Pregnancy Gingivitis Research Articles

Self-reported gingival conditions and self-care in the oral health of Danish women during pregnancy.

The purpose of the present study was to describe the self-assessment of gingival health conditions in pregnant women, their oral hygiene behaviour and dental visiting habits, and to analyse self-care practices of pregnant women in relation to perceived gingival problems. The study group comprised 1935 pregnant women living in two areas of Denmark consecutively recruited from August 1998 to March 1999. The survey data were based on telephone interviews. Questions in the interview concerned general health, lifestyles, socioeconomic conditions, gingival conditions, oral hygiene and utilisation of dental health services. One-third of the study population perceived signs of gingival inflammation; 5% of the pregnant women assessed their gingiva as poor, while 95% reported good or "normal" gingival condition. Ninety six per cent brushed their teeth at least twice a day and nine out of 10 were regular users of the dental-care system. Twenty-seven per cent of those women with pregnancy gingivitis responded to the symptoms by, for example, seeing a dentist or intensifying the oral hygiene habits. Despite a high level of self-efficacy among the pregnant women as for oral health and oral health care combined with a high level of oral hygiene and dental visiting habits, there seems to be a substantial need for increased awareness of gingival oral health.

Common oral manifestations during pregnancy: a review.

Pregnancy has far-reaching systemic effects extending beyond the reproductive system. Oral and masticatory changes during pregnancy have been documented for many years; however, their magnitude and frequency have not been stressed. This review highlights the major oral complications during pregnancy. Pregnancy gingivitis and pregnancy tumor are described and presented, and possible preventive strategies are suggested. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader will be able to summarize the major oral complications during pregnancy, to outline the etiologic factors associated with each of these conditions, and to explain the role of dental treatment during pregnancy.

The Effects of Progesterone on Matrix Metalloproteinases in Cultured Human Gingival Fibroblasts

Although pregnancy gingivitis is widely believed to result from elevated hormone concentrations, the mechanism(s) involved in the etiology of this condition remain unknown. Paradoxically, despite the apparent inflammation for a prolonged period, pregnancy gingivitis rarely progresses to periodontitis and usually resolves postpartum. We used several methods to test in vitro the hypothesis that the elevated progesterone levels of pregnancy might inhibit the production of some of the matrix metalloproteinases (MMPs) that are responsible for periodontal destruction. Cultured human gingival fibroblasts (GF) were tested in phenol red-free, serum-free medium with or without the progestogen, medroxyprogesterone acetate (MPA; 10(-6) M), using interleukin-1beta (IL-1beta) to initiate immune responses and MMP production. These MMP responses were examined by macroarrays, reverse transcription-polymerase chain reaction (RT-PCR), zymograms, and enzyme-linked immunosorbent assay (ELISA). Array analysis showed that pretreatment of GF with MPA reduced mRNA induction for MMPs-1, -3, and -10 in response to 6 to 8 hours incubation with IL-1beta. RT-PCR confirmed, that after 24 hours with IL-1beta , GF pretreated with MPA had undetectable levels of mRNA for MMPs-1, -2, -3, -7, -10, and -13. Zymograms of culture media from this 24-hour period showed reduction in several proteolytic activities. Examination of such 24-hour media using ELISA for MMP-3 and pro-MMP-13 confirmed that secretion of these enzymes was upregulated by IL-1beta and modulated downward by pretreatment with MPA. Production by GF of numerous MMPs in response to IL-1beta was significantly reduced by progesterone. This steroidal modulation of proteolytic enzymes could help to explain why pregnancy gingivitis typically is not characterized by progression to periodontitis.

The Effects of Periodontal Therapy on Intracrevicular Prostaglandin E2 Concentrations and Clinical Parameters in Pregnancy

The increase in circulating levels of progesterone during pregnancy stimulates production of prostaglandins, especially prostaglandin E2, possibly resulting in pregnancy gingivitis. The purpose of this study is to evaluate the influence of prostaglandin E2 concentrations on gingival tissues in pregnancy and to assess its relationship to clinical parameters. This study evaluates the effects of periodontal treatment on clinical indices including plaque index, gingival index, probing depth, and gingival crevicular fluid prostaglandin E2 levels of 22 pregnant women in their first, second, and third trimesters. Initial periodontal therapy consisting of scaling, root planing, and oral hygiene instruction was performed at the beginning of the first trimester and repeated each trimester. Prostaglandin E2 concentrations in gingival crevicular fluid were determined using a commercially available enzyme immunoassay kit. The statistical tests used were paired sample test and correlation analysis. The results of the study show that periodontal therapy has resulted in an improvement in clinical parameters (P<0.05). There is also a statistically significant decrease in levels of prostaglandin E2 at the second and third trimesters following periodontal therapy (P <0.001). The correlation between prostaglandin E2 concentrations and clinical parameters is found to be non-significant (P >0.05). Our data indicate that levels of prostaglandin E2 in gingival crevicular fluid may be used as a marker of gingival inflammation in order to determine the effects of periodontal therapy in pregnancy. Periodontal therapy that is performed throughout the entire pregnancy period may help prevent the threat of pregnancy gingivitis.

