During pregnancy, it is essential to take care of your oral health. For mothers-to-be who have a pre-existing condition, the risk is particularly increased of suffering from periodontitis. Dr. Grégoire Chevalier, periodontist, sheds light on this pathology, its symptoms and possible treatments during pregnancy.

' The periodontium is the organ that holds the teeth . It is made up of four fabrics: the gum is the only visible one of the four, the other three being the alveolar bone , the dental ligament (connecting the tooth to the bone) and the cementum (tissue covering the root and connecting the gum to the tooth). Periodontitis is an inflammatory disease of bacterial origin, affecting the periodontium “, explains Dr. Chevalier.

What is a parodontite ?

' The first symptoms are manifestations of inflammation : redness, swelling and bleeding. the bleeding gums is often misinterpreted as normal, as it is such a common symptom. However, any bleeding from the gums means that the periodontium is suffering, and justifies consultation and treatment' , observes the periodontist. The latter recalls that the symptoms of periodontitis are often discreet and that it remains a difficult disease to detect without a thorough professional clinical examination. ' This is why it is recommended to consult every year, even in the absence of a problem. Especially since periodontitis, even in its severe forms, is rarely painful .', he explains.

In the majority of cases, periodontitis is of moderate form (up to 50% of the general population), and results in loosening of teeth : denudation of the roots and weakening of the support of the teeth. When the disease is installed, we thus find a series of symptoms related to the retreat of the alveolar bone: cold sensitivities , triangles noirs between the teeth and associated food jams , dental mobility (the tooth moves when touched). Then can come tooth migration , before the fall. ' More rarely, periodontitis can cause periodontal abscesses (infection of the supporting tissues of the tooth). You can then see pus appear. Indeed, the main cause is bacterial ', adds the periodontist. Untreated, it can lead in its severe forms (11% of the population) to the tooth loss .

The causes of periodontitis

The main cause of periodontitis is accumulation of plaque and of tartar , the natural habitat of bacteria in the mouth. The mechanism is a microbiota dysbiosis ', i.e. an imbalance of the microbiota mouth, all the bacteria that live naturally. ' Among the 700 bacterial species of a symbiotic microbiota, there are a few species (called pathobionts), capable of creating periodontitis, but in quantities too low to trigger the disease. In the dysbiotic microbiota, there is an overexpression of these few species. When their quantity is too large, then periodontal disease begins. “, explains the specialist.

The accumulation of dental plaque is a necessary but not sufficient condition. Other factors come into play in the onset of periodontitis: genetics, immunity, dental hygiene . ' The gums were considered in popular knowledge to be a barometer of general health, and it's a truth: any change in general health can manifest itself in bleeding gums. This is precisely the case of pregnancy, which has a whole series of impacts on the periodontium “, explains Dr. Chevalier.

Pregnancy, a breeding ground for periodontitis

If pregnancy cannot create periodontitis - it takes a pre-existing ground - it can trigger it or make it worse . The responsibility is to be found on the side of hormones. ' Surprisingly, the gums are full of receptors for these pregnancy hormones. Schematically, they cause an increase in the permeability of the gums. The gums are a mucous membrane, and as such a barrier between the inside and the outside of the body. They are the seat of a permanent inflammatory noise, and of a constant dialogue between the bacteria living on their surface and the host cells ensuring the immune response. This balance, called homeostasis, is often disrupted by pregnancy. ', explains the periodontist. ' There is then an increase in inflammation, symptoms on the gums and potential damage from periodontitis .', he adds.

It is also important to add that the hormonal changes that the woman experiences during pregnancy are the same as those she undergoes during medically assisted procreation (PMA), but over much longer periods during the PMA. The risks of periodontitis are therefore also increased during an assisted reproduction course.

Pregnancy and oral health: regular monitoring before and during pregnancy

Pregnancy then has more indirect repercussions on oral health in general. Changes in diet can influence the caries risk (sometimes sweeter food intakes, and multiple during the day). ' Potential vomiting acidifies the mouth, weakens the enamel and promotes the work of bacteria that create the caries . Finally, changes in hygiene behavior can take place due to fatigue, and complete the very rich picture of the impacts of pregnancy on oral health. “, details Dr. Chevalier.

Do you know the saying: 'one pregnancy, one tooth'? Although it initially had no scientific basis, American epidemiologists* have actually shown it to be statistically true. ' But it's not inevitable: with proper care, we can limit the risks “, nuances the periodontist.

* Effect of pregnancy on gingival inflammation in systemically healthy women: a systematic review . J Clin Periodontol 2013; 40: 457–473. doi: 10.1111/jcpe.12053. PubMed PMID: 23557432.

Periodontitis and pregnancy: what are the risks?

The risks are numerous, both for pregnancy and for oral health. . ' Concerning the risk component of periodontitis on pregnancy, a recent study with a very high level* of scientific evidence showed that a pregnant woman with periodontitis had a 1.6 times greater risk of having a premature delivery , 1.7 times greater to have a low birth weight child, 2.2 times greater to suffer from preeclampsia and 3.4 times larger than premature birth of a low birth weight baby . “, details Dr. Chevalier.

Conversely, pregnancy puts the pregnant patient at risk of aggravating her periodontitis, and therefore of seeing sequelae appear on her gums (baring of the roots, black triangles between the teeth, tooth mobility and migration), or even lose one or more teeth . Dr. Chevalier therefore insists on the need to consult during pregnancy, or even better: before pregnancy.

*Daalderop LA, Wieland BV, Tomsin K, et al. Periodontal disease and pregnancy outcomes: overview of systematic reviews. JDR Clin Trans Res. 2018;3(1):10-27.)

Treatment of periodontitis during pregnancy: can we intervene?

It is possible to treat periodontitis during pregnancy , but treatments are limited. ' Except in an emergency, x-rays are not performed in pregnant women, because of the significant sensitivity of the fetus to x-rays. A usual treatment for periodontitis requires x-rays, but the treatment can exceptionally take place without for pregnant women. The radio assessment is then carried out after the term. “, explains the specialist. During pregnancy, prescriptions are also limited but luckily, periodontal treatments require few drug prescriptions. Antibiotics, for example, are rarely needed.

' Most analgesics and anti-inflammatories are contraindicated during pregnancy: periodontal surgeries are therefore not performed during pregnancy, as these surgeries (gum sanitation, gum grafts, or dental implants) are never urgent . They can therefore be postponed after the end of the pregnancy. “, also recalls the periodontist;

in revenge, the main treatment of periodontitis is possible during pregnancy . It's about surfacing , which is a intensive descaling and deep, between the teeth and the gums. ' This treatment is effective and sufficient to cure the majority of moderate periodontitis. Do not hesitate to consult during pregnancy in case of appearance of symptoms, even discreet, on the gums .”, concludes Dr. Chevalier.

Thanks to Dr. Grégoire Chevalier, liberal periodontist in Paris and head of clinic at Charles Foix University Hospital in Ivry Sur Seine (Paris Cité University)Source journaldesfemmes.fr