Moms’ Gums Matter — Oral Health Blog Series (3)

Tanden Frisk is back with the third part of our oral health blog Series. As we know, the mouth is the door of health to our bodies. This means that not only what we eat affects our bodies, but our own oral health habits have consequences on our general health as well.

After learning a little bit about dental caries in the second part of the blog series, this month, we will spotlight women’s oral health during pregnancy, specific causes, and risks of periodontal diseases. Pregnancy is not a time to delay dental care. Oral health is crucial for general health in the prenatal period. We will explain to you why.

First, it is important to know that pregnancy is a vulnerable state where the body changes to conserve and preserve life. Therefore, pregnancy is a unique and sensitive period during the oral health life course. In addition, due to changes in hormonal levels, pregnant women are more susceptible to oral infections.

The link between oral diseases and tooth loss, adverse pregnancy outcomes, cardiovascular disease, and diabetes cannot be ignored. In addition, one in four adults suffers from periodontal disease, with women being the most susceptible to it.

While women’s health care providers increasingly recognize dental care as a fundamental component of health and health care for pregnant women, it is a topic that is not always discussed by them or highlighted to pregnant women during their antenatal care visits. However, maintaining good oral health can improve the health of reproductive-aged women during pregnancy and overall health later in life.

Oral Infections

Oral infections occur mostly in 2 clinical conditions: Dental caries and periodontal diseases. These are infectious diseases of numerous origins that can aggravate and remit over time.

As mentioned earlier, we will focus on periodontal disease. Periodontal disease is divided into two main conditions:

• Gingivitis

• Periodontitis

Both conditions present halitosis, unpleasant taste in the mouth, and bleeding during tooth brushing.

Gingivitis is defined as the inflammation of the soft tissue surrounding the tooth. This stage is reversible. Gingivitis can be treated by removing dental tartar, that is, hardened dental plaque (Dental plaque is the sticky substance that forms on teeth from bacterial buildup). Dental tartar can be removed by dental prophylaxis and improvement of daily oral hygiene techniques.

If left untreated, gingivitis can lead to periodontitis, characterized by inflammation around the tooth that destroys supporting structures. As the disease progresses, the bacteria destroys the soft bone and support tissue of the teeth, producing dental mobility, that is, displacement of a tooth. The treatment for this stage is deep prophylaxis, as well as root scraping. If left untreated, it could result in tooth loss or dental extraction.

Impact of periodontal disease on maternal and child health

Periodontal disease occurs mainly among women with poor or no oral hygiene, who do not receive regular dental treatment, smoke, suffer from diabetes, or have immunosuppression.

From the moment that women start puberty, hormones such as estrogen and progesterone exaggerate the mechanism of gum reaction to plaque irritants, making women an easy target for the bacteria that cause periodontal disease. For example, the increase of estrogen and progesterone during the menstrual cycle causes the appearance of canker sores, inflammation, and bleeding gums.

During pregnancy, the increase of these hormones alters the connective tissue of the gum and its immune response to oral bacteria. As a result, the development of gingivitis between the second and eighth week is common, starting as red, swollen, or sensitive gums.

It has been found that 20–50% of pregnant women have periodontal disease. More importantly, evidence suggests that oral care during pregnancy is both safe and significant. Thus, given that rates of periodontal disease during pregnancy are high and the significant health implications of poor oral health for mother and offspring across the life course, there is a critical requirement to assess what interventions are available and effective that translate the oral health guidelines into practice

Risks

Periodontal disease during pregnancy has been associated with adverse pregnancy outcomes, such as premature births/low weight at birth, gestational diabetes, preeclampsia, cardiovascular disease, and fetal loss. The strength of these associations ranges from twofold to sevenfold increase in risk.

The American Academy of Periodontology advises that women should receive preventive services and any indicated therapeutic intervention during pregnancy. However, socioeconomic factors, lack of resources to pay for care, barriers to access to care, and lack of public understanding of the importance of oral health and effective self-care practices all represent reasons for observed deficiencies in oral health.

A study of 194 obstetricians reported that only 22% performed an oral evaluation during the initial prenatal assessment and that 49% rarely or never recommended a routine dental examination. Unfortunately, this means that the oral assessment may not be included in the prenatal evaluation forms and databases.

Other type of risks: Misconceptions or myths

One of the difficulties that health professionals face is the misconceptions or myths about dental health during the pregnancy period. Periodontal disease develops over a relatively long period, which means there is considerable time between the initial exposure of the disease and its clinical presentations. Therefore, we know that we have a long period of prevention, detection, and action to avoid the disease. However, studies have shown that in the United States, women believe that a deficiency in oral health and the presence of infectious diseases in the oral cavity during pregnancy can’t be avoided. Surprisingly, they also think that any dental treatment during pregnancy could affect the fetus negatively.

Adding up the lack of access for women living in vulnerable conditions and the misinformation, we can understand how relevant it is for health professionals who deal with women to promote oral health before, during, and after pregnancy.

Moving Forward

Reducing the knowledge gap on oral health before, during, and after pregnancy will be achieved by, initially, educating the health providers so that they motivate their patients. Here is where Tanden Frisk is aiming to make a difference. We aim to debunk those myths among pregnant women by improving the collaboration between health care providers to close the knowledge gap. We want to make oral screening and oral health education part of antenatal care. That is why we have updated our project’s mission to include pregnant women in Sweden, with a focus on women with migrant background. In future blog posts, we hope to fill you in on how much progress we would achieved.

What do you know about oral health and pregnancy in your country? Are health care providers paying attention to expectant mothers’ oral health? Learned anything from this article? Share your thoughts and let us know in the comments below! If you have any questions, feel free to contact Aya and Carolina or the bloggers!

And don’t forget to check out our previous oral health blog posts. If you missed the first or second part of our oral health series, here they are: ‘Be Proud of your Mouth with Tanden Frisk‘ and ‘Minding the tooth gap‘. Interested in eco-friendly ways to care for your teeth? Find all you need here: ‘Go Green With Your Teeth Clean!‘

See you next time, on the fourth and final part of our Oral Health Blog series!

Authors: Aya El Hajj and Carolina Garcia Sanchez