By: Stephanie Riesenman for Uterus1The to-do list for an expectant mom adds up quickly, and one item that is often overlooked is a visit to the dentist. It might come as a surprise, but pregnancy affects a woman’s teeth and gums just as other tissues in the body. And an expectant mother’s neglect of her oral health may have detrimental effects on her unborn child.
Periodontal disease has been associated with premature low-birth weight babies in some studies. At one time the American Academy of Periodontology (AAP) put the risk as much as seven times greater for women with periodontal disease. The more of the mouth affected with gum disease, the more likely a woman is to have a premature baby, according to a study of more than 2,000 pregnant women.
The AAP reports that about half of women experience pregnancy gingivitis, a condition characterized by swelling, redness and bleeding of the gums. It is caused by a sticky film of bacteria that forms on the teeth, called plaque. The increase in progesterone and estrogen levels during pregnancy causes the gums to react differently to the bacteria in plaque. If left untreated, gingivitis can develop into periodontitis, a serious infection that destroys the supporting bone and tissue where the teeth attach to the gums. Patients with periodontal disease develop deep pockets as the gums begin to recede, and severe cases can result in tooth loss.
It has been suggested that a labor-inducing chemical found in oral bacteria called prostaglandin, may trigger early delivery. High levels of the chemical are found in women with advanced periodontal disease. A study recently published in the Journal of Clinical Periodontology suggested that some bacteria associated with periodontal disease actually increased the risk of premature deliveries. In the same study the presence of certain oral bacteria had a protective effect against early delivery or low birth weight babies.
But as experts cite research that shows an association between periodontal disease and pre-term delivery, there are just as many studies that show there is no association between gum disease and having a baby that is born too early or too small.
“For the population in our study, there does not appear to be an association between periodontal disease and pre-term birth,” said Dr. Suzanne Farrell, Specialist Registrar in Restorative Dentistry at GKT Dental Institute, Guy’s and St. Thomas’ Hospital Trust, KCL, London.
Nearly 4,000 pregnant women from the United Kingdom were included in Dr. Farrell’s study. Each woman was evaluated for periodontal disease by looking for bleeding gums, measuring plaque on the teeth, pocket depth and tooth loss. They found that there was no significant relationship between the severity of periodontal disease and either pre-term birth or low birth weight babies. This research was published at the end of 2004 in the British Dental Journal.
However, the study did show some weak evidence suggesting a link between periodontal disease and late miscarriage, but Dr. Farrell said further research is necessary to investigate this observation since it is not possible to say if periodontal disease actually causes late miscarriage. Therefore it is unclear if treating periodontal disease will lessen a woman’s risk of miscarriage.
There is evidence to suggest that treating periodontal disease early in pregnancy lowers the chances of a preterm birth. A non-surgical procedure called scaling and root planing led to an 84 percent reduction in premature births in 366 women with periodontal disease who were less than 35 weeks pregnant. The procedure involves cleaning the root surfaces to remove plaque and tartar from deep periodontal pockets.
Dr. Farrell said prenatal care should involve some form of periodontal screening, since early diagnose of the disease can improve the success of treatment. She also reinforced the importance of other prenatal precautions a woman can take such as avoiding alcohol, improving nutritional intake, and stopping smoking.
“Smoking is a very strong risk factor for developing periodontal disease and smoking is likewise associated with a poor pregnancy outcome,” said Dr. Farrell.
Nearly 12 percent of babies are born preterm in the United States every year. When a child is born before 37 weeks of completed pregnancy, there is an elevated risk of death and lasting disabilities such as mental retardation, cerebral palsy, lung and gastrointestinal problems, and vision and hearing problems. Checking a dental exam off the list early in a pregnancy allows for detection and treatment of periodontal disease and goes a long way to ensure a healthy delivery.
