Periodontal disease is inflammation of the gums and supporting tissues, caused by bacterial infections that can damage bone and lead to tooth loss. Good oral health is particularly important during pregnancy, as bodily changes can affect gum health. This article explores how periodontal disease manifests in pregnancy, its physiological causes, potential implications for both the pregnant individual and the baby, and effective prevention and treatment strategies.
What is Periodontal Disease in Pregnancy
Periodontal disease in pregnancy begins with dental plaque accumulation. It typically presents in two forms: gingivitis and periodontitis. Gingivitis is the milder form, characterized by irritated, swollen, red, and tender gums that may bleed easily, often during brushing or flossing. This “pregnancy gingivitis” is common, affecting an estimated 60% to 75% of pregnant women.
If untreated, gingivitis can progress to periodontitis, a more severe gum disease. Periodontitis involves a serious infection that damages the gums and bone supporting the teeth, potentially leading to loose teeth and even tooth loss. Signs of periodontitis include bad breath, new spaces appearing between teeth, receding gums, or pus along the gumline.
Why Pregnancy Impacts Oral Health
Pregnancy involves significant hormonal shifts, especially increased estrogen and progesterone, which impact oral health. These elevated hormone levels can increase blood flow to gum tissues, making them more sensitive and prone to inflammation. This heightened sensitivity means gums may react more intensely to dental plaque bacteria, even if plaque levels remain unchanged.
Progesterone specifically encourages the production of prostaglandins, inflammatory substances that further increase the risk of gum disease. Changes in the oral microbiome may also contribute. While hormones do not cause gingivitis directly, their presence makes gums more susceptible to bacterial irritants, creating an environment where inflammation can flourish.
Risks to Mother and Baby
Periodontal disease during pregnancy can pose several risks to both the pregnant individual and the developing baby. For the mother, untreated gingivitis can worsen and progress to periodontitis, leading to more severe gum infection, potential bone loss around the teeth, and even tooth loss. This can cause ongoing discomfort and require extensive dental interventions.
For the baby, studies suggest an association between maternal periodontal disease and adverse pregnancy outcomes, including preterm birth, low birth weight, and pre-eclampsia. While these are associations and not direct causation, mechanisms involve systemic inflammatory responses. Periodontal infections can elevate inflammatory markers like C-reactive protein (CRP) and prostaglandins, which may trigger premature labor or affect placental blood flow, potentially restricting fetal growth. Oral bacteria can also enter the bloodstream and potentially colonize placental tissues.
Prevention and Safe Treatment Options
Maintaining good oral hygiene is important for preventing and managing periodontal disease during pregnancy. This includes brushing teeth twice daily for at least two minutes with fluoride toothpaste and flossing daily to remove plaque and prevent gum irritation. A soft-bristled toothbrush can help minimize gum irritation. If morning sickness causes vomiting, rinse immediately with water, a fluoride mouthwash, or a baking soda solution to neutralize stomach acid and protect enamel. Delay brushing for 30-60 minutes after vomiting to avoid further erosion.
Regular dental check-ups and cleanings are recommended throughout pregnancy. Preventive, diagnostic, and restorative dental treatments are considered safe at any stage. Procedures like scaling and root planing, which clean deep pockets around teeth, can be performed safely. Local anesthetics, such as lidocaine, are safe for use, and dental X-rays are also considered safe with appropriate shielding. Inform your dentist about your pregnancy and consult with both your dentist and obstetrician regarding any concerns or treatment plans.