Longitudinal study on clinical and microbial analysis of periodontal status in pregnancy

The effect of sex steroid hormones on the ecology of in vitro oral biofilms

Sex steroid hormones (SSH) such as oestrogen, progesterone and testosterone are cholesterol derived molecules that regulate various physiological processes. They are present in both blood and saliva, where they come in contact with oral tissues and oral microorganisms. Several studies have confirmed the effect of these hormones on different periodontal-disease-associated bacteria, using single-species models. Bacteria can metabolize SSH, use them as alternative for vitamin K and also use them to induce the expression of virulence factors. However, it is still unclear what the effects of SSH are on the oral microbiome. In this study, we investigated the effects of four SSH on commensal in vitro oral biofilms. Saliva-derived oral biofilms were grown in Mc Bain medium without serum or menadione using the Amsterdam Active-Attachment model. After initial attachment in absence of SSH, the biofilms were grown in medium containing either oestradiol, oestriol, progesterone or testosterone at a 100-fold physiological concentration. Menadione or ethanol were included as positive control and negative control, respectively. After 12 days with daily medium refreshments, biofilm formation, biofilm red fluorescence and microbial composition were determined. The supernatants were tested for proteolytic activity using the Fluorescence Resonance Energy Transfer Analysis (FRET). No significant differences were found in biofilm formation, red fluorescence or microbial composition in any of the tested groups. Samples grown in presence of progesterone and oestradiol showed proteolytic activity comparable to biofilms supplemented with menadione. In contrast, testosterone and oestriol showed a decreased proteolytic activity compared to biofilms grown in presence of menadione. None of the tested SSH had large effects on the ecology of in vitro oral biofilms, therefore a direct translation of our results into in vivo effects is not possible. Future experiments should include other host factors such as oral tissues, immune cells and combinations of SSH as present in saliva, in order to have a more accurate picture of the phenomena taking place in both males and females.

Sex Steroid Hormones as a Balancing Factor in Oral Host Microbiome Interactions

Sex steroid hormones (SSH) are cholesterol-derived molecules. They are secreted into saliva and enter the oral cavity, triggering physiological responses from oral tissues, with possible clinical implications, such as gingival inflammation and bleeding. SSH and hormonal changes affect not only oral host cells but also oral microorganisms.

Historically, most research has focused on the effect of hormonal changes on specific bacteria and yeasts. Recently a broader effect of SSH on oral microorganisms was suggested. In order to assess the role of SSH in host-microbe interactions in the oral cavity, this review focuses on how and up to what extent SSH can influence the composition and behavior of the oral microbiome. The available literature was reviewed and a comprehensive hypothesis about the role of SSH in host-microbiome interactions is presented. The limited research available indicates that SSH may influence the balance between the host and its microbes in the oral cavity.

Periodontology and pregnancy: An overview of biomedical and epidemiological evidence

Women are particularly susceptible to developing gingival problems during pregnancy. In addition, periodontal disease in pregnant women may lead to adverse outcomes for both mother and infant, which have serious clinical and public health implications. Both scenarios have been extensively researched, helping to bring attention to pregnant women as an important and vulnerable population as it concerns periodontal health. The increase in gingival inflammation caused by hormonal changes in pregnant women is undisputed and has been studied and documented since the 1960s, although the exact etiology is not fully understood. The relationship between periodontal disease during pregnancy and adverse pregnancy outcomes is less substantiated, because of conflicting evidence. This review of the biomedical and epidemiologic literature provides an overview of both sides of this relationship and examines the potential mechanisms for developing periodontal disease during pregnancy and the proposed mechanisms by which periodontal disease leads to adverse pregnancy outcomes.

