Pregnancy comes with a lot of physiological changes, among these changes includes increased acidity of the mouth and gums, loosening of ligaments, and an increased inflammatory response to plaque.2 Untreated, plaque and subsequently gingivitis can lead to periodontal progression. In a prospective study done by Coats, J. et al. (2001) pregnant women with general periodontal disease present had increased odds (4-7 times higher) of preterm delivery than women without periodontal disease present. Increased severity of the disease was also associated with greater odds of a preterm delivery. Although a causal link cannot be found between periodontal disease and preterm delivery the endotoxins created by gram-negative bacteria present in periodontal disease may be a biological mechanism for preterm delivery.3
Prostaglandin E2 (PGE2) is an inflammatory mediator that is most commonly seen in patients with periodontal disease.4,5 PGE2 has been cited as being associated with the development of preeclampsia which, if not treated, can lead to preterm delivery.6 PGE2 is a large factor and concern in preterm delivery due to its link to uterine contractions and dilation of the cervix.4 In a study conducted by Boggess, K. et.al (2003) they found an increased odds (2.4 adjusted OR) for women with severe periodontal disease also having preeclampsia at the time of birth.7 We cannot definitively say that periodontal disease is the cause of preterm delivery but, the association between periodontal disease and preterm delivery does exist. The American College of Obstetrics and Gynecology and the American Dental Association agree on the importance of good oral hygiene on overall health before, during and after pregnancy.2
- Leadership and Legacy: Oral Health Milestones in Maternal and Child Health.http://mchoralhealth.org/milestones/1965.html. Published 2012. Accessed 4 October 2016.
- Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;122:417–22.
- Jeffcoat M, Geurs N, Reddy M, Cliver S, Goldenberg R, Hauth J. Periodontal infection and preterm birth: Results of a prospective study. J Amer Dent Assoc 2001;132:875–80.
- Srinivas S, Parry S. Periodontal Disease and Pregnancy Outcomes: Time to Move On?. Journal Of Women's Health (15409996) [serial online]. February 2012;21(2):121-125. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 5, 2016.
- Stadelmann P, Alessandri R, Eick S, Salvi G, Surbek D, Sculean A. The potential association between gingival crevicular fluid inflammatory mediators and adverse pregnancy outcomes: a systematic review. Clinical Oral Investigations[serial online]. n.d.;17(6):1453-1463. Available from: Science Citation Index, Ipswich, MA. Accessed October 5, 2016.
- Is periodontal disease related to adverse pregnancy outcomes? A scoping review. Canadian Journal Of Dental Hygiene [serial online]. February 2011;45(1):53-60. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 5, 2016.
- Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, et al. (2003) Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstet Gynecol 101: 227–231.