data analysis, χ2 test and logistical regression.

Results The higher the school leaving qualification, the lower the probability that a pregnant woman smoked prior to pregnancy (OR 0.291; 95% CI 0.114 – 0.743) and that tartar was diagnosed (OR 0.424; 95% CI 0.185 – 0.973). Regular dentist visits (OR 4.026; 95% CI 1.613 – 10.049) increase with the attained school leaving qualification. There is a greater chance that women born in Germany taking part in the study were aware of dental risks in pregnancy (OR 2.652; 95% CI 1.285 – 5.472) and attended the dentist during pregnancy (OR 2.507; 95% CI 1.281 – 4.907).

Conclusion The rate of awareness of the risks and consequences of pregnancy for oral health must be increased. The main aim for primary prophylaxis should be a reduction in the periodontal bacteria and caries of the mother and father.

Keyword Trends for Mother-Child Oral Health in Korea Based on Social Media Big Data from Naver

Objectives

The present study examined trends in search keywords related to the oral health of infants and pregnant women using “social media cafés” on the Korean portal site, Naver.

Methods

We obtained data from January 2015 to December 2017, collected by searching for common terms related to oral health, such as “dental caries”, “oral health”, “scaling”, “tooth brushing”, and “oral examination”. Search results for these terms were organized by frequency and visualized by increase in the font size with increasing frequency.

Results

The ranking of keywords on Naver cafés for pregnant women and women with infants was as follows (in descending order): “oral examination”, “tooth filling”, and “tooth brushing”. The “oral health” network was linked to “dental caries”, “oral health education”, and “tooth brushing”. In addition, the analysis of trends of keyword frequencies according to time periods showed that “dental caries” and “oral examination” were of highest interest to the café users.

Conclusions

We found a high interest in keywords related to preventive measures for the oral health of infants and children, but there was a lack of awareness regarding the oral health of pregnant women. These findings suggest that prevention in infants and pregnant women is necessary, and that public awareness regarding education about oral healthcare needs to be raised.

Exploring oral paleopathology in the Central Andes: A review

This targeted review of oral paleopathology in the Central Andes explores research that focuses on a set of interrelated, multifactorial processes: dental caries, macrowear, alveolar abscess, antemortem tooth loss (AMTL), periodontal disease, and the presence of dental calculus. These conditions help characterize oral health because they result from the culturally mediated interaction of individuals' oral cavity with their external environment. To better understand how osteologists working in the Central Andes have interpreted the frequencies of these conditions, I review the etiology of each, as well as discuss the important issues in their analyses. I then highlight studies that integrate of a number of oral paleopathological conditions, that examine associations between oral conditions and other skeletal indicators of health, or that use multivariate statistical techniques to analyze conditions. In the Central Andes, these proxies for oral health have generally focused on several key research themes including the introduction of domesticated foods may have occurred earlier than expected, but that populations may have maintained mixed subsistence strategies for a significant period. Researchers have also identified that changes accompanying Inca imperialism were likely not as detrimental to local populations as was Spanish colonialism. Finally, the long-practiced, culturally important, activity of chewing coca has been shown to create an identifiable pattern of oral paleopathological conditions.

Integrating oral health into prenatal care: a scoping review

Purpose

Integrating preventive oral care into prenatal care is suggested as a strategy for reducing the burden of oral diseases among pregnant women and their offspring. This scoping review sought to synthesize available information and identify knowledge gaps on integrating oral health into prenatal care.

Design/methodology/approach

The scoping review was conducted based on the Joanna Briggs Institute scoping review framework using the following databases: CINAHL, Cochrane Database of Systematic Reviews, Medline, ProQuest Dissertation and theses Global, Psychinfo and Web of Science®. No search limits were used. Content analysis of the included articles was performed to identify conceptual frameworks, types of integration used, study designs, study objectives and outcomes.

Findings

Overall, 2,861 references were obtained from the databases search; and based on the inclusion and exclusion criteria 35 references were included in the final analysis. Of these 35 references, one document presented a conceptual model, six documents reviewed guidelines for integrating oral health in prenatal care, two were policy documents aimed at interprofessional collaboration for oral health during pregnancy, eight documents described programs focused on providing oral care during pregnancy, five of the references were literature reviews and the remaining 13 evaluated the impact of integration. Linkages between healthcare professionals were the most common type of integration used.

