Effects Of Systemic Health On Periodontology - Effects Of Pregnancy On The Periodontium

Question 1

What happens to the periodontal tissues during pregnancy?

Answer 1

Increased local inflammatory responses DUE TO :

– Changes in vasodilation and other responses mediated by increased oestrogen / progesterone
– Changes in local microbiome
• Direct – as a result of hormonal changes?
• Indirect – as a result in localised inflammation / responsiveness

Question 2

What effect does increase progesterone have during pregnancy

Answer 2

Increased oestrogen + progesterone

Increased progesterone = increase in gingival vascular permeability + gingival exudate + disturbs neutrophil chemotactic responsiveness
Progesterone + oestradiol = increase prostaglandin E2 production by lipopolysaccharide stimulated human monocytes -> increase inflammatarory reaction

Question 3

What happens to the host & microbiome during pregnancy?
What is seen during second trimester of pregnancy

Answer 3

increase in gingivitis
Increase in the ratio of anaerobic to aerobic bacteria
Increase in Prevotella intermedia.

Also Plaque uptake of C14‐steroids increased significantly during pregnancy and paralleled the plaque levels of Prevotella intermedia

Question 4

What happens to the host & microbiome during pregnancy?
Difference in organisms?
What organisms are important during pregnancy?

Answer 4

Shift to more pathogenic flora in pregnancy

MAIN 3:
Prevotella intermedia
Fretibacteria OT361
Porphyromonas endodontalis

Increased levels also of : Porphyromonas gingivalis, Treponema denticola

This shift is stable during pregnancy

There are interrelationships between these organisms during pregnancy

The flora tends to revert to a healthy one, with fewer inter-relationships after pregnancy

Question 5

What do periodontal changes during pregnancy manifest as / lead to ?
(3)

Answer 5

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

Question 6

What causes variation in severity of response?

Answer 6

Question 7

Pregnancy associated gingivitis
What does it look like?

Answer 7

Band of inflamed tissue around necks of teeth
Increased pocket depths in these areas
False pockets - probe cant get past EDJ - these pockets go after inflammation is gone

Question 8

Pregnancy-associated epulis
What does it look like

When can it be removed

Answer 8

Can only be removed after pregnancy if it becomes fibrous

Question 9

How is periodontal tissue inflammation as a result of pregnancy managed

Answer 9

– OHI, instrumentation
– Excision of residual epulis lesions, if persistent, after pregnancy

Question 10

Clinical changes in peridontium during pregnancy

Answer 10

BOP and PPD INCREASED - false pocketing, no loss of attachment but see pockets

Question 11

Summary
What might pregnancy enhance/create?
Why does this occur?
What causes inflammation to be more severe?
Is degree of response the same for all patients?
Do changes require follow up?
Do the changes lead to attachment loss?

Answer 11