The effects of periodontal therapy on intracrevicular prostaglandin E2 concentrations and clinical parameters in pregnancy

Inflammatory Response in Oral Biofilm during Pregnancy: A Systematic Review

Understanding the inflammatory response in oral biofilm during pregnancy and its association with oral and maternal health is essential for identifying biomarker patterns that may serve as markers of pregnancy-related complications. We aimed to conduct a systematic review of the available literature to assess: (1) inflammatory responses in oral biofilm during pregnancy, (2) the association between inflammatory responses in oral biofilm during pregnancy and maternal, oral or systemic conditions, (3) changes in the response of inflammatory biomarkers found in the oral biofilm during different pregnancy stages, and (4) the value of other risk factors such as nutrition and lifestyle. PubMed, Web of Science and Cochrane Library were systematically searched from inception until April 2022. From 5441 records, 39 studies were included for qualitative assessment. The oral biofilm in pregnant women was associated with increased inflammatory biomarkers when compared to non-pregnant women. Levels of inflammatory biomarkers in the oral biofilm were found to be highest in pregnant women with systemic conditions. Increased inflammatory biomarkers in the oral biofilm were also associated with worse oral health outcomes. Given the importance of nutrition and lifestyle for pregnancy and oral health outcomes and the fact that these factors were largely excluded in the included studies, future research should consider a holistic view of the mother during pregnancy to capture physiological, hormonal, immunologic, and metabolic changes in the context of inflammatory responses.

A Prospective Cohort Study to Assess and Correlate the Maternal Periodontal Status with Their Pregnancy Outcome

BACKGROUND

There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association between periodontal disease and preterm low birth weight of babies.

MATERIALS AND METHODS

A total of 300 pregnant women, between 20 and 24 weeks of gestation i.e., second trimester, were considered for the study. The periodontal status was recorded using the following parameters: probing pocket depth, clinical attachment level, oral hygiene index and plaque index. After initial examination in the second trimester, the pregnant women were followed till delivery of the baby. Postpartum data i.e., weight of baby, gestational age of pregnancy and type of delivery, were recorded.

RESULTS

Out of 300 pregnant women, 248 women had full-term delivery (12 low birth weight and 236 normal birth weight) while 52 had preterm delivery (6 normal birth weight and 46 low birth weight). There was significant association between body mass index and level of periodontal disease severity of pregnant women with birth weight of babies, gestational age of pregnant women and mode of delivery, respectively. As the level of periodontal disease severity increased, the proportion of delivering preterm and low birth weight babies also increased.

CONCLUSION

The conclusions obtained revealed that Periodontal disease is a potential risk factor for preterm low birth weight babies of pregnant women.

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.

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.

The potential association between gingival crevicular fluid inflammatory mediators and adverse pregnancy outcomes: a systematic review

OBJECTIVES

The association between periodontal disease and adverse pregnancy outcomes (APO), primarily preterm birth (PTB), is still controversially discussed in the literature. Therefore, the aim of the present systematic review was to analyze the existing literature on the potential association between inflammatory mediators detected in gingival crevicular fluid (GCF) and APO.

MATERIALS AND METHODS

MEDLINE (PubMed) and EMBASE databases were searched for entries up to April 2012 and studies were selected by two independent reviewers.

RESULTS

The majority of the eight studies included confirmed a positive association between GCF mediators, such as interleukin-1β, prostaglandin E2, and tumor necrosis factor-alpha, and APO. Due to the heterogeneity and variability of the available studies, no meta-analysis could be performed.

CONCLUSIONS

A positive association between GCF inflammatory mediator levels and APO/PTB might be present but the results need to be considered with great caution because of the heterogeneity and variability among the studies. Further studies with an adequate number of patients allowing for an appropriate analysis are warranted to definitely confirm this association.

CLINICAL RELEVANCE

The present findings suggest that an association between GCF inflammatory mediator levels and APO might exist.

Influence of combined oral contraceptives on the periodontal condition

Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations.

OBJECTIVE

The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake.

MATERIAL AND METHODS

Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson's correlation test and Spearman's correlation test.

RESULTS

The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed.

CONCLUSIONS

These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

The Effect of Menstrual Cycle on Periodontal Health

BACKGROUND

Fluctuation in estrogen/progesterone levels has been shown to affect the periodontium. The effects of pregnancy, prepuberty, and oral contraceptives on gingival health has been studied extensively, with gingival scores reported to be higher, in most instances, than in controls. Fluctuation in steroid sex hormone is also noticeable through women's menstrual cycle. Many women report an increase in gingival inflammation and discomfort associated with their menstrual cycle, most commonly around the menses period. However, this well-known phenomenon has never been studied. The purpose of this longitudinal, prospective study was to compare the periodontal status of premenopausal women at different times during their menstrual cycle.

METHODS

Eighteen premenopausal women, enrolled in our maintenance program, were recruited. Clinical examination was performed before the recall visit at three different time points in their menstrual cycle: ovulation (OV), premenstruation (PM), and menstruation (M). Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were examined around the Ramfjord index teeth. Analysis of variance, with Scheffe modification, was used to determine differences between the menstrual time points.

RESULTS

Several women in this study reported appreciable oral symptoms just before or during menses. Mean PI (0.85 +/- 0.06) was almost identical at all time points. Despite this, GI was significantly higher (P = 0.0245) in OV (0.54 +/- 0.07) and in PM (0.5 +/- 0.08) than in M (0.38 +/- 0.07). Mean patient's PD (2.22 +/- 0.08 mm) and CAL (2.92 +/- 0.15 mm) was not significantly different between examinations.

CONCLUSIONS

We observed changes in gingival scores during the menstrual cycles of periodontally healthy women. These changes need to be addressed when analyzing data from epidemiological and treatment studies in premenopausal women.