Research limitations/implications

Despite advances in understanding integrated care concepts for healthcare delivery, there is little evidence available on the impact of the various types of, and strategies for, integrating oral health into prenatal care. Future research to bridge the identified gaps is recommended.

Originality/value

The originality of this study is to provide evidence on integrated oral healthcare during pregnancy.

Co-occurrence of yeast, streptococci, dental decay, and gingivitis in the post-partum period: results of a longitudinal study

Objective: The interactions between yeast and streptococci species that lead to dental decay and gingivitis are poorly understood. Our study describes these associations among a cohort of 101 post-partum women enrolled in the Center for Oral Health Research in Appalachia, 2012–2013.

Methods: All eligible women without dental caries were included (n = 21) and the remainder were randomly sampled to represent the total number of decayed, missing, and filled teeth (DMFT) at enrollment. We used amplicon sequencing and qPCR of saliva from 2, 6, 12 and 24 visits to determine microbiome composition.

Results: Active decay and generalized gingivitis were strongly predictive of each other. Using adjusted marginal models, Candida albicans and Streptococcus mutans combined were associated with active decay (OR = 3.13; 95% CI 1.26, 7.75). However, C. albicans alone (OR = 2.33; 95% CI: 0.81, 6.75) was associated with generalized gingivitis, but S. mutans alone was not (OR = 0.55; 95% CI: 0.21, 1.44). Models including microbiome community state types (CSTs) showed CSTs positively associated with active decay were negatively associated with generalized gingivitis.

Discussion: C. albicans is associated with active decay and generalized gingivitis, but whether one or both are present depends on the structure of the co-existing microbial community.

Relationship between preterm birth and post-partum periodontal maternal status: a hospital-based Romanian study

PURPOSE

This cross-sectional case-control study of post-partum women aimed to estimate whether maternal periodontitis was a predictive contributor to preterm birth and to identify other risk factors associated with preterm birth in our target population.

METHODS

The case group included women who delivered preterm (74 cases) and the control group included women who had a normal term delivery (120 controls). Medical records, a 16-item questionnaire, and a full-mouth periodontal examination were used to collect information about socio-demographic characteristics, general health problems, birth-related information, behavioral factors and periodontal status. Logistic regression analysis was used to estimate the strength of the relationship between predictors and the categorical outcome variable, preterm birth.

RESULTS

The bivariate analysis revealed the significant associations between preterm birth and socio-demographic factors (educational level, p = 0.003), antepartum smoking habit (p = 0.001) and birth weight lower than 2500 g (p < 0.001). The multivariate analysis highlighted that the presence of post-partum maternal periodontitis and its severity remained independent risk factors of preterm birth in the presence of antepartum smoking habit and route of delivery [adjusted OR 2.26, 95% CI (1.06; 4.82), respectively, OR 3.46, 95% CI (1.08; 11.15)].

CONCLUSION

Post-partum maternal periodontal disease and its severity might, in part, be considered as contributor to preterm deliveries before 37 weeks of gestation.

Disparities in Access to Oral Health Care

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

Impact of preconception vaginal microbiota on women's risk of spontaneous preterm birth: protocol for a prospective case-cohort study

INTRODUCTION

Bacterial vaginosis (BV) and vaginal microbiota disruption during pregnancy are associated with increased risk of spontaneous preterm birth (SPTB), but clinical trials of BV treatment during pregnancy have shown little or no benefit. An alternative hypothesis is that vaginal bacteria present around conception may lead to SPTB by compromising the protective effects of cervical mucus, colonising the endometrial surface before fetal membrane development, and causing low-level inflammation in the decidua, placenta and fetal membranes. This protocol describes a prospective case-cohort study addressing this hypothesis.

METHODS AND ANALYSIS

HIV-seronegative Kenyan women with fertility intent are followed from preconception through pregnancy, delivery and early postpartum. Participants provide monthly vaginal specimens during the preconception period for vaginal microbiota assessment. Estimated date of delivery is determined by last menstrual period and first trimester obstetrical ultrasound. After delivery, a swab is collected from between the fetal membranes. Placenta and umbilical cord samples are collected for histopathology. Broad-range 16S rRNA gene PCR and deep sequencing of preconception vaginal specimens will assess species richness and diversity in women with SPTB versus term delivery. Concentrations of key bacterial species will be compared using quantitative PCR (qPCR). Taxon-directed qPCR will also be used to quantify bacteria from fetal membrane samples and evaluate the association between bacterial concentrations and histopathological evidence of inflammation in the fetal membranes, placenta and umbilical cord.

