Periodontal Disease and Pregnancy
There is increasing evidence to support the relationship between maternal gingivitis/periodontitis and preterm low birth weight babies. Evidence also supports the fact that periodontal treatment results in a significant reduction in the rate of preterm delivery and an increase in birth weight.
Infants who survive preterm births face a higher risk of developing neurodevelopmental problems (cerebral palsy, blindness, deafness), respiratory problems (asthma, lower respiratory infections, bronchopulmonary dysphasia, chronic lung disease), behavioral problems (attention deficit hyperactivity disorder), learning problems, cardiovascular disease and metabolic abnormalities (obesity, type 2 diabetes mellitus). As a result, the obstetric complications not only are a significant health care expense (estimated at more than 5.5 billion annually), but also affect the well-being of the affected infants throughout life. (1)
The results of many studies show that maternal infection with periodontal pathogens has a deleterious effect on fetal growth and viability. These virulent periodontal bacteria can destroy tissue directly or indirectly. They destroy tissue indirectly by inciting the release of inflammatory mediators such as cytokines, interleukins, tissue necrosing factor alpha, C-reactive protein and others.
At first the body’s immune system tries to contain the inflammation to the local periodontal tissue. Due to the chroniChesapeake and virulence of the disease it eventually finds its way into the systemic circulation where the inflammatory mediators travel to other parts of the body.
Ultimately the inflammatory mediators find their way to the placenta with the production of more cytokines. Placenta destruction now occurs. This placenta tissue damage will now compromise the normal exchange of nutrients between mother and child. Impaired fetal growth may now be the result.
The placenta damage and production of cytokines may also contribute to preterm rupture of the membranes and uterine contraction and lead to miscarriage or preterm delivery. (1)
Finally, periodontal bacteria and/or their virulence factors and inflammatory cytokines may cross the placenta and alter the fetal circulation. There, they may trigger a new set of fetal-host immune responses. The bacteria and virulence factors may gain access to various tissues and initiate local inflammatory response and consequently, structural damage to the fetal tissues and organ systems. Depending on the extent of this damage, the newborn may or may not survive. If newborns do survive they may possess deficiencies that may compromise their quality of life, even throughout adulthood. (1)
All studies to date show the beneficial effects of treating periodontal disease in pregnant women, usually in the second trimester of pregnancy. They also show that these treatments can be provided safely for both mother and child.
There is no evidence of a down-side to providing care to mothers, which suggests that such treatment may be beneficial for two. (1)
Much of the material for this discussion was gleaned from the following abstract. It is perhaps the most edifying and informational of all articles I have read on this subject. I pay my tribute to:
1. Yiorges A Bobetsis, DDS, PhD, Silvana P. Barras, DDS, PhD and Steven Offanbacher, DDS, PhD, MMSc- Exploring The Relationship between periodontal disease and pregnancy complications JADA, vol. 137. No suppl____ 2, 75-135
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