Effect of pregnancy on periodontal and dental health

Clinical studies have shown that oral tissues can be affected by pregnancy. Pregnancy-related changes are most frequent and most marked in gingival tissue. Pregnancy does not cause gingivitis, but may aggravate pre-existing disease. The most marked changes are seen in gingival vasculature. Characteristic of pregnancy gingivitis is that the gingiva is dark red, swollen, smooth and bleeds easily. Women with pregnancy gingivitis may sometimes develop localized gingival enlargements. The gingival changes usually resolve within a few months of delivery if local irritants are eliminated. The inflammatory changes are usually restricted to the gingiva and probably do not cause permanent changes in periodontal tissues more often than those in the non-pregnant state. Although it is widely believed that pregnancy is harmful to the teeth, the effect of pregnancy on the initiation or progression of caries is not clear. Previous studies, however, indicate that the teeth do not soften, i.e. no significant withdrawal of calcium or other minerals occurs in the teeth. It is mainly the environment of the tooth that is affected. The number of certain salivary cariogenic microorganisms may increase in pregnancy, concurrently with a decrease in salivary pH and buffer effect. Changes in salivary composition in late pregnancy and during lactation may temporarily predispose to dental caries and erosion. Although their underlying mechanisms of action are not fully understood, pregnancy-related changes in the oral environment may have some untoward temporary or permanent effects on oral health. Most of these effects could be avoided by practising good oral hygiene.

Hormonal factors in periodontal disease.

This article discusses the effects of sex steroid hormones, glucocorticoids and insulin deficiency on periodontal tissues, and the possible consequences on periodontal disease progression. The androgens and oestrogens have predominantly anabolic functions in stimulating matrix synthesis, which is applicable to periodontal repair and medication-induced gingival overgrowth. Oestrogen and progesterone can contribute to pregnancy gingivitis; long-term use of hormonal contraceptives can accelerate progression of periodontal disease. Higher levels of circulating cortisol, associated with stress, can influence the onset of acute necrotic ulcerative gingivitis. Gingivitis and periodontal disease are reported to be more prevalent in type 1 and type 2 diabetes mellitus (periodontal disease, particularly in older, less well controlled subjects) than in non-diabetic individuals.

Prevotella intermedia が産生する酸性ホスファターゼに関する研究

Prevotella intermedia (P. intermedia), an anaerobic gram-negative bacterium, has been implicated as a pathogen in adult periodontitis, in acute necrotizing ulcerative gingivitis and in pregnancy gingivitis. P. intermedia has been known to have a high acid phosphatase (ACP) activity, one of the potential virulence factors in periodontopathogenic bacteria. However, little is known about the structure and function of ACPs from oral bacteria. In this study, in order to examine the potential role of ACP, the ACP from P. intermedia ATCC 25611 was purified to homogeneity and characterized. The ACP from P. intermedia was solubilized by extraction with 1% Triton X-114, and the crude extract was purified by ion-exchange chromatography on DEAE Bio-Gel, CM Bio-Gel and cellulose phosphate, followed by hydrophobic chromatography on Phenyl-Sepharose. On sodium dodecyl sulfate-polyacrylamide gel electrophoresis, the purified enzyme revealed a single protein band with a molecular weight of Mr &ap;30 kDa. The molecular weight of the native enzyme from P. intermedia was estimated to be &ap;30 kDa using a gel filtration column with TSK gel G3000SW in the HPLC system. These findings suggest that the purified ACP is a monomer. The optimum pH for the enzyme was about 4.9 and the optimum temperature was 46℃. The enzyme activity was inhibited by sodium orthovanadate, sodium molybdate, sodium fluoride and Zn^<2+>, which are known as the inhibitors of protein tyrosine phosphatase (PTP) activity. On the other hand, it was not inhibited by okadaic acid, which is known to be a specific inhibitor of protein serine/threonine phosphatase (PP) activity. The enzyme had high activities against o-phospho-L-tyrosine and phosphotyrosine-containing peptides. The purified ACP was found to dephosphorylate the tyrosine-phosphorylated protein of a molecular weight &ap;170 kDa in an A431 cell lysate. The N-terminal amino acid sequence was determined for the purified ACP, and significant homology (64.3% identical amino acid residues) was found using the Swiss Prot Protein database between the purified ACP and the Pho C, the acid phosphatase of Morganella morganii. Thus, these findings suggest the possibility that the ACP from P. intermedia constitutes a novel class of ACPs, which has a PTP-like activity.

