2. INTRODUCTION
• Pregnancy is a condition where hormonal changes
produce systemic multiorgan effects, influencing the
cardiovascular, respiratory, dermal, genitourinary,
digestive, and nervous systems and even the oral
cavity.
• Many authors have maintained that hormonal
changes, together with plaque, are responsible for
alterations produced during pregnancy in
periodontal tissues.
3. • Research has demonstrated an increase in
progesterone at the oral level produced changes in
oral bacteria.
• Kenneth S. Kornman 1987
4. • During pregnancy there are specific gingival
alterations such as pregnancy gingivitis,
characterized by hypervascularity and non-specific
cellular inflammatory infiltration.
• Another alteration is pyogenic granuloma which is
an exaggerated proliferative fibrovascular
inflammatory reaction located in the gingiva.
5. • These periodontal alterations may trigger an
immune response and provoke release of
inflammatory mediators.
• Bacteria and their toxins activate macrophages and
other cells to synthesize and secrete a broad
spectrum of molecules, among them is C-reactive
protein (CRP).
6. • Alteration of CRP marker could be an indicator of
complications during pregnancy, such as
preeclampsia, premature birth, and low birth weight.
7. • There is scarcity of literature to evaluate the
behavior of CRP and periodontal changes that
women sustain postpartum.
• Also, soon after childbirth, production of estrogen
and progesterone decreases and reaches values
comparable to those present in non-pregnant
women.
8. AIM
To assess variations which take place postpartum
with reference to hormonal levels, periodontal
parameters, and plasma inflammatory mediators in
the absence of periodontal treatment.
10. EXCLUSION CRITERIA
• Risk for preterm delivery, twin pregnancies, obstetric
pathology prior to pregnancy such as uterine
malformation or cervical incompetence.
• Patients with fewer than 15 teeth (excluding third molars)
and having periodontal treatment during pregnancy.
• Any gynecologic complication or dental or periodontal
acute infection during the observation period.
11. LABORATORY EXAMINATION
• A fasting blood sample was collected to detect
levels of CRP and progesterone in plasma.
• Baseline levels of CRP were determined by
turbidimetry in an auto-analyzer.
• To detect progesterone an auto-analyzer was used,
applying the technique of competitive
chemiluminescent enzyme immunoassay.
12. PERIODONTAL EXAMINATION
• Plaque index (PI)
• Probing depth (PD),
• Clinical attachment level (CAL), and
• Bleeding on probing (BOP).
13. First Phase- 32 and 35
of pregnancy.
Second Phase- 6 and 8
weeks postpartum.
14. STATISTICAL ANALYSES
• Means of Time 1 and Time 2 were compared using
paired t tests.
• The Pearson correlation coefficient was used to
correlate quantitative variables.
21. DISCUSSION
• The first phase of the study was carried out between
weeks 32 and 35 of pregnancy.
• Progesterone levels throughout pregnancy will reach
concentration levels of up to 30 times the luteal
phase, with the highest increase occurring in the last
trimester, when levels reach rates of 250 to 300
mg/day.
• Therefore, progesterone levels should have a higher
influence in the periodontium of patients during
weeks 32 to 35 of pregnancy.
22. • Highest peak of periodontal inflammation reaches
during the third trimester.
• Ojanotko-Harri AO,1991 studied the metabolism of
progesterone in inflamed gingiva and gingival
granulomas in pregnant women.
23. • Loe and Silness demonstrated that the first clinical
signs of gingivitis appeared in the second month of
pregnancy and continued increasing until the eighth
month, when it reached its highest levels.
• The second phase of this study was carried out 6 to
8 weeks postpartum when progesterone returns to
preovulation phase levels (1 ng/mL).
24. • Figuero et al . detected a significant reduction of
gingival bleeding two months postpartum. They also
concluded that increase in PGE2 levels during
pregnancy causes increased inflammation.
• Ziskin et al 1946 were the first to relate levels of
progesterone during pregnancy with changes in
gingival tissue.
25. • Gursoy et al. examined periodontal changes during
pregnancy and postpartum in a longitudinal study to
assess if pregnancy could produce permanent
changes in the periodontium. Results showed that
BOP and PD increased during pregnancy without
relation to plaque, and they improved during
postpartum.
26. • Raber-Durlacher et al. reported that microbiologic
changes in periodontal tissues produced an
increase in BOP, whereas postpartum there was no
increase in microorganisms and gingival bleeding
was reduced with respect to pre birth without
carrying out any treatment.
27. • CRP level in healthy non-pregnant women is <1 mg/L,
but in the third trimester of pregnancy CRP ranges from
0.2 to 4 mg/L, and some systemic diseases may
increase this value even more. D Heather Watts
• Miller corroborated levels of CRP were higher in healthy
pregnant women than in non-pregnant women. 40% of
healthy pregnant women had high levels of CRP.
• They concluded that in some women pregnancy with a
sharp increase of progesterone could alter the immune
system and, as a result, provoke an increase in levels of
CRP unrelated to periodontitis.
28. • In essence, proper periodontal control during
pregnancy will significantly reduce effects of
progesterone on the periodontium, avoiding
destruction of supporting tissues as well as
production of inflammatory mediators which could
enter the bloodstream affecting the fetus.
• It is therefore paramount to provide periodontal
supervision during pregnancy, together with
gynecologic control.
29. CONCLUSION
There is a dramatic reduction in progesterone and
CRP, together with an improvement in BOP, PD, and
CAL in the absence of periodontal treatment and a
decrease in CRP is related to an improvement in
periodontal bleeding.
30. REFERENCES
• Wander K, Brindle E, O’Connor KA. C-reactive protein across the
menstrual cycle. Am J Phys Anthropol 2008;136:138-146.
• Raber-Durlacher JE, van Steenbergen TJ,. Experimental gingivitis
during pregnancy and post-partum: Clinical, endocrinological, and
microbiological aspects. J Clin Periodontol 1994;21:549-558.
• Watts DH, Krohn MA, Wener MH, Eschenbach DA. Creactive
protein in normal pregnancy. Obstet Gynecol 1991;77:176-180.
• Miller EM. Changes in serum immunity during pregnancy. Am J Hum
Biol 2009;21:401-403.
• FigueroE,Carrillo-de-AlbornozA,HerreraD. Gingival changes during
pregnancy: I. Influence of hormonal variations on clinical and
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