IADR study: Is gingivitis likely in pregnant women?

Women who are pregnant are likely to have moderate to severe gingivitis and may need regular care to maintain their oral health and help avoid adverse pregnancy outcomes, according to a new study.

The researchers also found that gingivitis is relatively stable in the late first and second trimester. The study was presented on June 23 at the International Association for Dental Research (IADR) meeting in Seoul, South Korea, by Michael Reddy, DMD, dean of the school of dentistry at the University of Alabama at Birmingham (UAB).

"There exists compelling evidence based on epidemiologic, microbial, and intervention studies suggesting an association between pregnancy gingivitis and adverse pregnancy outcomes," Dr. Reddy told DrBicuspid.com in an email. "Pregnancy gingivitis is the most common form of periodontal disease in pregnant women and yet the data are limited on potential demographic, social, and gestational age effects."

Gingivitis prevalence

Sources estimate that fewer than 40% to almost 80% of pregnant women have gingivitis. Given the ubiquity of the condition, this multicenter study attempted to focus on the need for better oral healthcare during pregnancy.

The researchers sought to evaluate the effect, if any, of gestational age, study site, and demographic factors on first- and second-trimester pregnancy gingivitis. Working with trained examiners, they identified more than 600 pregnant women (between eight and 24 weeks of gestation) with at least 30 gingivitis bleeding sites. The examiners also measured whole-mouth gingivitis scores at up to 168 sites using a four-point clinical index, the Loe Silness GI.

The researchers found that study site and maternal age were significant factors in gingival bleeding during the first two trimesters of pregnancy, but that gestational age and ethnicity were not. They also found that younger women, in general, had higher measured gingival inflammation.

Dr. Reddy said this study overturned some of the conventional wisdom about gingival inflammation as pregnancy progresses.

"The conventional wisdom indicates that gingival inflammation increases progressively throughout pregnancy and returns to baseline levels postpartum," he said. "In this study we found that the level of pregnancy gingivitis was the same for women at eight weeks of gestation as it was for 24 weeks with no significant difference in the first or second trimester."

Age-related issues

Which patients experienced gingival inflammation was another surprising result.

"The gingival inflammation was more significant for young women, whereas most periodontal diseases tend to escalate in severity associated with age," Dr. Reddy said. "This may represent a lack of exposure to certain microbes in the younger mothers-to-be."

He said that all dentists should be aware of the potential issues posed by gingivitis during pregnancy.

"Pregnancy gingivitis may not be a harmless oral finding, and intervention may be important for the patient's oral health and for the well-being of the fetus," Dr. Reddy said.

As for the next steps, he said that further study is needed to clarify which women are at greater risk.

"Pregnant women should not be considered as a homogenous group," he said. "Further study of the demographic, social, environmental, microbial, and genetic aspects will enable us to add precision and to use a personalized approach to dentistry during pregnancy."

He said the data presented in Seoul are part of an ongoing randomized controlled clinical trial to evaluate the effect of late-first- to midsecond-trimester introduction of advanced daily oral hygiene on gingivitis and maternity outcomes.

Dr. Reddy was joined in the current study by co-authors from UAB, the University of Alabama, the University of Pennsylvania, and Procter & Gamble.