BSPID/EFP oral health and pregnancy guideline

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The main hormonal changes in a woman’s life take place during pregnancy—and the mouth is one of the main areas affected by such changes. Elevated hormone levels (oestrogen and progesterone) significantly increase vascular permeability in the gingival tissues and, in the presence of dental plaque, promote gingival inflammation.

In cases of women who already have periodontitis, the clinical parameters will worsen. Both a larger localised gingival swelling (pregnancy epulis) and a more generalised one (pregnancy gingivitis) are associated with pregnancy, although women usually revert to health after delivery.

Pregnancy may be subject to complications that include:

  • low birth weight (less than 2.5 kg), or very low birth weight (less than 1.5 kg)
  • preterm birth (before 37 weeks) or very preterm birth (before 32 weeks)
  • growth restriction (weight for gestational age)
  • pre-eclampsia (commonly defined as maternal hypertension and proteinuria after the twentieth gestational week)
  • miscarriage and/or stillbirth.

Some of these outcomes may occur simultaneously. It appears that periodontitis is associated with a higher risk of low birth weight, preterm birth, and—especially —pre-eclampsia. However, research is inconclusive and solid conclusions cannot yet be drawn. Possible mechanisms that link periodontitis and adverse pregnancy outcomes involve commensal and pathogenic bacteria colonising the fetoplacental unit through haematogenous dissemination. Thus, the presence of periodontal bacteria and by-products in the fetoplacental unit may activate a local immune/inflammatory response that might subsequently contribute to the development of adverse pregnancy outcomes.

Specific oral hygiene regimens, together with professional interventions, have been shown to be both safe when implemented during pregnancy and efficient in reducing gingival inflammation and in enabling periodontal health to be maintained during pregnancy.

Based on current understanding of the effects on the foetal-placental unit of maternal periodontal infections and inflammation, it is possible that periodontal therapy would be more effective in reducing the risk of adverse pregnancy outcomes if it took place before conception.

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