Periodontal /Gum Disease Treatment Should be Included in Pregnancy Care Programs

Periodontal /Gum Disease Treatment Should be Included in Pregnancy Care Programs

Ideally, prenatal care should start before you get pregnant. If you're planning a pregnancy, see your health care provider for a complete checkup. He or she can do routine testing to make sure you're in good health and that you don't have any illnesses or other conditions that could affect your pregnancy. If you've been experiencing any unusual symptoms, this is a good time to report them.For your baby's sake and yours, it's important to take especially good care of yourself during your pregnancy.Some women are concerned about preexisting medical conditions, such as diabetes, and how they could affect a pregnancy.

In fact, a growing body of research finds that conditions in utero (i.e., while you're pregnant) have the potential to affect your child's health even decades down the road. For instance, one study found that women who drink during pregnancy could increase their child's risk of alcohol addiction later in life, even with just one drinking binge. Other studies suggest significant correlations between a mother's nutrition during pregnancy and her child's risk for being overweight and developing diabetes and heart disease later in life.

The health care provider you choose for pregnancy can make a big difference in your experience. Although the nature of your pregnancy may dictate which type of health care provider is best for you, personal preferences matter, too. Before making a decision, consider all of your options.

Black women are three times more likely than white women to die during pregnancy, and twice as many black babies as white babies die in infancy.While compliance with traditional prenatal care among black women has improved in recent years, it still lags behind white women: 75 percent of black women seek prenatal care vs. 89 percent of white women. The discrepancy continues after the baby is born too: 58 percent of white infants get all recommended well-child care, compared to 35 percent of black infants.

Prenatal care' refers to the medical care recommended for women before and during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate nutrition, exercise, vitamin intake etc), and to direct the woman to appropriate specialists, hospitals, etc. if necessary. The availability of routine prenatal care has played a part in reducing maternal death rates and miscarriages as well as birth defects, low birth weight, and other preventable infant problems in the developed world

Women who have congenital heart disease are born with a defect in the structure of the heart or the large blood vessels that carry blood to and from the heart. In general, most women with a congenital heart defect (especially those who've had corrective surgery) can look forward to having children. However, the outcome of pregnancy can be affected by many factors including the type of heart defect, the severity of symptoms, the presence of high blood pressure in the lungs (pulmonary hypertension), and the type of prior surgery and any remaining heart or lung disease. All risk factors must be carefully weighed for a woman with congenital heart disease who is considering pregnancy; each case must be individually evaluated.

Strong scientific evidence suggests the interrelationship between oral health and general health, particularly the associations between oral infections and adverse pregnancy outcomes. Common risk factors also exist between oral and chronic diseases, like diabetes, heart disease, and stroke.Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis.To ensure a minimum level of access to oral health care for all, by addressing gaps in care for the most vulnerable groups should consider concurrent disease risk factors through indicators of overall health, HIV exposure, diabetes, nutrition, cancer, pregnancy.

The word periodontal literally means "around the tooth." Periodontal diseases, also called gum diseases, are serious bacterial infections that destroy the gums and the surrounding tissues of the mouth. If the inflammation is left untreated, the disease will continue and the underlying bones around the teeth will dissolve, and will no longer be able to hold the teeth in place. Chronic inflammation, resulting from a periodontal disease, is responsible for 70 percent of all adult tooth losses, and affects 75 percent of people at some point in their lives.Periodontal disease has been identified as a risk factor for heart disease, rheumatoid arthritis, and other medical conditions, perhaps through a pathway of increased systemic inflammation.

Two studies published provide additional evidence that treating gum disease in pregnant women may prevent preterm birth.

"These data suggested that periodontal treatment should be included in prenatal care programs," conclude Dr. Catia M. Gazolla of Vale do Rio Verde University in Tres Coracoes and colleagues, who authored one of the studies. Both reports appear in the May issue of the Journal of Periodontology.

Gazolla and her team found that while pregnant women whose periodontal disease was treated were no more likely to deliver their babies prematurely than women with no gum disease, those who didn't get treatment had a nearly 90-fold increased risk of premature delivery.

And a US team found that the more bacteria women with periodontal disease had in their gums during and after pregnancy, the more likely they were to deliver their infants prematurely.

The Brazilian researchers followed 450 pregnant women, 328 of whom had periodontal disease. Given that it would be unethical to withhold treatment for periodontal disease, the researchers offered it to all of the women with gum disease and 266 received treatment in their second trimester. The remaining 62 dropped out of the study.

Among the women with healthy gums, 4.1 percent delivered infants weighing less than 2,500 grams (5 pounds 8 ounces) before 37 weeks gestation. The rate of preterm, low-birth weight delivery for women with treated periodontal disease was 7.5 percent, not a significant difference.

But among study dropouts, the rate of preterm, low-birth weight delivery was 79 percent.

In the second study, Dongming Lin of the University of North Carolina at Chapel Hill and colleagues investigated the amount of eight different types of oral bacteria and level of antibody response to one of the microbes in 31 pregnant women with periodontal disease, 14 of whom delivered their infants before 37 weeks gestation.

At 22 weeks, levels of seven of the bacteria tended to be higher among the women who delivered prematurely. These women also had levels of an antibody against a bacterium that is a leading cause of periodontal disease that were nearly four-fold lower than in women who delivered full-term infants. This suggests that their immune response to the microbe was suppressed.

After the women gave birth, levels of all eight types of bacteria were at least twice as high in those who had delivered their infants preterm. The researchers also found that levels of all bacteria types increased from 22 weeks gestation to postpartum among women in the preterm delivery group, while they remained about the same in the women who delivered full-term infants.

If other researchers confirm the findings, Lin and colleagues conclude, it may be possible to use antibody levels and oral bacterial "load" to help gauge a pregnant woman's risk of delivering preterm.

Preterm births (those occurring before 37 weeks of gestation) make up 12.5% of births in the United States. They account for 70% of perinatal deaths and nearly half of all long-term neurologic complications — the most important adverse outcomes of pregnancy.1 The earliest preterm births account for a disproportionate number of such adverse outcomes. Over the past several decades, despite extensive research and intensive medical and public health efforts, the rate of preterm birth has risen. Preterm birth may follow spontaneous preterm labor (in 50% of cases), membrane rupture (in 25% of cases), or the induction of labor or cesarean section triggered by maternal or fetal indications (in another 25% of cases).

For most women, the chance that their baby will have a birth defect is about one or two percent. But some women who have health conditions of their own, such as diabetes or disorders treated with certain medicines, have a much higher chance of having a baby with a birth defect.Treating depression is just as important as treating any other health concern during pregnancy. Without treatment, the depression can get worse or be harmful to the baby or mother. Studies also show that postpartum depression is more likely to occur if depression during pregnancy goes untreated. Therefore, it is important to get help while you are pregnant. There are many treatment options available to help depression.

The increase in the rate of preterm birth is mostly attributable to an increase in the number of preterm births attributable to maternal or fetal indications and to the occurrence of multiple births associated with assisted reproductive therapies; 50% of twin births and nearly all higher-order multiple births are preterm.Periodontal disease may lead to preterm birth through seeding of the placenta or amniotic fluid by oral pathogens.Systemic inflammation that is initiated by periodontal disease may lead to both preterm labor and membrane rupture .

The treatment of periodontal disease has included the use of antiseptic mouthwash, various antibiotics, and periodontal cleaning and plaque removal (scaling and root planing). The last treatment is believed to be the most effective for periodontal disease. Two small studies have suggested that treatment of periodontal disease in pregnancy is feasible and may reduce the risk of preterm birth.


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