Aggravation of gingival inflammatory symptoms during pregnancy associated with the concentration of plasminogen activator inhibitor type 2 (PAI-2) in gingival fluid.

Gingival inflammatory symptoms are aggravated during pregnancy. In vitro studies suggest a hormonal influence on the plasminogen activator inhibitor type 2 (PAI-2), and a disturbed balance of the fibrinolytic system could help to explain pregnancy gingivitis. Gingival crevicular fluid (GCF) was sampled in 14 women in pregnant and post-pregnant states. The gingival condition was assessed by the gingival index of Løe & Silness (GI) and the amount of bacterial plaque by the plaque index of Silness & Løe (PI). The ratio of sites with gingivitis to sites with bacterial plaque was calculated (G/P-ratio). Antigen levels of tissue plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitors type 1 (PAI-1) and PAI-2 in GCF were determined with ELISAs and 17 beta-oestradiol and progesterone in serum with radioimmunoassays. For each individual the differences (delta) in hormone levels and PAs and PAIs between pregnancy and post-pregnancy were calculated. Based on differences in G/P-ratio between pregnancy and post-pregnancy, subgrouping was done into a high-reacting and a low-reacting group. For the total group, the mean G/P-ratio was 2.0 during and 1.2 after pregnancy (p = 0.064). A statistically significant correlation between delta progesterone and delta PAI-2 was noted: the higher delta progesterone, the lower delta PAI-2. No other significant correlations between hormone levels and components of the fibrinolytic system were found. For the total group of women, the concentrations of PAI-2, PAI-1 and t-PA were significantly higher during than after pregnancy. The individuals in the high-reacting group, however, showed a lower or unchanged production of PAI-2 during pregnancy, while those in the low-reacting group showed a greatly increased production. The lower inhibitory capacity in terms of a low production of PAI-2 during pregnancy in women with a higher inflammatory reaction indicates that the components of the fibrinolytic system may be involved in the development of pregnancy gingivitis and implies that PAI-2 serves as an inhibitor of importance for tissue proteolysis. The present finding contributes to the explanation of pregnancy gingivitis.

Beyond pregnancy gingivitis: bringing a new focus to women's oral health

The compromised functional status, physical confinement, medical conditions, and cognitive impairments of significant numbers of women have important implications for oral health risk and dental treatments. In addition, there are a variety of economic, social, psychological, and behavioral factors which are operative in placing women at high risk for development of oral diseases. This paper describes the available U.S. data on women's oral health and examines some of the biological, behavioral, and societal factors which may be important for a more comprehensive understanding of this subject. It is this broad array of factors which differentiate women from men and which should be considered when defining priority research and treatment issues for women's oral health.

Experimental gingivitis during pregnancy and post-partum: immunohistochemical aspects.

The histoimmunological response of 8 individuals was studied longitudinally in relation to the development of experimental gingivitis during pregnancy and post-partum. At day 0 as well as at day 14 of experimental gingivitis the mean periodontal pocket bleeding index (PPBI) was higher during pregnancy than post-partum, whereas the amount of plaque that accumulated was similar. The number of CD1 positive cells (mainly Langerhans) in the oral epithelium was found to be higher during pregnancy. In the sulcular epithelium, however, the number of these cells tended to decrease during pregnancy as compared to post-partum. The number of CD4 positive cells in oral and sulcular epithelium was increased during pregnancy (P < 0.05). It was speculated that this increase in the number of CD4 positive cells is confined to the Th-1 subset, since the number of CD14 positive cells (mainly macrophages and granulocytes) together with the number of B cells was found to be decreased during pregnancy. Th-1 cells are known to be cytotoxic against these HLA class II antigen bearing cells. Consequently, cytotoxicity directed against B cells and macrophages may result in diminished immunoresponsiveness in pregnancy gingivitis.

