Periodontal Disease in Mother and Consequences for both Mother and Baby Volume 7 - Issue 1

Karimi M, DMD, BS*

Department of Pediatric Dentistry, Sepideh Dental Clinic, Iran

Received:October 19, 2021;   Published: November 01, 2021

*Corresponding author: Karimi M, Department of Pediatric Dentistry, Sepideh Dental Clinic, Iran

DOI: 10.32474/IPDOAJ.2021.07.000251

Abstract PDF

Periodontal disease is a type of bacterial infectious disease that causes bone destruction and supportive fibers of periodontal tissues. It seems the prevalence of this disease is more common in adults and would increase during pregnancy. Researchers believe hormonal changes are the main factors of developing this disease. Inflammation or infection of the gums increases the risk of low birth weight and preterm birth. If the problem is left untreated, mothers who would experience severe oral infections and gingival bleeding during the pregnancy would be at a greater risk for preterm birth.

Keywords:Periodontal disease; pregnancy; hormonal changes; Inflammation and infection; gingival bleeding; preterm birth; low birth weight

Hormonal changes during pregnancy affect the oral tissues that may develop problems such as inflammation, bleeding, and swelling of the gingiva and periodontal tissues. Periodontal disease can induce a significant source of infection in the mother’s body. Most women suffer from gingivitis during pregnancy that this type of gingivitis is usually called pregnancy gingivitis. This is caused by the changes in the mother’s body hormones during pregnancy. Hormonal changes cause an inflammatory reaction that increases the risk of gum disease [1-3]. There are two sets of proteins in the immune system called cytokines that regulate the body’s response to inflammation. These proteins are present in two types of proinflammatory cytokines and anti-inflammatory cytokines. In a normal pregnancy, the proteins that cause inflammation in the body (pre-inflammatory) are controlled by the proteins that cause inflammation (anti-inflammatory). This prevents the body from becoming inflamed because the inflammation in the pregnant woman’s body can repel the fetus [4-7]. When a pregnant woman has inflammation and infection around the teeth, the balance between the proteins that cause the inflammation and the proteins that fight the inflammation is disturbed [6-8]. As a result, premature labor pain may occur in a pregnant woman [7].

When a baby is born at or before 37 weeks of gestation, it’s called preterm birth [9-11] that causes the babies to suffer some complications and consequences throughout their lifetime.

Preterm birth has various factors. However, for our purposes in this article, there is strong evidence to support that periodontal disease is also a risk factor for preterm births. Since pregnant females are more at risk of developing gum diseases due to overactive hormones, mothers should be more cautious of their oral hygiene, hence, it requires immediate attention in a pregnant female. The treatment has to be more aggressive and involves scaling and root planning. It is believed the bacterial of the oral cavity can reach the endometrium [12]. The bacterial activity will release toxins are known as endotoxins there causing inflammation of that muscle. Therefore, it develops muscle contractions that lead to premature birth [13,14]. In 1996, Offenbacher and et al. were the first ones who indicated the relationship between maternal periodontal disease and preterm birth. Periodontal disease is a bacterial infection of the mouth that affects the majority of the population, and the prevalence has to be higher in pregnant women [15]. The possibilities of reaching oral periodontal pathogens to the placenta and enforcing various changes in pregnancy have been reported. These changes may lead to the development of adverse pregnancy outcomes such as preterm birth that a few researchers have provided evidence for that [16]. Some studies recently have been focused on oral infection (especially periodontal infection) as a risk factor, or risk indicator for preterm birth [15,17]. The evidence reveals that maternal periodontal disease is correlated with the enhancement of the incidence of preterm births [18]. Periodontopathic bacteria have also been associated with PTB [19- 25].

