The effect of female sex hormones on subgingival plaque

Periodontitis exacerbation during pregnancy in mice: Role of macrophage migration inhibitory factor as a key inductor

OBJECTIVE

The present study was designed to investigate the role of macrophage migration inhibitory factor (MIF) in the exacerbation of pregestational periodontal disease (PGPD).

BACKGROUND

Periodontitis (PT) is a severe stage of periodontal disease characterized by inflammation of the supporting tissues of the teeth, which usually worsens during pregnancy. MIF is a proinflammatory cytokine that is significantly elevated in periodontitis, both at the beginning and at the end of pregnancy. Although periodontitis usually presents with greater severity during pregnancy, the participation of MIF in the evolution of periodontitis has not been established.

METHODS

To analyze the relevance of MIF in the exacerbation of PGPD, we employed a model of PGPD in WT and Mif-/- mice, both with a BALB/c genetic background. PT was induced with nylon suture ligatures placed supramarginally around the second upper right molar. For PGPD, PT was induced 2 weeks before mating. We evaluated histological changes and performed histometric analysis of the clinical attachment loss, relative expression of MMP-2 and MMP-13 by immunofluorescence, and relative expression of the cytokines mif, tnf-α, ifn-γ, and il-17 by quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS

Our data revealed that periodontal tissue from PGPD WT mice produced a twofold increase in MIF compared with PT WT mice. Moreover, the evolution of periodontitis in Mif-/- mice was less severe than in PGDP WT mice. Periodontal tissue from Mif-/- mice with PGPD produced 80% less TNF-α and no IFN-γ, as well as 50% lower expression of matrix metalloproteinase (MMP)-2 and 25% less MMP-13 compared to WT PGDP mice.

CONCLUSIONS

Our study suggests that MIF plays an important role in the exacerbation of periodontitis during pregnancy and that MIF is partially responsible for the inflammation associated with the severity of periodontitis during pregnancy.

Trends in maternal oral health services at primary healthcare centers in Saudi Arabia: a cross-sectional study

BACKGROUND

During pregnancy, many complex physiological changes and increased levels of pregnancy hormones are associated with adverse oral health and increased prevalence of periodontal disease. Our study aimed to assess the oral health needs of pregnant women and describe the patterns of dental services provided to them before, during, and after pregnancy. Assessing the oral health needs of pregnant women and understanding the patterns of dental services provided to them are important to facilitate efficient utilization of oral health services to promote better health outcomes for the mother and baby.

METHODS

Our study utilized a cross-sectional design to examine the prevalence of dental problems and use of dental services among a sample of postpartum women who visited primary healthcare centers (PHCs) in Jeddah for antenatal care, between 2018 and 2019. A link to a questionnaire adapted from the Pregnancy Risk Assessment Monitoring System (PRAMS) was sent to participants via the WhatsApp messaging platform. A total of 1350 postpartum women responded to the online survey. We estimated the prevalence of dental problems among women before and during pregnancy and assessed the association between their dental problems and their respective demographic characteristics. We calculated the prevalence of each dental service received before, during, and after pregnancy and examined the trends in dental services over these three periods. All bivariate associations were tested using Pearson's chi-squared test.

RESULTS

We found that significantly fewer women visited a dental clinic during pregnancy (31.0%) compared to pre-pregnancy (38.2%) and post-pregnancy (47.3%). The prevalence of toothache, dental caries, gum disease, and dental extraction need before pregnancy was 45.9%, 57.0%, 27.3%, and 40.0%, respectively. These percentages remained the same during pregnancy, except for the need for dental extraction, which significantly decreased to 35.3%. Check-up dental visits increased significantly to 70.6% during pregnancy compared to pre-pregnancy (51.7%) and post-pregnancy (59.9%).

CONCLUSION

Increasing women's awareness of the importance and safety of oral healthcare during pregnancy, training dental students and primary healthcare dentists in the practice guidelines for the dental management of pregnant women, and developing and monitoring key performance indicators for maternal oral healthcare are the starting steps for improving the oral health and well-being of women and their children.

The Maternal Microbiome and Gestational Diabetes Mellitus: Cause and Effect

Gestational diabetes mellitus (GDM) is a growing public health concern that affects many pregnancies globally. The condition is associated with adverse maternal and neonatal outcomes including gestational hypertension, preeclampsia, placental abruption, preterm birth, stillbirth, and fetal growth restriction. In the long-term, mothers and children have an increased risk of developing metabolic diseases such as type 2 diabetes and cardiovascular disease. Accumulating evidence suggest that alterations in the maternal microbiome may play a role in the pathogenesis of GDM and adverse pregnancy outcomes. This review describes changes in the maternal microbiome during the physiological adaptations of pregnancy, GDM and adverse maternal and neonatal outcomes. Findings from this review highlight the importance of understanding the link between the maternal microbiome and GDM. Furthermore, new therapeutic approaches to prevent or better manage GDM are discussed. Further research and clinical trials are necessary to fully realize the therapeutic potential of the maternal microbiome and translate these findings into clinical practice.

Relationship between the subgingival microbiome and menopausal hormone therapy use: The Buffalo OsteoPerio study

BACKGROUND

This study investigated the association between menopausal hormone therapy (HT) use and the subgingival microbiome, for which published information is limited.

