Effects of pregnancy on periodontitis

Question 1

What happens to the periodontal tissues during pregnancy?

Answer 1

Increased inflammatory responses:

1. Changes in vasodilation and other responses mediated by increased oestrogen/progesterone.
2. Changes in local microbiome

Direct - as a result of hormonal changes

Indirect - as a result in localised inflammation/responsiveness.

Question 2

What can increased levels of progesterone and oestrogen lead to during pregnancy?

Answer 2

1. Increased local inflammatory responses
2. Elevated circulating progesterone levels may contribute to enhanced gingival vascular permeability and gingival exudate
3. Sex hormones, especially progesterone but also oestradiol in higher concentrations, can increase the prostaglandin E2 production by lipopolysaccharide-stimulated human monocytes which is considered to increase the inflammatory reaction.
4. Neutrophil chemotactic responsiveness can be disturbed by elevated progesterone levels

Question 3

What happens to the host and microbiome during pregnancy based on a study in 1980?

Answer 3

2nd Trimester - increase in gingivitis, ratio of anaerobic to aerobic bacteria, and the proportional levels of Prevotella intermedia.

3rd Trimester - both gingivitis and levels of Prevotella intermedia decreased.

Plaque uptake of progesterone increased significantly during pregnancy, and parallels the plaque levels of Prevotella intermedia.

2nd Trimester - recovery of Prevotella was strongly correlated with plasma levels of oestrogens an progesterone.

Question 4

What happens to the host and microbiome during and after pregnancy based on a study in 2018?

Answer 4

1. Pregnancy is associated with a general shift to a more pathogenic flora containing: P. gingivalis, Treponema forsythia, Campylobacter rectus, Fusobacterium nucleatum, Aggregatorbacter actinomycetemcomitans, Prevotella intermedia, Treponema denticola, Fretibacteria OT361, P, endodontalis.
2. Shift is stable during pregnancy.
3. There is evidence of established interrelationships between these organisms during pregnancy.
4. Flora reverts to a healthy one with fewer inter-relationships after pregnancy

Question 5

What do periodontal changes during pregnancy manifest as?

Answer 5

1. Pregnancy gingivitis
2. Development of gingival epulis/epulides
3. Increased mobility

Question 6

What is individual variation in the severity of host response to pregnancy related to?

Answer 6

1. Variations in oral hygiene.
2. Variations in degree of host response - not consistently the same.

Question 7

What does pregnancy-associated gingivitis present as?

Answer 7

1. Sometimes heavy plaque build up.
2. Band of inflamed tissue around necks of teeth.
3. Increased pockets depths in these areas.
4. False pockets - probe can’t get past EDJ - these pockets go after inflammation is gone.

Question 8

What does pregnancy-associated epulis present as?

Answer 8

1. When located it is tender and can bleed.
2. Pedunculated - narrow base and swelling on top - like a stalk.
3. If inflammation resides - epulis can shrink and disappear by itself.

Question 9

How is periodontal tissue inflammation as a result of pregnancy managed?

Answer 9

1. OHI, instrumentation - scaling, non-surgical therapy.
2. Excision of residual epulis lesions, if persistent, after pregnancy.

Question 10

What differences are seen with bleeding and point pocket depth?

Answer 10

1. BOP and PPD increased simultaneously without relation to plaque between 1st and 2nd trimesters and thereafter decreased during subsequent visits.
2. Profuse bleeding seen more in 2nd and 3rd trimester.
3. Plaque levels stay similar over pregnancy.
4. Changes during pregnancy do not themselves lead to attachment loss.
5. Pocket depths peak in trimester 2 then slowly go down