Effect of Periodontal Diseases on Pregnancy

Abstract

Pregnancy is a unique physiological state that affects almost all the organs, because of changes in the hormonal milieu meant to support the pregnancy. These changes, generally reversible after delivery, are sometimes not without adverse effects. Recent upsurge in the interest in periodontal disease in pregnancy is attributed to association between periodontitis and adverse pregnancy outcome. Periodontal diseases are a group of infections and conditions that cause inflammation of the gingiva and the surrounding structures, which leads to destruction of the supporting tooth structures. Periodontal infections are predominantly caused by Gram-negative bacteriae that induce local and systemic elevations of proinflammatory cytokines. Transient bacteremia that occurs due to high vascularity of the periodontal tissue may lead to direct bacterial invasion of the fetoplacental unit. The release of toxic products incites host's response and triggers an inflammatory response. As a source of subclinical and persistent infection along with the cascade of systemic inflammatory responses and immune-mediated injury, periodontitis puts the pregnancy at high risk. Evidence for and against association between oral diseases and adverse pregnancy outcome comes from cross-sectional studies and a few trials. Like any other association of obstetric outcome with systemic diseases, this one is also a subject of debate. We reviewed the studies providing evidence for and against effect of periodontal diseases on pregnancy. We found that different investigators have used different parameters to define periodontal disease, hence different results. Larger randomized controlled trials with uniform definitions of disease and outcome are needed to arrive at a definite conclusion.