ETHICS AND DISSEMINATION

This study was approved by ethics committees at Kenyatta National Hospital and the University of Washington. Results will be disseminated to clinicians at study sites and partner institutions, presented at conferences and published in peer-reviewed journals. The findings of this study could shift the paradigm for thinking about the mechanisms linking vaginal microbiota and prematurity by focusing attention on the preconception vaginal microbiota as a mediator of SPTB.

Preventive hygiene protocol of University of Milan for women during pregnancy: A qualitative and quantitative bacterial plaque analysis prospective original study

Introduction

The aim of this article is to describe the preventive hygiene protocol of University of Milan for women during pregnancy analyzing the bacterial plaque quantitatively and qualitatively.

Materials and methods

A sample of 35 pregnant women following a protocol of periodic visits starting from the first month of pregnancy until the childbirth and in follow up controls were analyzed. Several samples (n = 4) of bacterial plaque for quantitative and qualitative analysis were taken, from the lingual surface of the lower first molar, during the first visit (T0), during the first trimester (T1), during the second or third trimester of pregnancy (T2), and one month after childbirth (T3).

Results

By performing a quantitative analysis, it was calculated that the average plaque index (Fig. 1) was n = 48.1% (T0), n = 14.7% (T1), n = 18.4% (T2) and n = 18.9% (T3). The plaque index score presents a downward trend, passing from 48.1% (T0) to 18.9% (T3). The number of total cocci (Fig. 2) was n = 205.39 (T0), n = 57.5(T1), n = 74.6 (T2) and n = 75.4(T3). The number of total bacilli (Fig. 3) was n = 62.7 (T0), n = 23.1 (T1), n = 25.3 (T2), n = 27.1(T3). The total values of cocci and bacilli were correlated and the average trend of the various samples was calculated. By performing a qualitative analysis, the value of G+ cocci (Fig. 5) was n = 2.7 (T0), n = 1.4 (T1), n = 1.4 (T2) and n = 1.5 (T3). The value of G− cocci (Fig. 5) was n = 2.3 (T0), n = 0.7 (T1), n = 1.1 (T2) and n = 1.1 (T3). The value of G+ bacilli (Fig. 6) was n = 1.6 (T0), n = 0.9 (T1), n = 1.2 (T2) and n = 1.2 (T3). The value of G− bacilli (Fig. 6) was n = 1.3 (T0), n = 0.3 (T1), n = 0.7 (T2) and n = 0.7 (T3).

Conclusions

The preventive hygiene protocol used in the Dental Hygiene Department of the University of Milan, during the gestation period, is a suitable method for the control of the bacterial plaque. A considerably decrease of the plaque index and bacterial components between the first visit and the subsequent check-ups was calculated.

Factors associated with dental visit and barriers to the utilization of dental services among tribal pregnant women in Khurda district, Bhubaneswar: A cross-sectional study

Background:

There is a lack of knowledge related to the utilization of dental services by tribal pregnant women who constitute over 35% of the Indian population. The aim of the present study was to identify barriers to the utilization of the dental services and also the factors that concern the tribal mothers’ visit to the dental office.

Materials and Methods:

A total of 300 tribal mothers visiting a tertiary care unit participated in this cross-sectional, observational study. A pilot study with twenty participants was conducted before the commencement of the study. Data were collected using a modified questionnaire consisting of demographic data and questions relating to oral health knowledge, attitude, and practices, as well as barriers to the utilization of dental services and factors that concern dental visits during pregnancy. Data analysis was done using SPSS software package 21.0. Nonparametric statistical tests were done to analyze oral health knowledge and attitude of the participants. Various factors were identified using univariate and multivariate models using simple logistic regression analysis and multiple logistic regression analysis.

Results:

Among the two different tribes considered in the present study, the Saora tribe seemed to be more conscious toward oral health, and 29.7% of participants visited the dentist during pregnancy. The age and experience of the participants along with the educational level, employment status, and knowledge about oral health-related pregnancy outcomes influenced their dental visits. The most reported barrier included the lack of awareness and knowledge of the availability of the dental services. Accessibility and distance to the dental clinic were not found to be negative confounding factors among the participants for the utilization of the services.

Conclusion:

This study concludes that previous experience and consciousness of the mother to utilize the dental services played a vital role in the utilization of dental services among tribal pregnant women. However, the findings of the present study clearly indicate the need for further research to understand barriers to the utilization of dental services among underprivileged tribal groups of population.