METHODS

This cross-sectional study included 1270 postmenopausal women, aged 53-81 years, who completed clinical examinations. Detailed information on HT use (type, delivery mode, duration) was obtained from questionnaires. HT use was categorized into three groups (never, former, current). 16S rRNA sequencing was performed on subgingival plaque samples obtained during dental examinations. Operational taxonomic units were centered log2-ratio (CLR) transformed to account for the compositional data structure. Analysis of variance was used to compare mean microbial relative abundances across HT categories with Benjamini-Hochberg correction.

RESULTS

Significantly higher alpha diversity (Shannon Index) and beta diversity (Aitchison distance) was observed in never compared with current HT users (p < 0.05, each). Of the total 245 microbial taxa identified, 18 taxa differed significantly among the three HT groups, 11 of which were higher in current users and seven of which were lower in current users as compared with never users (p < 0.05, each). Differences in relative abundance between never and current HT users were materially unchanged after adjustment for age, body mass index, and oral hygiene.

CONCLUSIONS

Relative abundance of several subgingival bacteria differed significantly between never and current HT users in a cohort of postmenopausal women. Additional studies are needed to determine the extent that these relationships might account for the previously reported inverse association between HT use and periodontal disease in older women.

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.

Oral microbiome shifts during pregnancy and adverse pregnancy outcomes: Hormonal and Immunologic changes at play

Because of hormonal and immunologic changes, there are significant changes in the oral microbiome that emerge during pregnancy. Recent evidence further suggests that there is an association between the presence of periodontal disease and a pregnancy‐associated oral dysbiosis. Although this oral dysbiosis and pathogenic periodontal bacteria are considered to be associated with adverse pregnancy outcomes, it is still not clear how an oral dysbiosis during pregnancy can modulate oral diseases and birth outcomes. To develop preventive or therapeutic interventions, it is critical to understand the oral microbiome changes that emerge during pregnancy and their association with adverse pregnancy outcomes. In the present review, we summarize the current literature on normal changes in the oral microbiome that occur during pregnancy; the pathogenic changes in the oral microbiome believed to occur in association with adverse pregnancy outcomes; and the association between the placental microbiome and the oral microbiome.

Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures

Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.

Dysbiosis of the Human Oral Microbiome During the Menstrual Cycle and Vulnerability to the External Exposures of Smoking and Dietary Sugar

Physiological hormonal fluctuations exert endogenous pressures on the structure and function of the human microbiome. As such, the menstrual cycle may selectively disrupt the homeostasis of the resident oral microbiome, thus compromising oral health. Hence, the aim of the present study was to structurally and functionally profile the salivary microbiome of 103 women in reproductive age with regular menstrual cycle, while evaluating the modifying influences of hormonal contraceptives, sex hormones, diet, and smoking. Whole saliva was sampled during the menstrual, follicular, and luteal phases (n = 309) of the cycle, and the participants reported questionnaire-based data concerning their life habits and oral or systemic health. No significant differences in alpha-diversity or phase-specific clustering of the overall microbiome were observed. Nevertheless, the salivary abundances of genera Campylobacter, Haemophilus, Prevotella, and Oribacterium varied throughout the cycle, and a higher species-richness was observed during the luteal phase. While the overall community structure maintained relatively intact, its functional properties were drastically affected. In particular, 11 functional modules were differentially abundant throughout the menstrual cycle, including pentose phosphate metabolism, and biosynthesis of cobalamin and neurotransmitter gamma-aminobutyric acid. The menstrual cycle phase, but not oral contraceptive usage, was accountable for greater variations in the metabolic pathways of the salivary microbiome. Further co-risk factor analysis demonstrated that Prevotella and Veillonella were increased in current smokers, whereas high dietary sugar consumption modified the richness and diversity of the microbiome during the cycle. This is the first large study to systematically address dysbiotic variations of the oral microbiome during the course of menstrual cycle, and document the additive effect of smoking and sugar consumption as environmental risk factors. It reveals the structural resilience and functional adaptability of the oral microbiome to the endogenous hormonal pressures of the menstrual cycle, while revealing its vulnerability to the exogenous exposures of diet and smoking.

Oral microbiome and pregnancy: A bidirectional relationship

The oral cavity contains the second most complex microbial population within the human body, with more than 700 bacterial organisms. Recent advances in Next Generation Sequencing technology have unraveled the complexities of the oral microbiome and provided valuable insights into its role in health and disease. The human oral microbiome varies dramatically during the different stages of life, including pregnancy. The total viable microbial counts in pregnant women are known to be higher compared to non-pregnant women, especially in the first trimester of pregnancy. A balanced oral microbiome is vital for a healthy pregnancy, as perturbations in the oral microbiome composition can contribute to pregnancy complications. On the other hand, physiological changes and differences in hormonal levels during pregnancy, increase susceptibility to various oral diseases such as gingivitis and periodontitis. A growing body of evidence supports the link between the composition of the oral microbiome and adverse pregnancy outcomes such as preterm birth, preeclampsia, low birth weight among others. This review aims to summarize the dynamics of oral microbiome during pregnancy and to discuss the relationship between a dysbiotic oral microbiome and pregnancy complications.

