24. Does Periodontal treatment decrease the chances of low birth weight ? S adatmansouri S, Sedighpoor N, Aghaloo M. Effects of periodontal treatment phase I on birth term and birth weight. J Indian Soc Pedod Prev Dent 2006;24:23-6
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Editor's Notes
Assalamo-Alaikum and Good morning ladies and gentle men, my name is Muhammad Haseeb and today I will present few of my cases on the topic which is unfortunately overlooked both by patients and doctors
I will try to enable the participants to understand few important consideration for the management of pregnant patients
The increased levels of estrogen and progestrone hormones in pregnancy does a lot to the body system A low response of lymphocytes in pregnancy weakens the body defense system and alters the host immune-modulatory response to bacterial pathogens
Oral cavity harbors a lot of bacterial species, pregnancy not only affects the response of bacteria but also favors the growth of certain bacterias. P. intermedia is a Vit K dependent bacteria and the structure of estrogen resembles that of vit K so the bacteria utilizes the estrogen as a substrate. The increased amount of hormones also causes an increased fluid flow to gingiva Inflammation of gingiva is termed as gingvitis which is quite common in pregnancy Other manifestation which can appear in pregnancy is pregnancy granuloma, tooth erosion and tooth mobility
These myths are common as well and were also documented in older literature. Probably you might also have listened atleast one of them.
But the fact is that there is scientific evidence behind them.
Important to note here is that plaque causes gingivitis, pregnancy causes a hypersensitive response to plaque microorganisms. In the absence of plaque, pregnancy wont itself cause the disease
This patient exhibits swollen gingiva in buccal and palatal aspect
In this case you can appreciate the gingival hyperplasia, the picture was taken after scaling was done.
Same patient, the picture shows hyperplasia on lingual aspect as well.
Patient is instructed to maintain the oral hygiene, professional scaling and polishing is mandatory along with root planing and curettage to remove the irritants that is plaque and calculus
Second trimester is generally considered safe for all elective dental treatment, but scaling and polishing can be done in all trimesters with equal safety.
About 10% of pregnant patients get effected by pregnancy granuloma, the etiology is the irritation from toxins produced by plaque microorganisms. The granuloma is of purple red color due to stasis of blood in it.
This is a fairly large pregnancy granuloma, Pedunculated and originating from the interdental area.
The same patient after resection of pregnancy granuloma using Electrocautery.
There are some other lesions which mimic pregnancy granuloma, so you need not to label every person as pregnant with similar presentation What this can be ? Similar in presentation but the patient is not pregnant
Another case in a male patient
Hyperplasia in another patient
The word pyogenic is misleading because there is no pus associated with it. Pyogenic granuloma usually present in females owing to increased hormone levels both in pregnancy as well as due to use of oral contraceptive drugs.
The problem with pregnancy granuloma is to decide whether to resect or not, because if resected it can recur and if not resected it can harbor bacteria and can cause periodontal disease apart from compromising speech and mastication.
Till now I have been discussing with you the effect of pregnancy on oral cavity, now I would like to reveal you the facts of periodontal disease on pregnancy outcome. The preterm birth and low birth weight have been shown as possible adverse out come of periodontal disease
This flow chart shows the sequele of effect of periodontal disease in causing preterm birth. Release of interleukins from the periodontal tissues and increased levels of prostaglandin E can possibly cause uterine contraction and cervical dilation.
What we mean by preterm birth is the delivery of a new born before 37th week of gestation. Low birth weight refers to the weight of a new born less than 2.5 kg Increased rate of Preterm birth in America is also attributed to high consumption of alcohol and tobacco.
It would be quite surprising for most of you that Bidirectional relationship in adverse pregnancy outcomes and periodontal disease has also been documented. Treatment of periodontal disease during pregnancy can reduce the chances of preterm birth.
This is really important to note. Usually it is a prevailing concept not only in Pakistani population but also in American population that dental treatment can harm the fetus which is absolutely wrong.
The truth is that dental treatment is safe and scaling and polishing should be advised to pregnant women atleast two times in pregnancy Getting a radiograph specially for diagnostic purpose is safe as well.
I would conclude my talk by highlighting what is needed by the general practitioners and specialist doctors. Please do refer the patients to dentist for mechanical cleaning of teeth. If you have considerations of sterilization of dental equipment, let me tell you that in Fatima memorial hospital dentistry department ensures that all protocols of sterilization and cross infection control are practiced so it is quite safe for your patients to have treatment there.
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