Pregnancy and Periodontal Disease: It’s All About Prevention

There is a large body of research examining the potential association between periodontal disease and adverse pregnancy outcomes. Even a casual examination of the research reveals inconsistent conclusions regarding the effect of gum disease on preterm birth and other adverse pregnancy outcomes including preeclampsia. There is a similar level of inconsistency in the interventional studies. Some showed a reduction in preterm births following periodontal therapy and others did not. One study, by Dr. Marjorie Jeffcoat, et al (BJOG. 2011 Jan;118(2):250-6.) examined the effect of periodontal treatment on pregnancy outcomes differently. This study included 322 pregnant women with periodontal disease of 6-20 weeks of gestation. 160 of them received SRP plus oral hygiene instructions and 162 received only oral hygiene instructions. No significant difference was found between the incidence of preterm birth (PTB) in the two groups, indicating that professional intervention had no beneficial effect. Rather than stop there however, the data was further teased out to look at the effect of successful periodontal therapy on the incidence of PTB. When the study data was analyzed in this manner there was a strong and significant relationship between successful periodontal treatment and full-term birth. Subjects refractory to periodontal treatment were significantly more likely to have PTB.

So, how do we proceed as clinicians with our patients who intend to have children? A good starting place is to provide salivary diagnostic testing. The results of the salivary test can be used as an indicator of risk for perio disease development and identification of high risk perio pathogens before a woman is pregnant. This would constitute a sophisticated preventive strategy, protecting the health and well-being of the mother and ultimately the developing baby. Accompanying such a plan would be recommendations for specific home care devices to improve biofilm control on a daily basis.

For individuals who are pregnant and have perio disease, perio treatment should be deferred until the late second or third trimester. Patients should also use a power toothbrush at home for at least 3 weeks prior to active therapy. This will reduce the bacterial population (which can also be confirmed with salivary testing), enhancing the likelihood of a successful treatment outcome.

There is no wiggle room with our female perio patients who are pregnant. There is no downside to providing detailed home care and biofilm control device recommendations. This should always include a power toothbrush along with interdental brushes, floss, tongue cleaner and an antimicrobial rinse. Salivary testing is non-invasive, carries no risk and provides enormous benefit as an integral part of a sophisticated preventive strategy for our patients who may become pregnant at some future point in time.

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Richard H. Nagelberg, DDS
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