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prevention International magazine for oral health No. 1, 2018

| systemic diseases Gain a child, lose a tooth? By Prof. Nicole Arweiler, Germany The most important physiological, hormonal and per- haps also most beautiful changes in a woman’s life occur during pregnancy. And the mouth is one of the main areas involved in these changes. Although gingival inflammation during pregnancy tends to increase—even with correct oral hygiene—pregnancy gingivitis does not normally cause lasting damage to the periodontium. In the post-partum phase, even women with periodontitis who did not receive periodontal treatment during their pregnancy show an improvement in all clinical perio- dontal parameters. So all is well, right? Unfortunately not. The research agrees: pregnant women require special oral hygiene instructions, owing to hormonal changes, in order to avoid periodontitis. This is because periodon- tal treatment can be nerve-racking, time-consuming and bad for their health. How important is periodontal health for pregnancy really? Its significance is actually increasing with current research findings. Pregnancy gingivitis is one of the most important periodontal diseases. Like other forms of gin- givitis, untreated it can lead to periodontitis. No specific type of periodontitis is linked to pregnancy, but periodon- titis seems to be a potential risk factor for negative preg- nancy outcomes. But how strong are the connections between periodontitis and negative pregnancy outcomes like premature birth, low birthweight and pre-eclampsia really? More on that later. The legislature has already known for decades about the importance of periodontal health for expectant mothers (e.g. the maternal health passport guides women in Germany and Austria through pregnancy). Federal com- mittees and health insurance companies also require that gynaecologists and dentists speak about the importance of oral hygiene for mother and child in the last trimester as needed. Unfortunately, the reality is that only 5 to 10 per cent of pregnant women worldwide see a dentist during pregnancy. Certainly, socioeconomic status, fear and perhaps also apathy mean that many patients avoid the dentist. Many expectant mothers say they do not have time to go to the dentist several times. “Gain a child, lose a tooth,” as your grandmother used to say. What is pregnancy gingivitis? Various periodontal diseases, including pregnancy gin- givitis, granuloma gravidarum (pregnancy tumour, also epulis gravidarum) and periodontitis, affect the (oral) health of pregnant women. Pregnancy gingivitis is there- fore among the classic gingival diseases. Besides plaque- induced gingival disease, pregnancy gingivitis ranks among the diseases altered by systemic factors. This includes hormonal influences, like puberty, menstruation, preg- nancy and diabetes mellitus or even blood disorders. In appearance and form, pregnancy gingivitis does not differ from classic gingivitis, but it does differ in prev- alence. Already in 1933, Ziskin et al. spoke of a 30 to 100 per cent occurrence.1 In more recent studies,2–4 this varied between 38 per cent and 93.7 per cent. Gingivitis has 18 prevention 1 2018

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