Q&A: Pregnancy gingivitis can impact health of both mother, baby

Many women develop gingivitis during pregnancy, which can affect their health far beyond their gumline.

Healio spoke with Kate Zoumboukos, DMD, FAGD, of SW Austin Dental in Austin, Texas, to find out more.

Healio: What is pregnancy gingivitis?

Kate Zoumboukos

Zoumboukos: Pregnancy gingivitis refers to the inflammatory response of the gingiva to bacterial plaque accumulation at or below the gumline, which is modified by hormonal changes. During pregnancy, the body’s response to existing plaque bacteria is often amplified, resulting in pain, swelling of the gums, discomfort and increased bleeding during flossing. In Clinical Periodontology, Fermin A. Carranza, DDS, and his coauthors said, “Pregnancy affects the severity of previously inflamed areas. It does not alter healthy gingiva.”

Healio: What causes pregnancy gingivitis?

Zoumboukos: Pregnancy gingivitis is caused by bacterial plaque and influenced by increased hormone levels, mainly progesterone. Currently, studies are being conducted to evaluate if bacteria and hormone-based interaction could alter or change bacterial plaque composition, which could lead to increased gingival inflammation. Progesterone, a hormone elevated during pregnancy, has been shown to “aggravate” gingivitis and affect blood vessels, leading to increased bleeding of the gums, according to Carranza et al.

Healio: Can pregnancy gingivitis have any impact on the mother’s overall health?

Zoumboukos: Being evaluated by a dentist and treating pregnancy gingivitis should be prioritized in an effort to stop progression into a more serious form of gum disease called periodontitis, which can result in bone loss, loosening teeth, and/or total loss of teeth. According to a 2018 study published in the Journal of the American Dental Association that measured the weighted averages of the prevalence of periodontal disease, about 42% of dentate U.S. adults have periodontitis. Currently, many studies are being conducted to evaluate the systemic influence of periodontal disease and inflammation. Many studies already have found connections between periodontitis and heart disease, diabetes, respiratory disease, cancer and even Alzheimer’s disease.

Healio: Can pregnancy gingivitis have any impact on pregnancy outcomes?

Zoumboukos: The health of the mother and child are both affected by the teeth and gums. Research has shown an association with poor oral health, premature baby delivery and lower birth weight, according to Mariano Sanz, MD, DDS, and Kenneth Kornman, DDS, PhD, in their 2013 study. More research is required in this area.

Healio: What are the risks of periodontitis specifically for pregnant patients?

Zoumboukos: Most of the current studies including Sanz and Kornman again available show an association between periodontal disease, pre-term birth and pre-eclampsia. Studies are also evaluating the effects of maternal periodontal disease and infant development. More research is required, as we currently have insufficient data to make policy recommendations, said Sanz and Kornman.

Healio: What are treatment options for pregnancy gingivitis?

Zoumboukos: Pregnancy gingivitis is treated by dental prophylaxis and follow-up treatments if necessary. It is not uncommon during the dental prophy, or cleaning, for the patient to present with increased gingival bleeding. Typically, improvement is seen following the treatment, but the patient must follow a dental hygiene routine and follow up with their dentist if outcomes are not improving.

Healio: What are preventive options for pregnancy gingivitis?

Zoumboukos: Excellent oral hygiene will markedly reduce the chances of developing pregnancy gingivitis. The CDC estimates that between 60% and 75% of pregnant women experience pregnancy gingivitis. I advise brushing twice a day and flossing at least once a day. Patients should strive to remove all bacterial plaque.

Healio: What should OB/GYN doctors do to address pregnancy gingivitis and other aspects of oral health with patients who are pregnant or planning to become pregnant?

Zoumboukos: They should help expecting mothers and families by connecting them with a dentist. It is important that the expecting mother receive a full-mouth evaluation and periodontal therapy. Also, the American Dental Association provides current updates in the dental field. Patients can be directed to MouthHealthy.org from the American Dental Association, which is a patient-friendly website packed with valuable information and videos. The American Academy of Pediatric Dentistry also has great resources for parents and expecting parents.

Healio: Do you have any other recommendations pertaining to oral health for doctors who specialize in women’s health?

Zoumboukos: The American Dental Association’s Find-A-Dentist directory is one way to search for local dentists in your area. Reach out to your local dentists, and do not hesitate to contact one of the professional organizations such as the American Dental Association to find help!

References:

• Carranza FA, et al. Clinical Periodontology. Tenth edition. Saunders; 2006.
• Eke PI, et al. J Am Dent Assoc. 2018;doi:10.1016/j.adaj.2018.04.023.
• Sanz M and Kornman J. J Clin Periodontol. 2013;doi:10.1111/jcpe.12083.
• Pregnancy and Oral Health. https://www.cdc.gov/oralhealth/publications/features/pregnancy-and-oral-health.html. Updated Feb. 19, 2019. Accessed Nov. 11, 2021.