Periodontitis During Pregnancy: Premature Births and Other Dangers

schwangere Frau kontrolliert Ihre Zähne© Hannes Eichinger - Fotolia.com

Schwangerschaft und Zähne

The gingiva has receptors that are sensitive to estrogen and progesterone.

Through these, the hormones can influence the morphology of the gingiva tissue of a pregnant woman. For example, there are changes in the blood vessels (e.g., increased vascular permeability, proliferation), but the connective tissue undergoes changes as well (increased fibroblast proliferation).

This may lead to an intensifying of already existing inflammations of the gingiva or their initiation during pregnancy. Furthermore, surveys performed during recent years point towards the fact that untreated periodontitis can be a risk factor for a premature birth and should therefore be treated early on. Studies involving animal experiments – as well as clinical studies – also show a possible correlation between periodontitis and premature babies with insufficient birth weight.

In case of an existing periodontitis, bacteria products such as lipopolysaccharides (LPS) of gram-negative bacteria are released. Our immune system – more precisely, macrophages – are able to release various chemical transmitters after coming in contact with these bacteria products, which in turn play an important role in the periodontal destruction of the hard and soft tissue.

In patients with periodontitis, increased levels of these chemical transmitters can be observed in the sulcus fluid. These transmitters have also been observed in the amniotic fluid and show an increase in women experiencing premature labor. Studies involving animal experiments with golden hamsters have shown that the LPS of gram-negative bacteria (Escherichia coli and Porphyromonas gingivalis) have a dose-dependent, harmful influence on the weight of the fetus (significantly lower birth weight) and may lead to deformities.

It was shown that non-surgical periodontal treatment can benefit the course of a pregnancy. Premature birth rates were higher in an untreated control group than in the treated test group.

However, one can also find studies in medical literature in which no correlation between periodontitis and premature birth with corresponding low birth weight was shown. In this context, one must neglect neither the ethnicity nor the varying socioeconomic backgrounds of the study population in the various study groups. More detailed studies are still required!

This raises the question of whether periodontal therapy should be carried out during pregnancy or not. Periodontal therapy during pregnancy must consider respective findings, already present risk factors, complications of premature birth, and the age of the pregnant woman. According to current knowledge, a blanket recommendation cannot be given.

In general, in the first trimester and in the second half of the third trimester, no selective procedures should be done. If necessary, patients receive a professional tooth cleaning with instructions about oral hygiene. In any case, pain therapy should be performed since stress symptoms resulting from pain can have a more adverse influence on the mother and the unborn child than the negative consequences of treatment.

If the periodontal examination indicates inflammatory periodontal disease, then the second trimester is the safest time to perform non-surgical periodontal treatment. An X-ray diagnosis should only be performed in individual cases, not before the second trimester, and in consideration of a critical risk/benefit analysis.

Wearing a lead apron reduces the unborn child’s exposure to a minimum. Surgical periodontal treatments should be postponed until after the birth, unless, e.g., a pyogenic granuloma occurs that impedes food intake, causes pain or severe bleeding, in which case it should be removed during the pregnancy.

If the patient shows an increased risk for a premature birth, then antibiotic prophylaxis should be considered after consultation with the treating gynecologist and prior to the periodontal treatment (during which a transient bacteremia occurs).

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