Is the use of contraceptives associated with periodontal diseases? A systematic review and meta-analyses

BACKGROUND

Previous studies indicated an impact of hormonal contraceptive use on oral health. This systematic review aimed to investigate the evidence supporting the impact of the use of hormonal contraceptives and periodontal diseases.

METHODS

This study is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and based on the PECO acrostic. Inclusion criteria comprised observational studies including women (P), which evaluated hormonal contraceptive users (E) and hormonal contraceptive non-users (C), to verify the association between this hormonal therapy and the periodontal diseases (O). Searches were performed on 5 databases: PubMed, Scopus, Web of Science, Cochrane Library, LILACS and grey literature (OpenGrey and Google Scholar). After the selection process, the included studies were evaluated qualitatively. Moreover, quantitative data were analyzed in two meta-analyses for clinical attachment loss (CAL) and probing depth (PD). Finally, the level of certainty was measured with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool between periodontal clinical parameters.

RESULTS

18 articles were eligible for the qualitative synthesis and 7 of them were selected for quantitative analysis. Hence, 15 of the eligible articles reported an association between the use of hormonal contraceptives and severity of periodontal disease. However, 6 articles demonstrated high risk of bias and were excluded from quantitative synthesis. The meta-analysis showed a statistically significant difference for CAL (MD 0.24 [0.09, 0.40]; p = 0.002), but in PD (MD 0.05 [- 0.05, 0.15]; p = 0.33) such difference was not identified. A very low level of evidence was found between the clinical parameters.

CONCLUSIONS

The use of hormonal contraceptives may be associated to severity of periodontal diseases. However, the quantitative analysis points to an inconclusive outcome due to the high level of heterogeneity. The association is biologically plausible, however additional studies are warranted to better elucidate the clinical significance of this possible association.

[Treatment strategy for pregnancy epulis]

Pregnancy epulis is a tumor-like lesion with high prevalence in China. The local lesion, the general condition of the pregnant patient, and the complications during treatment should be taken into consideration when making a treatment plan for pregnancy epulis. In this study, three representative pregnancy epulis cases were presented, and related studies at home and aboard were reviewed to summarize the etiology, differential diagnosis, treatment, and prevention of pregnancy epulis and share the clinical experience in the treatment of pregnancy epulis.

Alternations of gut microbiota composition in neonates conceived by assisted reproductive technology and its relation to infant growth

The gut microbiome in newborns may be strongly influenced by their intrinsic host microenvironmental factors (e.g., the gestational age) and has been linked to their short-term growth and potentially future health. It is yet unclear whether early microbiota composition is significantly different in newborns conceived by assisted reproductive technology (ART) when compared with those who were conceived spontaneously. Additionally, little is known about the effect of gut microbiota composition on weight gain in early infancy. We aimed to characterize the features and the determinants of the gut microbiome in ART newborns and to assess the impact of early microbiota composition on their weight gain in early infancy in mother-infant dyads enrolled in the China National Birth Cohort (CNBC). Among 118 neonates born by ART and 91 neonates born following spontaneous conception, we observed significantly reduced gut microbiota α-diversity and declined Bacteroidetes relative abundance in ART neonates. The microbiota composition of ART neonates was largely driven by specific ART treatments, hinting the importance of fetus intrinsic host microenvironment on the early microbial colonization. Following up these neonates for six months after their births, we observed the effects of gut microbiome composition on infant rapid weight gaining. Collectively, we identified features and determinants of the gut microbiota composition in ART neonates, and provided evidence for the importance of microbiota composition in neonatal growth.

Unculturable and culturable periodontal-related bacteria are associated with periodontal inflammation during pregnancy and with preterm low birth weight delivery

Recent studies revealed culturable periodontal keystone pathogens are associated with preterm low birth weight (PLBW). However, the oral microbiome is also comprised of hundreds of 'culture-difficult' or 'not-yet-culturable' bacterial species. To explore the potential role of unculturable and culturable periodontitis-related bacteria in preterm low birth weight (PLBW) delivery, we recruited 90 pregnant women in this prospective study. Periodontal parameters, including pocket probing depth, bleeding on probing, and clinical attachment level were recorded during the second trimester and following interviews on oral hygiene and lifestyle habits. Saliva and serum samples were also collected. After delivery, birth results were recorded. Real-time PCR analyses were performed to quantify the levels of periodontitis-related unculturable bacteria (Eubacterium saphenum, Fretibacterium sp. human oral taxon(HOT) 360, TM7 sp. HOT 356, and Rothia dentocariosa), and cultivable bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum and Prevotella intermedia) in saliva samples. In addition, ELISA analyses were used to determine the IgG titres against periodontal pathogens in serum samples. Subjects were categorized into a Healthy group (H, n = 20) and periodontitis/gingivitis group (PG, n = 70) according to their periodontal status. The brushing duration was significantly lower in the PG group compared to the H group. Twenty-two of 90 subjects delivered PLBW infants. There was no significant difference in periodontal parameters and serum IgG levels for periodontal pathogens between PLBW and healthy delivery (HD) groups. However, ordinal logistic regression analysis revealed that a higher abundance of Treponema denticola, Prevotella intermedia, Fretibacterium sp. HOT360 and lower levels of Rothia dentocariosa were significantly associated with the presence of periodontal disease during pregnancy. Moreover, the amount of Eubacterium saphenum in saliva and serum IgG against Aggregatibacter actinomycetemcomitans were negatively correlated with PLBW. Taken together, unculturable periodontitis-associated bacteria may play an important role both in the presence of periodontal inflammation during pregnancy and subsequent PLBW.

