Download - Dr.M Haseeb
Dr Muhammad HaseebDepartment of Periodontology,
Fatima Memorial Hospital College of Medicine and Dentistry.
Outcome:Understand the effects of pregnancy on oral
healthUnderstand the oral manifestations which
can arise during pregnancyUnderstand the importance of Oral health
and its effects on systemic healthUnderstand the rationale behind some
common beliefsUnderstand the importance of referring the
patient to a dentist
Systemic changes in Pregnancy
Increased progesterone levelsIncreased estrogen levelsCD4:CD8 ratio may be decreasedLow response of lymphocytes
Mukherjee PM, Almas K. Orthodontic considerations for gingival health during pregnancy: a review. Int J Dent Hygiene 8, 2010; 3–9
Changes in Oral cavityAlteration in micro flora (Prevotella
intermedia, Porphyromonas gingivalis, Tannerella sp. dominates) in pregnancy
Increased gingival crevicular fluidPregnancy gingivitisPregnancy granuloma/epulis/tumorPeriodontal disease and Tooth mobilityTooth surface loss
Old wives tales about pregnancy
The baby extracts calcium from the tooth of mother !!!
You lose a tooth for every pregnancy !!!
Gums always bleed in pregnancy !!!
Rationale behind the talesThere is increased tendency of vomiting in
pregnancy which causes stomach acid to erode the tooth surface
With lack of maintenance of oral hygiene, the periodontal condition gets worsen and leads to increased mobility of teeth
Gums bleed because of pregnancy gingivitis
Pregnancy Gingivitis
Clinical Features:Inflammation of gingivaIncreased swelling of gingivaBleeding from gums while brushing or spitting
Pathophysiology:Primary cause is dental plaque, pregnancy
makes it hypersensitive to plaque irritation
Pregnancy Gingivitis
Pregnancy gingivitis
A 20 year old pregnant woman (7th Month) presents with gingival hyperplasia on buccal and lingual sides.
Treatment for Pregnancy gingivitis
Oral hygiene instructionsScaling and root planingCurettage
Significance of each trimester
1st Trimester:Severity of Gingivitis increases from 2nd month
2nd Trimester:Considered safest for the elective dental
procedures3rd Trimester:
Gingival swelling again gets increased in third trimester
Pregnancy GranulomaPedunculatedUsually originates from inter dental papilla
(part of the gum between two teeth)Highly vascularizedCompromise estheticsMay compromise mastication or speech
PregnancyGranulomaA 28 years old woman in her 8th month of pregnancy presents with a pregnancy granuloma , hanging in the palatal surface between the central incisors
Diagnosis ???
This patient is not pregnant
Diagnosis ???
He is a man, cant be pregnant !
Diagnosis ???
This 20 years old lady is not pregnant
Diagnosis
Pyogenic Granuloma It is an over growth of soft tissues due to
irritation, physical trauma or hormonal factors
Pregnancy granuloma is a type of pyogenic granuloma
Treatment for Pregnancy Granuloma
Remove the irritating source (plaque/calculus)
Regresses after pregnancyShould better be removed if it is
compromising mastication or speechExcision
Surgical Electrocautery
Potential problems with excisionProfuse bleeding if surgically excisedChance of recurrence
Possible Effects of Periodontitis on pregnancy outcome
Pre-term Low birth
Birth Weight Clothier B, Stringer M, Jeffcoat MK. Periodontal disease and
pregnancy outcomes: exposure, risk and intervention. Best Pract Res Clin Obstet Gynaecol. 2007;21(3):451–466
Preterm birth and low birth weightPreterm birth refers to the delivery of new
born before 37th week of gestationLow birth weight refers a weight equal or
less than 2500 gramsRate of preterm birth varies with country to
country. (1 in 8 births in USA)Preterm birth is one of the most common
reason for infant mortality
MacDormann MF, Mathews TJ. Behind international rankings of infant mortality: how the United States compares with Europe. Int J Health Serv. 2010;40(4):577-88.
Does Periodontal treatment decrease the chances of low birth weight ?
Sadatmansouri S, Sedighpoor N, Aghaloo M. Effects of periodontal treatment phase I on birth term and birth weight. J Indian Soc Pedod
Prev Dent 2006;24:23-6
A Common Misbelief !Usually women tend to believe that any
dental procedures can harm their pregnancy
One American study showed that women seek dental treatment less during pregnancy period, specially getting a radiograph
Peilei Jiang, Eric P. Bargman, Nancy A. Garrett, et al. A Comparison of Dental Service Use Among Commercially Insured Women in Minnesota Before, During and After
Pregnancy. J Am Dent Assoc. 2008 Sep;139(9):1173-80.
The truth !American Dental Association recommends that
all dental procedures are safe and can be carried out in pregnancy
Periodontal scaling and prophylaxis is considered safe in all trimesters.
ADA endorses at least 2 dental visits during pregnancy
According to the American Academy of Family Physicians, you would need 50,000 dental x-ray examinations to reach the 5-rad cumulative dose to the fetus.
Recommendations for Family Physicians/Specialists
Examine the oral cavity of every pregnant patient
Educate the patient on maintaining good oral health
Refer to the dental surgeons specially periodontists for tooth cleaning (scaling)
Take Home Message !
Timely referral to the dentist will save complications like preterm birth and low birth weight babies of your patients which will eventually benefit your practice
Prevention of preterm birth and low birth weight will reduce the financial burden on part of government and the individual