CD4 to CD8 Ratio and In Vitro Lymphoproliferative Responses During Experimental Gingivitis in Pregnancy and Post‐Partum

The absolute numbers and percentages of peripheral T, B, and NK cells were assessed in 7 women, both during the second trimester of pregnancy and 6 months post-partum. Furthermore, the in vitro responses of peripheral blood lymphocytes (PBL) to several mitogens and a preparation of Prevotella intermedia were compared in a period of experimentally-induced gingivitis during pregnancy and post-partum. Clinically, the periodontal pocket bleeding index (PPBI) was found to be higher during pregnancy than post-partum. The absolute numbers of CD3, CD4, and CD19 positive cells appeared to be decreased during pregnancy as compared to post-partum. However, the results did not indicate any evidence for a reduced in vitro PBL response to several mitogens and a preparation of P. intermedia during pregnancy.

Altered tissue metabolism of progesterone in pregnancy gingivitis and granuloma

The metabolism of progesterone may play a special role in the gingival physiology. The lower the metabolism the higher its hormonal activity in the tissue. In healthy human gingiva, progesterone is metabolized only partially and is therefore in an active form. In the present study, gingival samples from pregnancy gingivitis (n = 1) and granulomas (n = 4) were studied histologically and biochemically. All samples were homogenized and then incubated with [4-14C]-progesterone and NADPH for 2 h at pH 7.4 and 37 degrees C. The metabolites were separated and characterized with column, solvent and thin-layer chromatographies as well as radioautography and quantified with liquid scintillation counting. The results showed low metabolism of progesterone, indicating active hormonal function as in healthy gingiva. It is suggested that progesterone functions as an immunosuppressant in the gingival tissues of pregnant women, preventing the rapid acute-type of inflammatory reaction against plaque, but allowing an increased chronic-type of tissue reaction, resulting clinically in an exaggerated appearance of inflammation.

Baby on the Way: Basics (review)

465 Review BABY ON THE WAY: BASICS By The American College of Obstetricians and Gynecologists (ACOG), Literacy Volunteers of America, and the editors of Baby Talk magazine. 48 pp. Washington, DC: ACOG, 1991. MOST of the current literature on prenatal care is written by and for persons who are comfortable with the written word. But many of the infants in this country who suffer from poor prenatal care are born to mothers who never graduated from high school or who have limited reading skills. This disparity prompted the publishers of Baby Talk, the country's oldest monthly baby magazine, to team up with The American College of Obstetricians and Gynecologists (ACOG) and Literacy Volunteers of America to produce Baby on the Way: BASICS, a magazine that dispenses advice about prenatal care using accessible, easy-to-understand language. Baby on the Way: BASICS was released in November 1991, a year after the successful launch of Baby on the Way, a magazine designed to guide literate women through healthy, complication-free pregnancies. To illustrate the difference between the two, here are sample passages from the first version: The increase in progesterone levels can also cause your gums to become inflamed and bleed. This is known as pregnancy gingivitis. If the swelling is severe, permanent damage could occur, although your gums usually return to normal after you give birth. Regular brushing and flossing can prevent or lessen the severity of this gum condition. and the simplified second version: Your gums may get red and bleed. Brush and floss your teeth at least two times a day. Your gums will get better after the baby is born. The demand for the BASICS magazine, like that of its predecessor, was overwhelming. In June 1991, one month after a publicity mailing to Women, Infant, and Children (WIC) and Maternal and Child Health programs nationwide , ACOG received 1,200 orders for 175,000 copies of the magazine. Since then, the demand for Baby on the Way: BASICS has far exceeded its first-year press run of 514,000. Given the content of this magazine, and the desperate need Journal of Health Care for the Poor and Underserved, Vol. 2, No. 4, Spring 1992 466__________________________________________________________ for material prepared for low-literacy populations, the enthusiastic reception is not difficult to understand. The magazine contains articles titled "Your Pregnant Body: Head to Toe," a nutrition guide called "Eating for Two," and subsequent articles on exercise, medical checkups, medical tests during pregnancy, harmful habits, and infections . Articles on childbirth ("What Happens When Your Baby is Born") depict both regular and Cesarean deliveries. A section on what happens after delivery takes care to mention the likelihood that sometimes babies who are "very small" must go to an intensive care unit, and advises "If this happens, you might not get to see or hold your baby very much. But you should try to go to the hospital to visit your baby even if you can only see or touch your baby for a short time." Articles follow on family planning, breastfeeding, getting acquainted with the baby, a glossary ("Words Doctors Use") and furniture and other accessories to provide for the baby. The though tfulness of these presentations is illustrated by the placement on the edge of the magazine page of a truncated ruler measuring 2 Vi6 inches long—this to help the reader measure the space between the bars of a crib because "small babies can get caught or hurt themselves if the crib isn't safe." Thus Baby on the Way: BASICS highlights the most important aspects of prenatal care. The writing is simple without sounding patronizing, and the fullcolor illustrations and photographs are informative and gently upbeat. There are shortcomings, however. Although African-American women are featured in photographs, only one-quarter of the illustrations feature babies or mothers with brown skin, and four of the six men portrayed in the magazine are white. I think it is important to use blacks in such illustrations; certainly the audience for this magazine is significantly black. A greater presence of black babies and families would almost certainly help blacks feel that the magazine is directed at them and reflects them. I also question...