Low birth weight, defined as a weight of fewer than 2,500 grams, is strongly associated with mortality [26]. If the baby weighs less than 1500 grams, his probability of death is 100 percent [27]. Recently, the researchers believed periodontal disease could be a risk factor for low-birth-weight babies (PLBW) since in the pathway of the disease the bacteria could migrate from periodontal tissues into blood circulation, and it could induce the production of inflammatory mediators which are responsible for the early onset of delivery. In other words, due to microbial toxins entering the uterine cavity during pregnancy, the inflammation in this area could promote the preterm birth and delivery of the baby with low birth weight [15,28-33]. Jeffcoat and colleagues indicated similar results and reported that the risk of early birth of a preterm infant increases 4-7 times if the severity of the periodontal disease increases [17]. Another study by Lopez et al showed a correlation between pregnancies with gingivitis and LBW [34]. On the contrary, Mitchell-Lewis et al and Lunardelli and Peres reported that periodontal disease had no significant effect on having preterm infants, or there is no relation between maternal periodontal disease and LBW [35,36]. Lastly, even though most studies show a relative association between preterm birth and low birth weight, the main aim should be the prevention of periodontal disease during pregnancy. Hence, a periodontal assessment as an oral hygiene protocol is essential to proceed before and during maternity for all mothers.

Studies show that periodontal disease during pregnancy may be associated with preterm delivery and low birth weight. During pregnancy, with increasing levels of estrogen and especially progesterone, the rate of vascular permeability increases, which causes gingival swelling and gingival exudation. As a result, it causes inflammation of the gingival tissue, which over time can lead to gum disease. Periodontal diseases are infections that can affect the production of significant amounts of pro-inflammatory cytokines that induce labor pains, rupture of fetal membranes, and preterm labor and low-birth-weight babies.