Oral microflora and pregnancy: a systematic review and meta-analysis

Understanding changes in oral flora during pregnancy, its association to maternal health, and its implications to birth outcomes is essential. We searched PubMed, Embase, Web of Science, and Cochrane Library in May 2020 (updated search in April and June 2021), and conducted a systematic review and meta-analyses to assess the followings: (1) oral microflora changes throughout pregnancy, (2) association between oral microorganisms during pregnancy and maternal oral/systemic conditions, and (3) implications of oral microorganisms during pregnancy on birth outcomes. From 3983 records, 78 studies were included for qualitative assessment, and 13 studies were included in meta-analysis. The oral microflora remains relatively stable during pregnancy; however, pregnancy was associated with distinct composition/abundance of oral microorganisms when compared to postpartum/non-pregnant status. Oral microflora during pregnancy appears to be influenced by oral and systemic conditions (e.g. gestational diabetes mellitus, pre-eclampsia, etc.). Prenatal dental care reduced the carriage of oral pathogens (e.g. Streptococcus mutans). The Porphyromonas gingivalis in subgingival plaque was more abundant in women with preterm birth. Given the results from meta-analyses were inconclusive since limited studies reported outcomes on the same measuring scale, more future studies are needed to elucidate the association between pregnancy oral microbiota and maternal oral/systemic health and birth outcomes.

Oral Status in Pregnant Women from Post-Industrial Areas of Upper Silesia in Reference to Occurrence of: Preterm Labors, Low Birth Weight and Type of Labor

Increased levels of steroid hormones, action of local irritants and the lack of proper hygiene measures are of great importance in the development of dental caries, gingivitis and inflammation of the periodontal area in pregnant women. The aim of the study was to evaluate the state of oral hygiene and the periodontal area is such a population and assess the effectiveness of performed hygiene treatments and analyse changes in hygiene habits after oral hygiene instructions. The study was performed in two parts on a group of 50 pregnant women. The first part took place between the 14th and 17th week of pregnancy. The control study was conducted between the 27th and 30th week of pregnancy. Patients were subjected to a dental examination. Poor oral hygiene was observed among the examined patients. After the first examination, oral hygiene instruction was provided to 25 randomly selected pregnant patients. The effect of periodontal diseases on the time of labor was observed. Oral hygiene instructions significantly affected the state of the periodontal area of pregnant women for whom it was performed. It was confirmed that the advancement of pregnancy influences deterioration of the periodontium and also term of childbirth. Undoubtedly, pregnant women receive insufficient dental care. Priority should be given to dental care education of for pregnant women and alleviating the impact of oral diseases on the organism of a pregnant woman.

A Cross-Sectional Analysis of Dental Care Utilization Among Pregnant Women in Saudi Arabia

BACKGROUND:

Oral and systemic problems are common among pregnant women. Routine dental visits are important for the maintenance of optimal oral health which is linked with systemic health.

AIM:

To evaluate dental care utilization and related factors among pregnant women in the Eastern province of Saudi Arabia.

METHODS:

This cross-sectional study was conducted in hospitals and healthcare centers in the cities of Khobar, Dammam, and Qatif in the Eastern province of Saudi Arabia. A piloted tested self-administered questionnaire available in Arabic and English languages was distributed among a calculated sample of 341 pregnant women. Pearson’s chi-square test and multiple logistic regression analyses were performed.

RESULTS:

In the study, 270 questionnaires were analyzed giving a response rate of 79.2%. Mean age of the participants was 29 ± 5.9 years. There were 43.7% pregnant women who received dental treatment when they have a dental problem and only 13.7% performed routine dental visit. Half the sample (52.6%) avoided dental visits during pregnancy and dental treatment being unsafe was the most common reason for avoiding dental visits. After adjustment, routine dental visits during pregnancy were 7.38 times higher among Saudis compared with non-Saudis women (p 0.05). The participants who had a negative perception about the safety of dental treatment had significantly lower odds (OR 0.31, p 0.036) of dental attendance for routine dental visits.

CONCLUSION:

Routine dental visits were low among pregnant women and many visited dentists when they had a dental problem. Negative perception about the safety of dental treatment was associated with reduced regular dental visits during pregnancy. Pregnant women should be educated about the importance of receiving dental care for the maintenance of optimal oral health.

Pregnancy, parity and periodontal disease

Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post-partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.