[Multiple pregnancy epulides: a case report]

Pregnancy epulis is a tumor-like lesion that results from aggravating gingivitis due to high level of gonadal hormone concentration. Pregnancy epulis is commonly manifested as a single lump. A case of multiple pregnancy epulises, which has been rarely explored, is reported in this paper. The patient received no other treatment but a single supragingival scaling. Results showed no remarkable changes in the lesion. However, all the epulides regressed spontaneously in five months after the parturition.

The oral microbiota - a mechanistic role for systemic diseases

Human oral microbiota is the ecological community of commensal, symbiotic, and pathogenic microorganisms found in the oral cavity. Oral microbiota generally exists in the form of a biofilm and plays a crucial role in maintaining oral homeostasis, protecting the oral cavity and preventing disease development. Human oral microbiota has recently become a new focus research for promoting the progress of disease diagnosis, assisting disease treatment, and developing personalised medicines. In this review, the scientific evidence supporting the association that endogenous and exogenous factors (diet, smoking, drinking, socioeconomic status, antibiotics use and pregnancy) modulate oral microbiota. It provides insights into the mechanistic role in which oral microbiota may influence systemic diseases, and summarises the challenges of clinical diagnosis and treatment based on the microbial community information. It provides information for noninvasive diagnosis and helps develop a new paradigm of personalised medicine. All these benefit human health in the post-metagenomics era.

Prevalence of oral mucosal disorders during pregnancy: A systematic review and meta‐analysis

OBJECTIVE

To assess the prevalence of oral mucosal disorders during pregnancy.

METHODS

Observational studies were selected by two reviewers in a two-phase process. Search strategies were applied at CINAHL, LILACS, LIVIVO, PubMed, Scopus, Web of Science, Google Scholar, OpenGrey, and ProQuest. The risk of bias was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data. Synthesis of results was calculated by the software R Statistics version 3.5.1 (The R Foundation, Vienna, Austria). Confidence in cumulative evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

Fifteen studies met the eligibility criteria and were selected for qualitative synthesis and meta-analysis, of which 5935 participants were enrolled. The overall prevalence of oral mucosal disorders was 11.8%. Gingival hyperplasia (17.1%), morsicatio buccarum (10%), oral candidiasis (4.4%), pyogenic granuloma (3%), and benign migratory glossitis (2.8%) were the most prevalent lesions. The overall risk of bias was considered moderate, and the quality of evidence was very low.

CONCLUSION

Disorders of the oral mucosa were present in approximately 1 out of 10 pregnant women. Gingival hyperplasia was the most prevalent lesion. Further studies should apply homogeneous methodology to improve the quality of evidence.

Keystone Species in Pregnancy Gingivitis: A Snapshot of Oral Microbiome During Pregnancy and Postpartum Period

It is well known that pregnancy is under the constant influence of hormonal, metabolic and immunological factors and this may impact the oral microbiota toward pregnancy gingivitis. However, it is still not clear how the oral microbial dysbiosis can modulate oral diseases as oral microbiome during pregnancy is very poorly characterized. In addition, the recent revelation that placental microbiome is akin to oral microbiome further potentiates the importance of oral dysbiosis in adverse pregnancy outcomes. Hence, leveraging on the 16S rRNA gene sequencing technology, we present a snapshot of the variations in the oral microbial composition with the progression of pregnancy and in the postpartum period and its association with pregnancy gingivitis. Despite the stability of oral microbial diversity during pregnancy and postpartum period, we observed that the microbiome makes a pathogenic shift during pregnancy and reverts back to a healthy microbiome during the postpartum period. Co-occurrence network analysis provided a mechanistic explanation of the pathogenicity of the microbiome during pregnancy and predicted taxa at hubs of interaction. Targeting the taxa which form the ecological guilds in the underlying microbiome would help to modulate the microbial pathogenicity during pregnancy, thereby alleviating risk for oral diseases and adverse pregnancy outcomes. Our study has also uncovered the possibility of novel species in subgingival plaque and saliva as the key players in the causation of pregnancy gingivitis. The keystone species hold the potential to open up avenues for designing microbiome modulation strategies to improve host health during pregnancy.