Primary Gingival Enlargement as a Diagnostic Indicator in Acute Myelomonocytic Leukemia

A 25-YEAR-OLD CHINESE FEMALE, five months pregnant, came to our dental clinic with a chief complaint of slight gingival inflammation. A diagnosis of pregnancy gingivitis was made. One week later, there was a sudden onset of extremely generalized gingival enlargement and very high WBC count (144,000/cmm) was noted. Physical, laboratory, and microscopic examination led to the diagnosis of acute myelomonocytic leukemia. The observations of good oral hygiene and clinical course suggested that leukemic cell infiltration was the major cause of sudden onset of gingival enlargement. This article emphasizes the importance of primary gingival enlargement in the initial diagnosis of leukemia.

Pregnancy gingivitis and estimation of oxygen consumption in gingival tissue.

AbstractForty females were included for the clinical dental examination and estimation of oxygen consumption in the gingival tissue using the Warburg manometrictechnique. In the twenty pregnant females there were no significant difference in the plaque and retention indices as compared to the non‐pregnant females. However the gingival index was significantly higher in pregnant women. The oxygen consumption in the gingival tissue showed a statistically significant increase in the pregnant women. Explanation for these changes were discussed.

The Nurse as the First Line of Defense Against Periodontal Disease

Pregnancy gingivitis is one of the most frequent forms of periodontal disease seen by nurses. Nurses can be an invaluable "first line of defense" against this malady. A basic dental diagnostic procedure for the nurse is presented in this paper.

Plasma Female Sex‐Hormone Levels and Gingivitis in Pregnancy

This investigation has confirmed that there is an increase in gingival inflammation between the 14th and 30th weeks of pregnancy and that this will occur despite a fall in the amount of plaque at the dento-gingival junction. This implicates a further factor in addition to plaque accumulation to explain the increased inflammmation. It was confirmed that there are marked increases in the plasma levels of estradiol and progesterone between the 14th and 30th weeks of pregnancy but it was not possible to demonstrate a direct association between these increases and the increase in gingival inflammation.

Maternal T‐Lymphocyte Response and Gingivitis in Pregnancy

The exacerbation of a chronic gingivitis during pregnancy was confirmed in a group of 24 pregnant patients who were observed at the 14th and 30th weeks of pregnancy and postpartum. This exacerbation occurred despite a fall in the amount of plaque accumulation and confirmed that during pregnancy some factor in addition to plaque is involved in the increased inflammation. Using in vitro methods, it was shown that during pregnancy there is a depression of maternal T-cell responsiveness and it is suggested that this depression of the cell-mediated immune response could be a factor in the altered responsiveness of the gingival tissues to plaque. However lymphocytes responses to Veillonella alkalescens ultrasonicate (a plaque antigen) were generally poor and it was not possible to demonstrate any significant difference between the altered responsiveness of maternal lymphocytes to Veillonella and those of nonpregnant controls.

Gingivitis and pariodontal disease in pregnancy : SAMANT A., MALKI C. P., CHABRA S. K. and DEVI P. K.J. Periodontol.47 (1976) 415–418

Gingivitis and pariodontal disease in pregnancy : SAMANT A., MALKI C. P., CHABRA S. K. and DEVI P. K.J. Periodontol.47 (1976) 415–418

Clinical comparison of thickened and unthickened urea peroxide-glycerin products

Preliminary findings suggest the advisability of further investigation on the clinical utility of a thickened urea peroxide-glycerin product as a professional adjunctive aid to better control the incidence and severity of pregnancy gingivitis. The results also tend to confirm previous reports on the value of urea peroxide in glycerin (thickened or unthickened) as an aid in controlling the severity of gingival inflammation in the general population.