Periodontal Management and Adverse Pregnancy Outcomes: Mechanisms and Interdisciplinary Protocols
Mechanisms and Interdisciplinary Protocols
Dental questlowell. Introduction
- Maternal periodontitis associates with increased risk of preterm birth (PTB), low birth weight (LBW), and preeclampsia. Source: https://link.springer.com/article/10.1007/s40496-024-00371-6
- Association moderate for LBW (OR ~2.5), weaker for PTB (OR 1.8-2.0); heterogeneity in evidence. Source: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1526406/full
- Bidirectional: Hormonal changes exacerbate gingival inflammation.
Pathophysiologic Mechanisms
Inflammatory Pathways
- Periodontal pathogens elevate systemic cytokines (IL-6, TNF-α, PGE2). Source: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.963956/full
- Translocation to feto-placental unit induces placental inflammation. Source: https://pubmed.ncbi.nlm.nih.gov/32385871/
Microbial Translocation
- Fusobacterium nucleatum, Porphyromonas gingivalis detected in amniotic fluid/placenta. Source: https://www.mdpi.com/2075-1729/13/7/1559
- Hematogenous spread triggers preterm labor cascades. Source: https://onlinelibrary.wiley.com/doi/10.1111/prd.12486
Hormonal Modulation
- Estrogen/progesterone surge increases vascular permeability, gingival hyperplasia. Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC3681080/
- Pregnancy gingivitis/pyogenic granuloma in 30-100% cases if plaque present.
Evidence Overview (Recent Meta-Analyses)
- Mendelian randomization: Causal link stronger for chronic periodontitis and LBW (OR 1.41). Source: https://www.sciencedirect.com/science/article/pii/S0020653924001370
- Network meta-analysis: NSPT shows variable reduction in APO risk; no definitive prevention. Source: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1373691/full
- Bibliometric trends: Focus shifting to microbiota, interventions, high-risk populations (2025). Source: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1526406/full
Dental Management Protocols in Pregnancy
Safe Interventions
- Non-surgical periodontal therapy (NSPT) safe across trimesters; preferred second trimester. Source: https://www.periodontalcare.sdcep.org.uk/guidance/managing-disease/systemic-conditions/pregnancy/
- Oral hygiene reinforcement; scaling/root planing as needed.
Gingival Hyperplasia/Pyogenic Granuloma
- Conservative: Plaque control, chlorhexidine rinses. Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC3800415/
- Excision only if interfering (post-first trimester); recurrence possible if irritants remain.
Restorative Considerations
- Minimize invasive procedures; biomimetic adhesives for caries control. Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9936671/
- Local anesthetics safe (lidocaine preferred); avoid supine hypotensive syndrome.
Interdisciplinary Pearls
- Prenatal-perio coordination: Screen severe periodontitis as APO risk marker. Source: https://pubmed.ncbi.nlm.nih.gov/37149740/
- Shared care: OB-GYN referrals for uncontrolled inflammation; monitor biomarkers.
- Postpartum: Resolve residual hyperplasia often spontaneously.
Key Takeaways
- Modifiable risk: Optimal perio control may mitigate APOs, though intervention evidence mixed. Source: https://link.springer.com/article/10.1007/s40496-024-00371-6
- Prioritize prevention: Preconception clearance ideal. Source: https://onlinelibrary.wiley.com/doi/10.1111/prd.12486
- Future: Microbiome-targeted therapies, angiogenic biomarkers. Source: https://www.frontiersin.org/journals/dental-medicine/articles/10.3389/fdmed.2025.1625995/full
Created by Dr. Chandra Manish,
Dental Quest Lowell Website: https://dentalquestlowell.com/
Address: 1275 Pawtucket Blvd, Lowell, MA 01854