Pregnancy-induced periodontal inflammation: Influence of salivary cytokines and antimicrobial proteins

The aim of this study was to evaluate the association between pregnancy-induced periodontal inflammation and levels of some salivary cytokines and antimicrobial proteins (AMPs). The study was a cohort longitudinal study that included pregnant women attending a secondary health facility. Consented participants had oral examination and saliva sampling during pregnancy and post-partum (three months after pregnancy). Saliva samples were used for the analysis of cytokines (TNF-α, IFN-gamma and IL-1β) and AMPs (Lactoferin, Lysozyme, and β defensin-1) using ELISA. Data are presented as median with interquartile range and compared using related sample Wilcoxon signed rank test. Correlations between levels of the salivary factors and indices of periodontal inflammation were determined using Spearman’s correlation test. Salivary flow rate, pH, levels of salivary IL-1β and IFN-gamma were significantly lower; while gingival index, periodontal index and level of salivary TNF-α were significantly higher during pregnancy compared with postpartum period. However, salivary lactoferin, lysozyme and β defensin-1 did not show significant difference comparing during pregnancy and postpartum period. Level of salivary IFN-gamma showed negative correlation with gingival index while level of salivary TNF-α showed positive correlation with gingival and periodontal indices. Lower levels of salivary IL-1β and IFN-gamma along with higher TNF-α concentration during pregnancy suggest their contributions to the pathophysiology of pregnancy-induced periodontal inflammation.

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.

Oral hygiene status, gingival status, periodontal status, and treatment needs among pregnant and nonpregnant women: A comparative study

Objectives:

The gingival and periodontal changes during pregnancy are well known. Gingivitis is the most prevalent oral manifestations associated with pregnancy. The hormonal and vascular changes that accompany pregnancy are known to exaggerate the inflammatory response to the local irritants. Hence, a study was designed to assess oral hygiene status, gingival status, periodontal status, and treatment needs (TNs) among pregnant and nonpregnant women.

Materials and Methods:

A cross-sectional study was conducted among 120 pregnant and 120 nonpregnant women of 18–44 years age attending the Outpatient Department of Gynaecology and Obstetrics in Government Hospital of Belgaum city, Karnataka, India. The study consisted of an interview and oral examination. Type 3 examination was followed. Simplified Oral Hygiene Index (OHI-S), Gingival Index, and Community Periodontal Index and TNs Index were used to assess “oral hygiene status,” “gingival status,” and “periodontal status and TNs,” respectively.

Results:

The pregnant women showed poor oral hygiene with the mean OHI-S score as 2.68. Gingivitis was prevalent in almost all the pregnant and nonpregnant women. However, it was found more severe in pregnant women with mean gingival score as 1.25. A definite increase in gingivitis was found from Trimester II to Trimester III. The mean number of sextants showing healthy gingiva was significantly (P < 0.01) lower among pregnant women.

Conclusions:

Pregnant women showed poor oral hygiene, more gingival inflammation, and more periodontal disease as compared to nonpregnant women. The severity of gingivitis increased in Trimester III. Proper oral hygiene practice can prevent these diseases and further complications.

The effect of training interventions on the psychological factors of oral health in pregnant women

Background and aim

Oral health is crucial for high-risk pregnant women in order to preserve their health and the health of their infants. Therefore, this study aimed to determine the impact of training programs on the behavior of pregnant mothers concerning oral health in Khorramabad, Iran.

Methods

This is an educational experimental study carried out in 2015 on 164 pregnant women referring to health centers in the city of Khorramabad who were randomly divided into two groups (each n=82). The instruments for data collection included a questionnaire based on the Health Belief Model regarding oral health and two checklists of oral health indexes (OHIS and DMFT). Data were analyzed using SPSS 20 via paired-samples t-test, independent-samples t-test and Chi-square.

Results

The mean score of knowledge and performance, and the variables of the components of the Health Belief Model including the perceived susceptibility, severity, benefits, barriers and self-efficacy regarding the oral health care, significantly increased in the intervention group following the training intervention (p<0.001). However, the DMFT index did not show any changes after the intervention in the intervention and control groups (p=0.381). On the other hand, the OHIS index significantly decreased in the intervention group as compared with the pre-intervention scores (p=0.002).

Conclusion

The results of this study showed that training based on the Health Belief Model leads to the enhancement of performance regarding oral health in pregnant women and thus prevents any increase in OHIS and DMFT levels during pregnancy.

[Management of oral diseases during pregnancy]

Management of oral diseases during pregnancy prefers to be a comprehensive oral health care strategy throughout pre-pregnant, pregnant and prenatal stages. It provides guidance not only to promote the overall health in pregnant women, but also concern fetus development and children's oral health. Pregnancy is a time of particular vulnerability in terms of oral health due to complex physical and physiological changes. Physicians and dentists are responsible for providing professional medical care and treatment following clinical guidelines especially for pregnancy. It is also an opportune time in pregnancy to educate women about oral health care and preventing oral problems in young children. This article reviews the commonly occurring oral problems and their pathogenesis during pregnancy, dental procedures that can be carried out by physicians and preventive strategies that could be helpful in promoting oral health in both pregnant women and young children.

