Challenge: Pregnant, periodontal maintenance patient appointed with increasing periodontal measurements over the last two periodontal maintenance appointments. The goal of testing is to establish the cause for the increase of inflammation.
Background: My 44-year-old periodontal maintenance patient with a regular recall and excellent home care consisting of electric toothbrushing 2 times per day, nightly flossing, and use of Waterpik™ 2 times per day presented for a maintenance appointment. Upon reviewing her medical history, she indicated she was 4 months pregnant. Her chief complaint was the presence of pus around crowns in the morning. I completed the periodontal assessment and discovered active disease consisting of 4-9 mm periodontal pockets with bleeding. The appearance of the tissue was red, inflamed, and bulbous. Her periodontal history started in 2013 with her most recent active therapy completed in 2018. Both therapies included the application of LANAP. Maintenance was achieved both times.
Solution: To address the active periodontal disease, the oral rinse specimen was collected on 8/13/2021. The presence of several pathogens determined the cause of the inflammation was bacterial not just hormonal. For the duration of the pregnancy, the periodontal maintenance appointments were adjusted to every month until delivery. This allows for close monitoring and placement of Arestin® when needed. The systemic antibiotic was not considered. However, emphasis was placed on home care without modifications. The need for active therapy will be addressed following the delivery, periodontal reassessment, and retesting.
Results: Periodontal health during pregnancy can be extremely difficult to achieve. There are many systemic conditions such as immunosuppressive hormones and stress, in addition to potential localized triggers such as periodontal pathogens that may need to be addressed at the same time. To know exactly how to approach care, MyPerioPath® testing was a must and revealed significant pathogens, some of which could complicate a pregnancy.
- Pregnancy & Periodontal Inflammation: Pathogens or Hormones? - November 19, 2021