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been found to correlate with hormone level and plaque. In the second and third trimesters, pregnant women gener- ally notice an increase in gingivitis and bleeding, since the body produces the steroid hormones proges- terone and oestrogen more strongly. The more plaque, the higher the risk of gingivitis. The causes of pregnancy gingivitis, how- ever, seem to be more complicated than previously believed. Even small quantities of plaque in pregnant women lead to an exces- sive inflammatory reaction in the suscepti- ble tissue. Not only does the immune sys- tem change, but so do blood circulation and the cell system. The entire oral mucosa pre- pares for the birth. The practice team must therefore pay particular attention to the dental biofilm. Progesterone and oestrogen directly promote the pathogens Prevotella intermedia and Porphyromonas gingivalis. Indirectly, the soft tissue is more sensitive to bacteria that reach the oral cavity. Does pregnancy gingivitis lead to premature birth? Generally, science assumes that periodontal inflam- mation plays an important role in pregnancy complica- tions. Periodontitis as a chronic inflammation is ultimately caused by a bacterial infection and thus represents a potential source of circulating inflammatory biomarkers. These inflammatory mediators spread throughout the entire body and are related to possible negative preg- nancy outcomes. In studies on periodontitis in pregnant women, the occurrence of the disease varied between 0 per cent5 and 61 per cent.3 Clinical studies further suggest that bacteria, like P. gingivalis, Treponema denticola, Tannerella forsythia and Fusobacterium nucleatum, from the oral cavity col- onise the foetus and the placenta, with blood being the most likely transfer medium. These periodontal patho- gens may therefore represent a risk factor for negative pregnancy outcomes, including low birthweight, pre- mature birth and pre-eclampsia (high blood pressure). Actually, there is still no clear proof to support the con- nection between periodontitis and negative pregnancy outcomes. Some studies indicate that there could be a link. Further studies are needed, however, to understand the complex biological processes. Three facts remain. First, a pre-existing periodontal condition in the woman can exacerbate periodontitis during pregnancy. Second, after the birth, the periodontal status of women with peri- odontitis improves without active periodontal therapy. However, the disease does not disappear and can even worsen after the birth. Third, pregnancy gingivitis alone does not lead to negative pregnancy outcomes. systemic diseases | Prof. Nicole Arweiler Treatment and prevention Whether the mouth is healthy, has gingivitis or even periodontitis, nowadays, organisations and researchers recommend that pregnant women make three visits to the dentist, ideally once per trimester. This way, dentists can advise them comprehensively in the first trimester. The second trimester is suitable for a professional tooth clean- ing and, if necessary, periodontitis treatment. The practice team should use the third trimester for consultation on the dental health of the baby. Ideally, prophylaxis should begin for the child during pregnancy. Different studies show how important it is to educate women during pregnancy and right after the birth in order to reduce the risk of caries in children. In the dentist’s office, pregnant patients should learn everything important about the development of den- tal caries, routes of infection and nutrition; however, the emphasis here is not just on the information, but also on targeted, preventative therapy. Expectant mothers who become enthusiastic about prophylaxis pass this expe- rience on to their children. This way, prophylaxis for the child, the first primary prophylaxis even before the birth, becomes the focus of dentistry. Mechanical and professional plaque control Mechanical plaque control has always been the focus of pregnancy prophylaxis. Brushing with a toothbrush with prevention 1 2018 19