Periodontal Health Status and Associated Factors: Findings of a Prenatal Oral Health Program in South Brazil

Objective. The aims of this study were to evaluate the periodontal health of pregnant women and to investigate the association of periodontal status with demographic and socioeconomic characteristics, as well as medical and dental history. Materials and Methods. A total of 311 pregnant women were interviewed to obtain sociodemographic data along with medical and dental histories. Clinical examinations were performed to record the presence of visible plaque, gingival bleeding, and caries activity. The periodontal condition was evaluated by Community Periodontal Index of Treatment Needs (CPITN) in one tooth of each sextant (16, 11, 26, 36, 31, and 46). Results. After the adjustment analysis, the presence of visible plaque remained the main determinant of gingival bleeding (OR = 2.91, CI = 1.91–4.48). First-trimester pregnancy status was also a predictor, with a lower prevalence of gingival bleeding observed in the second (OR = 0.87, CI = 0.77–0.99) and third (OR = 0.82, CI = 0.73–0.93) trimesters. Conclusion. In pregnant women, the presence of dental plaque and first-trimester pregnancy status were the main implicated factors predicting gingival bleeding.

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

This study was aimed to provide a longitudinal overview of the subgingival bacterial microbiome using fluorescence in situ hybridization (FISH) technique, in women in the second trimester of pregnancy (between 14 and 24 weeks), and 48 h and 8 weeks postpartum. Of 31 women evaluated during pregnancy, 24 returned for the 48-h and 18 for their 8-week exams postpartum. Probing depth (PD), bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected, and FISH was used to identify the numbers of eight periodontal pathogens. Friedman test was used to compare differences between follow-up examinations, followed by a multiple comparison test for a post hoc pairwise comparison. Clinically, a significantly greater number of teeth with PD = 4-5 mm were found during pregnancy than on postpartum examinations. Microbial analysis showed a statistically significant decrease in cell count over the study period for Prevotella nigrescens. P. intermedia, Campylobacter rectus, and Porphyromonas gingivalis also decrease, although not significantly, and Aggregatibacter actinomycetemcomitans increased. No significant changes were found for Fusobacterium nucleatum, Treponema denticola, or Tannerella forsythia. Our data demonstrate a change in the subgingival microbiota during pregnancy, at least for P. nigrescens.

Smoking, pregnancy and the subgingival microbiome

The periodontal microbiome is known to be altered during pregnancy as well as by smoking. However, despite the fact that 2.1 million women in the United States smoke during their pregnancy, the potentially synergistic effects of smoking and pregnancy on the subgingival microbiome have never been studied. Subgingival plaque was collected from 44 systemically and periodontally healthy non-pregnant nonsmokers (control), non-pregnant smokers, pregnant nonsmokers and pregnant smokers and sequenced using 16S-pyrotag sequencing. 331601 classifiable sequences were compared against HOMD. Community ordination methods and co-occurrence networks were used along with non-parametric tests to identify differences between groups. Linear Discriminant Analysis revealed significant clustering based on pregnancy and smoking status. Alpha diversity was similar between groups, however, pregnant women (smokers and nonsmokers) demonstrated higher levels of gram-positive and gram-negative facultatives, and lower levels of gram-negative anaerobes when compared to smokers. Each environmental perturbation induced distinctive co-occurrence patterns between species, with unique network anchors in each group. Our study thus suggests that the impact of each environmental perturbation on the periodontal microbiome is unique, and that when they are superimposed, the sum is greater than its parts. The persistence of these effects following cessation of the environmental disruption warrants further investigation.

The Oral Microbiota

The oral microbiota represents an important part of the human microbiota, and includes several hundred to several thousand diverse species. It is a normal part of the oral cavity and has an important function to protect against colonization of extrinsic bacteria which could affect systemic health. On the other hand, the most common oral diseases caries, gingivitis and periodontitis are based on microorganisms. While (medical) research focused on the planktonic phase of bacteria over the last 100 years, it is nowadays generally known, that oral microorganisms are organised as biofilms. On any non-shedding surfaces of the oral cavity dental plaque starts to form, which meets all criteria for a microbial biofilm and is subject to the so-called succession. When the sensitive ecosystem turns out of balance - either by overload or weak immune system - it becomes a challenge for local or systemic health. Therefore, the most common strategy and the golden standard for the prevention of caries, gingivitis and periodontitis is the mechanical removal of this biofilms from teeth, restorations or dental prosthesis by regular toothbrushing.

Significant increase of oral bacteria in the early pregnancy period in Japanese women

AIM

Oral microflora during pregnancy is critical to oral health care in the mother and her child. We examined the changes in the oral microbiota between pregnancy and nonpregnancy periods.

METHODS

The study was performed using 132 healthy pregnant women enrolled from Hiroshima City Asa Citizens Hospital and 51 healthy nonpregnant women as control. During pregnancy, 132 subjects were assessed for seven microbial species by the cultured method and polymerase chain reaction at the early (7-16 weeks gestation), the middle (17-28 weeks), and the late (29-39 weeks) pregnancy periods. Pregnant women completed a series of questionnaires regarding oral and systemic health and lifestyle habits.

RESULTS

The total cultivable microbial counts in the early pregnancy were significantly higher than that of the nonpregnant women (P < 0.05). The incidences of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in gingival sulcus during the early and middle pregnancy were significantly higher than the nonpregnant group (P < 0.05), while Prevotella intermedia and Fusobacterium nucleatum did not change. Candida species were more frequently detected during the middle and late pregnancy.

CONCLUSION

The data suggest that pregnancy, especially in the early periods, promotes the proliferation of microorganisms in the oral cavity and facilitates a colonization of periodontal pathogens.

