HJAR Mar/Apr 2021

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2021 55 which in turn causes the gingivitis, most no- tably in the second to eighth month period of pregnancy. 4 Increased levels of circulat- ing estrogen have been found in expectant mothers and are associated with a high prevalence of gingival irritations, gingivi- tis and gingival hyperplasia. 5 Pregnant women are more prone to den- tal caries for a number of reasons. Dietary cravings for a particular sugary food or treat are a common occurrence. Recurrent vomiting, which accompanies morning sick- ness, produces an acidic state intraorally and leads to bacteria growth and increased demineralization, which decays and erodes teeth. 5 Because of the increased acidity level of the oral cavity during pregnancy, this en- vironment invites the decay process. Nausea and repeat vomiting make it irritating for expectant mothers to brush often, as tooth brushing during this time often produces a gagging sensation. Periodontal disease is an especially dif- ficult oral disease to manage during preg- nancy, and it presents as a risk for develop- ing adverse birth outcomes. 6 This particular condition has been associated with preterm Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas birth, gestational diabetes and delivery of low birthweight infants. 7 Systemic inflam- mation caused by periodontal disease re- sults in an infection that aids bacterial colonization in the oral cavity. When peri- odontal disease is uncontrolled, this infec- tion is particularly problematic for women who have diabetes or gestational diabetes. There is a bi-directional link in periodonti- tis and diabetes. 8 Studies have documented evidence that patients with chronic peri- odontal disease have more destruction of the supporting structures of their teeth if they also have diabetes. Diabetic patients, in turn, have poorer glycemic control if they also have uncontrolled or untreated peri- odontal disease. 8 Further research has shown periodontal pathogens reach the maternal reproduc- tive system via the bloodstream and trigger the inflammatory process. When chronic periodontitis is uncontrolled and left un- treated, this infectious process affects the body. These bacteria enter the bloodstream, producing a bacteremia, and travel through- out the body. 9 Inflammatory cytokines are produced from the infectious process and IT has been well established through numer- ous studies that oral health affects overall health. In the case of pregnancy, a woman’s oral heath affects not only her health but also the overall health of her unborn child. 1 An expectant mother with good oral health is the best-case scenario. However, there are instances, even when an expect- ant mother has good oral hygiene, that she may experience a flare-up in her oral cavity. Common oral health issues that can occur in pregnancy include pregnancy gingivitis, gingival irritation, tooth erosion, salivary alterations, dental caries and periodontitis. 2 Research has shown that poor oral health during pregnancy can lead to negative out- comes for both expectant mothers and their newborn children. 3 While pregnancy is a natural physiological process, it is also a process that brings considerable physical and hormonal changes in women’s bodies, and the oral cavity is no exception. 3 Hormonal levels fluctuate throughout the duration of pregnancy, which can lead to pregnancy gingivitis caused by an increased level of progesterone. The progesterone in- creases the susceptibility of bacterial plaque, “Regular visits and dental treatment ensure optimal oral health during pregnancy. The second trimester is the ideal time for any needed dental treatment or elective treatment to take place… but treatment [of present infection] should not be delayed even in the first or third trimester.”