1. Machuca G, Khoshfeiz O, Tuan R, Lacalle CM, Pedro B (1999) The influence of general health and socio-cultural variables on the periodontal condition of pregnant women. J Periodontol 70: 779-785.
2. Güncü GN, Tözüm TF, Caglayan F (2005) Effects of endogenous sex hormones on the periodontium - Review of the literature. Aust Dent J 50: 138-145.
3. Figuero E, Carrillo-de-Albornoz A, Herrera D, Bascones-Martínez A (2010) Gingival changes during pregnancy: I. Influence of hormonal variations on clinical and immunological parameters, J Clin Periodontol 37(3): 220-229.
4. Mor (2011) Inflammation and pregnancy: the role of the immune system at the implantation site. Annals of the New York Academy of Sciences 1221(1): 80-87.
5. Abrahams VM (2004) Macrophages and apoptotic cell clearance during pregnancy. Am J Reprod Immunol 51: 275-282.
6. Adams Waldorf, Kristina M, Ryan M McAdams (2013) Influence of infection during pregnancy on fetal development, Reproduction, Cambridge, England 146(5): 151-162.
7. Saini Rajiv (2010) Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. Journal of natural science, biology, and medicine 1(1): 40-42.
8. Phoebus N Madianos, Yiorgos A Bobetsis, Steven Offenbacher (2013) Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. Journal of Clinical Periodontology 14: 170-180.
9. https://www.who.int/news-room/fact-sheets
10. Honest H, Forbes CA, Durée KH, Norman G, Duffy SB, et al. (2009) Screening to prevent spontaneous preterm birth: Systematic reviews of accuracy and effectiveness literature with economic modeling. Health Technol Assess 13: 1-627.
11. Goldenberg RL, Hauth JC, Andrews WW (2000) Intrauterine infection and preterm delivery. N Engl J Med 342: 1500-1507.
12. TM Wassenaar, P Panigrahi (2014) Is a fetus developing in a sterile environment? Letters in Applied Microbiology 59: 572—579.
13. JT Barbieri (2009) Exotoxins, Moselio Schaechter (Eds.), Encyclopedia of Microbiology (Third Edition), Academic Press pp. 355-364.
14. (2007) Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Behrman RE, Butler AS (Eds.), Preterm Birth: Causes, Consequences, and Prevention, National Academies Press, Washington, USA p. 6.
15. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, et al. (1996) Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 67: 1103-1113.
16. Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, et al. (1995) Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant, The Vaginal Infections and Prematurity Study Group. N Engl J Med 333: 1737-1742.
17. Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, et al. (2001) Periodontal infection and preterm birth: results of a prospective study. J Am Dent Assoc 132: 875-880.
18. Clothier B, Stringer M, Jeffcoat MK (2007) Periodontal disease and pregnancy outcomes: exposure, risk, and intervention. Best Pract Res Clin Obstet Gynaecol 21: 451-466.
19. Ebersole JL, Novak MJ, Michalowicz BS, Hodges JS, Steffen MJ, et al. (2009) Systemic immune responses in pregnancy and periodontitis: relationship to pregnancy outcomes in the Obstetrics and Periodontal Therapy (OPT) study. J Periodontol 80: 953-960.
20. Durand R, Gunselman EL, Hodges JS, Diangelis AJ, Michalowicz BS (2009) A pilot study of the association between cariogenic oral bacteria and preterm birth. Oral Dis 15: 400-406.
21. Novak MJ, Novak KF, Hodges JS, Kirakodu S, Govindaswami M, et al. (2008) Periodontal bacterial profiles in pregnant women: response to treatment and associations with birth outcomes in the obstetrics and periodontal therapy (OPT) study. J Periodontol 79: 1870-1879.
22. Vettore MV, Leao AT, Leal Mdo C, Feres M, Sheiham A (2008) The relationship between periodontal disease and preterm low birthweight: clinical and microbiological results. J Periodontal Res 43: 615-626.
23. Buduneli N, Baylas H, Buduneli E, Turkoglu O, Kose T, et al. (2005) Periodontal infections and pre‐term low birth weight: a case‐control study. J Clin Periodontol 32: 174-181.
24. Hill GB (1998) Preterm birth: associations with genital and possibly oral microflora. Ann Periodontol 3: 222-232.
25. Han YW, Fardini Y, Chen C, Iacampo KG, Peraino VA, et al. (2010) Term stillbirth caused by oral Fusobacterium nucleatum, Obstet Gynecol 115: 442-445.
26. Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, et al. (2001) William’s obstetrics 21st ed. McGraw-Hill, Toronto, USA pp. 743-755.
27. Mathews TJ, MacDorman MF, Menacker F (2002) Infant mortality statistics from the 1999 period Linked birth/death data set. National Vital Stat Rep 50(4): 5.
28. Gholami Q, Alipanah R (1999) Effect of maternal periodontal diseases on preterm birth and low birth weight. Dentistry J Shahid Beheshti Univ 17: 45-53.
29. Clothier B, Stringer M, Jeffcoat MK (2007) Periodontal disease and pregnancy outcomes: exposure, risk, and intervention. Best Pract Res Clin Obstet Gynaecol 21: 451-466.
30. Offenbacher S, Lieff S, Boggess KA, Murtha AP, Madianos PN, et al. (2001) Maternal periodontitis, and prematurity. Part I: Obstetric outcome of prematurity and growth restriction. Ann Periodontol 6: 164-174.
31. Michalowicz BS, Durand S (2007) Maternal periodontal disease and spontaneous preterm birth. Periodontol 44: 103-112.
32. Romero R, Chiquito CS, Elejalde LE, Bernardoni CB (2002) Relationship between periodontal disease in pregnant women and the nutritional condition of their newborns. J Periodontol 73: 1177-1183.
33. Williams CE, Davenport ES, Sterne JA, Sivapathasundaram V, Fearne JM, et al. (2000) Mechanisms of risk in preterm low birth weight infants. Periodontol 23: 142-145.
34. Lopez NJ, Dasilva I, Ipinza J, Gutierrez J (2005) Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol 76: 2144-2153.
35. Mitchel-Lewis D, Engerbertson SP, Chen J, Lamster IB, Papapanou PN (2001) Periodontal infections and preterm birth: early findings from a cohort of young minority women in New York. Eur J Oral Sci 109: 34-39.
36. Lunardelli AN, Peres MA (2005) Is there an association between periodontal disease, prematurity, and low birth weight: a population-based study, J Clin Periodontol 32: 938-946.