Temporal and spatial variation of the human microbiota during pregnancy

Despite the critical role of the human microbiota in health, our understanding of microbiota compositional dynamics during and after pregnancy is incomplete. We conducted a case-control study of 49 pregnant women, 15 of whom delivered preterm. From 40 of these women, we analyzed bacterial taxonomic composition of 3,767 specimens collected prospectively and weekly during gestation and monthly after delivery from the vagina, distal gut, saliva, and tooth/gum. Linear mixed-effects modeling, medoid-based clustering, and Markov chain modeling were used to analyze community temporal trends, community structure, and vaginal community state transitions. Microbiota community taxonomic composition and diversity remained remarkably stable at all four body sites during pregnancy (P > 0.05 for trends over time). Prevalence of a Lactobacillus-poor vaginal community state type (CST 4) was inversely correlated with gestational age at delivery (P = 0.0039). Risk for preterm birth was more pronounced for subjects with CST 4 accompanied by elevated Gardnerella or Ureaplasma abundances. This finding was validated with a set of 246 vaginal specimens from nine women (four of whom delivered preterm). Most women experienced a postdelivery disturbance in the vaginal community characterized by a decrease in Lactobacillus species and an increase in diverse anaerobes such as Peptoniphilus, Prevotella, and Anaerococcus species. This disturbance was unrelated to gestational age at delivery and persisted for up to 1 y. These findings have important implications for predicting premature labor, a major global health problem, and for understanding the potential impact of a persistent, altered postpartum microbiota on maternal health, including outcomes of pregnancies following short interpregnancy intervals.

Relationship between gingival inflammation and pregnancy

An increase in the prevalence and severity of gingival inflammation during pregnancy has been reported since the 1960s. Though the etiology is not fully known, it is believed that increasing plasma sex steroid hormone levels during pregnancy have a dramatic effect on the periodontium. Current works of research have shown that estrogen and progesterone increasing during pregnancy are supposed to be responsible for gingivitis progression. This review is focused not only on epidemiological studies, but also on the effects of progesterone and estrogen on the change of subgingival microbiota and immunologic physiological mediators in periodontal tissue (gingiva and periodontal ligament), which provides current information about the effects of pregnancy on gingival inflammation.

Association between polycystic ovary syndrome, oral microbiota and systemic antibody responses

Polycystic ovary syndrome (PCOS) is a hormonal disorder of women that not only is the leading cause of infertility but also shows a reciprocal link with oral health. This study aimed to investigate the hypothesis that the levels of putative periodontal pathogens in saliva and their antibody response in serum are elevated in PCOS, compared to systemic health. A total of 125 women were included in four groups; 45 women with PCOS and healthy periodontium, 35 women with PCOS and gingivitis, 25 systemically and periodontally healthy women, 20 systemically healthy women with gingivitis. Salivary levels of seven putative periodontal pathogens were analyzed by quantitative real-time polymerase chain reaction and serum antibody levels were analyzed by ELISA. In women with PCOS, salivary Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus oralis and Tannerella forsythia levels were higher than matched systemically healthy women, particularly in the case of gingivitis. Aggregatibacter actinomycetemcomitans and Treponema denticola levels were similar among study groups. The presence of PCOS also enhanced P. gingivalis, Prevotella intermedia and S. oralis serum antibody levels, when gingivitis was also present. Gingival inflammation correlated positively with levels of the studied taxa in saliva, particularly in PCOS. The presence of P. gingivalis and F. nucleatum in saliva also exhibited a strong positive correlation with the corresponding serum antibody levels. In conclusion, as an underlying systemic endocrine condition, PCOS may quantitatively affect the composition of oral microbiota and the raised systemic response to selective members of this microbial community, exerting a confounding role in resultant gingival inflammation and periodontal health. The most consistent effect appeared to be exerted on P. gingivalis.

Oral contraceptives and the periodontium

Oral contraceptives are a safe and effective means of contraception for millions of women worldwide. The first formulations of these drugs contained much higher doses of estrogens and progestins than those available today, and these were associated with an unacceptably high rate of unwanted effects including serious cardiovascular events. In addition, a number of case reports and clinical studies suggested that use of the first generation oral contraceptives was also associated with an increased risk for gingival and/or periodontal disease. Unfortunately, many of these early studies suffered from significant methodological flaws which throw their findings into question. Nonetheless, these studies provided the basis for a perception among the dental profession that oral contraceptives increase the risk for gingivitis and/or periodontitis. Realisation that the adverse events profile of oral contraceptives was dose dependant led to the development of the modern low dose formulations that are in use today. There have been far fewer studies to investigate whether modern oral contraceptives have any impact on the periodontium compared to studies of the early contraceptive formulations, but the quality of the more recent research is undoubtedly better. Following extensive review of the relevant literature and consideration of the historical perspective, the best available evidence strongly supports that oral contraceptives no longer place users at any increased risk for gingivitis or periodontitis. Oral contraceptives should not be viewed as a risk factor for gingival or periodontal disease.

Bi-directional relationship between pregnancy and periodontal disease

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

Oral health education and therapy reduces gingivitis during pregnancy

BACKGROUND

Pregnant women demonstrate increases in gingivitis despite similar plaque levels to non-pregnant counterparts.

AIM

To evaluate an intensive protocol aimed at reducing gingivitis in pregnant women and provide pilot data for large-scale randomized controlled trials investigating oral hygiene measures to reduce pregnancy gingivitis and alter maternity outcomes.

MATERIALS AND METHODS

One hundred and twenty participants between 16 and 24 weeks gestation with Gingival Index (GI) scores ≥2 at ≥50% of tooth sites were enrolled. Plaque index (PI), gingival inflammation (GI), probing depth (PD), and clinical attachment levels (CAL) were recorded at baseline and 8 weeks. Dental prophylaxis was performed at baseline and oral hygiene instructions at baseline, 4 and 8 weeks. Pregnancy outcomes were recorded at parturition. Mixed-model analysis of variance was used to compare clinical measurements at baseline and 8 weeks.

RESULTS

Statistically significant reductions in PI, GI, PD, and CAL occurred over the study period. Mean whole mouth PI and GI scores decreased approximately 50% and the percentage of sites with PI and GI ≥2 decreased from 40% to 17% and 53% to 21.8%, respectively. Mean decreases in whole mouth PD and CAL of 0.45 and 0.24 mm, respectively, were seen.

CONCLUSIONS

Intensive oral hygiene regimen decreased gingivitis in pregnant patients.

Environmental stimuli shape biofilm formation and the virulence of periodontal pathogens

Periodontitis is a common inflammatory disease affecting the tooth-supporting structures. It is initiated by bacteria growing as a biofilm at the gingival margin, and communication of the biofilms differs in health and disease. The bacterial composition of periodontitis-associated biofilms has been well documented and is under continual investigation. However, the roles of several host response and inflammation driven environmental stimuli on biofilm formation is not well understood. This review article addresses the effects of environmental factors such as pH, temperature, cytokines, hormones, and oxidative stress on periodontal biofilm formation and bacterial virulence.

Dental cleaning before and during pregnancy among Maryland mothers

Despite increasing recognition of the importance of oral health to overall health, dental care utilization remains low in the US. Given the established link between maternal oral health and child oral health, this study examined factors related to preventive dental care utilization at two critical time points, before and during pregnancy. Data were obtained from a sample of 6,171 women who delivered a live birth during 2004-2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System postpartum survey. Multinomial logistic analyses examined associations between predisposing and enabling factors with dental cleaning before and during pregnancy. Women with less than a high school education or a history of physical abuse and non-Hispanic black and Hispanic women were less likely to report teeth cleaning before and during pregnancy. Having no insurance at the start of pregnancy was associated with significantly lower risk of teeth cleaning before pregnancy and both before and during pregnancy. Receipt of oral health counseling during pregnancy was positively related to teeth cleaning during pregnancy. Dental cleaning is associated with insurance, oral health counseling and maternal factors such as race, ethnicity, education and history of physical abuse. Better integration of oral health into prenatal health care, particularly among ethnic and racial minority groups, may be beneficial to maternal and infant well-being. Oral health promotion, disease prevention and health care should be a part of the local, state and national health policy agendas.

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

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

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

AIM

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Oral health and dental care during pregnancy

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

The influence of sex hormones on proinflammatory cytokines in gingiva of periodontally healthy premenopausal women

BACKGROUND AND OBJECTIVE

The aim of this work was to investigate any correlation between the fluctuation of levels of specific proinflammatory cytokines in gingival crevicular fluid and the fluctuation of sex hormones in peripheral blood at ovulation and progesterone peak.

MATERIAL AND METHODS

Eighteen premenopausal women with normal and consistent menstrual cycles and healthy periodontium were included in this study. The exclusion criteria were as follows: (i) pregnancy; (ii) use of oral contraceptives; (iii) metabolic or systemic disease that might affect the periodontium; (iv) use of antimicrobial or nonsteroidal anti-inflammatory drugs during the past 6 mo; and (v) smoking. The measurements were performed at two specific time points for each participant [(i) on the day of ovulation; and (ii) on the day of the progesterone peak) and included the following: (i) plaque index; (ii) bleeding on probing; and (iii) the gingival crevicular fluid levels of interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor-α (TNF-α).

RESULTS

During the menstrual cycle, plaque index values remained unchanged (0.71 ± 0.07 at ovulation; 0.73 ± 0.08 at progesterone peak; p > 0.05), as did bleeding on probing (0.35 ± 0.07 at ovulation; 0.41 ± 0.07 at progesterone peak; p > 0.05). At ovulation, mean gingival crevicular fluid levels were as follows: IL-1β, 13.3 pg/sample; IL-6, 5.9 pg/sample; IL-8, 18.7 pg/sample; and TNF-α, 25.9 pg/sample. The corresponding values at progesterone peak were as follows: 14.1, 10.1, 19.5 and 26.3 pg/sample. Only IL-6 gingival crevicular fluid levels were significantly different between ovulation and progesterone peak (p < 0.05). This could reflect sensitivity to subclinical amounts of plaque and biofilm constituents.

CONCLUSION

The subclinical increase of IL-6 at progesterone peak is not accompanied by clinical changes in the periodontium.