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The Link between Premature Birth and Bad Oral Health

Approximately 57 infants are born prematurely each day in Australia; roughly 8% of births each year. For a full term pregnancy, the gestational period ranges between 37 to 41 weeks. Premature (Preterm) birth is defined medically as an infant being born before 37 weeks gestation. Preterm births are associated with numerous neonatal problems that can lead to severe morbidity and mortality in newborn infants. Evidence now suggests that oral health, in particular periodontal disease, may have an influence on the incidence of premature births, often resulting in low birth weight babies.1

Throughout pregnancy, it is not uncommon for women’s oral health to alter considerably due to dietary and hormonal changes. During this time, gums may become increasingly sensitive to bacterial inflammation and irritation, often leading to pregnancy gingivitis.

Gingivitis, which is an inflammation of the gums, is one of the most prevalent global oral health burdens2 affecting almost all individuals at some point in their life.3 As a result of increased progesterone secretion, pregnant women face a greater risk of experiencing gingivitis. Studies illustrate that 30 to 100% of women will develop gingivitis at some point in their pregnancy; most commonly occurring during the second trimester. The good news is gingivitis is preventable and reversible through implementation of the correct dental care, tools, techniques and medicines.

Gingivitis is the result of a build-up of dental plaque, a sticky microbial biofilm4 on the surface of the teeth.5 Early signs of gingivitis are swelling, redness and bleeding of the gums when brushing or flossing. Curiously, it is common that no pain will be experienced by individuals suffering from gingivitis. Consequently, gingivitis can go undiagnosed and may develop into periodontitis and irreversible oral damage. However, with early intervention the development of periodontitis can be avoided and tissue damage caused by gingivitis can be reversed with no permanent damage to the surrounding bone.6,7,8

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  • Brush your teeth at least twice daily for two minutes using the technique your dentist has shown you. This helps remove bacteria from food and plaque.
  • Floss your teeth after brushing.
  • Use antibacterial (non-alcoholic) mouth wash for added protection against plaque build-up.
  • Do not smoke – smoking increases inflammation and damages gum tissue and the foetus.
  • Maintain a healthy diet.
  • Schedule regular dental check-ups – Dentists are trained to detect and treat gum disease.

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Periodontitis is caused by bacteria that set off an inflammatory response in the gums surrounding the teeth and bone, consequently damaging and destroying both. As the disease progresses the bone surrounding the teeth is destroyed, forming space between the teeth and gum known as periodontal pockets.10,11 Periodontal tissue destruction is irreversible and transpires in an irregular manner with long periods of disease dormancy preceding short destructive periods. Furthermore, the breakdown of tissue within the mouth does not all occur simultaneously. Rather, a number of specific surfaces will usually be devastated at a time.12

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    • Do not brush your teeth immediately after vomiting or reflux. This could cause further damage as the enamel is still soft and can be brushed away. Delay brushing teeth for one hour.
    • As an alternative to brushing, water should be used to clear the mouth of acid and will aid in rehydration and increasing salivary flow.
    • Chewing on gum can help to neutralise and re-harden tooth surfaces and stimulates saliva production.
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Although a link has been identified between periodontitis and both premature birth and low birth weight, the specific association is still unknown. However, research shows that untreated periodontitis in pregnancy will allow bacteria to travel through the body, which may reach the foetus. Furthermore, numerous studies have illustrated that routine periodontal treatment is associated with a decreased incidence of spontaneous preterm birth.13,14

By identifying and treating early stages of gingivitis, progression into more severe stages such as periodontitis and loss of teeth can be prevented. It is for this reason that it is imperative for all women to have the health of their gums checked by a dentist during pregnancy.

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Sources:

        1. Jeffcoat et al., “Periodontal infection and preterm birth: successful periodontal therapy reduces the risk of preterm birth”, An International Journal of Obstetrics and Gynaecology 118, (2011): 250-256.
        2. L. J. Jin et al., “Global oral health inequities – task group-periodontal disease,” in Periodontal diseases- Advances in research and treatment: 2012 ed. Scolarly Editions (Atland: ScholarlyEditions, 2012), 70.
        3. Michael Wilson et al., eds., Bacterial disease mechanisms: an introduction to cellular microbiology (Cambridge: The Press Syndicate of the University of Cambridge, 2002), 23.
        4. Alexandrina L. Dumitrescu and Makoto Kawamura, “Etiology of periodontal disease: dental plaque and caculus”, in Etiology and pathogenesis of periodontal disease, Edited by Alexandrina L. Dumitrescu (Berlin: Springer-Verlag, 2010), 1.
        5. C. M. Marya, “Epidemiology of periodontal disease,” in a textbook of public health dentistry, 1st ed. Edited by C. M. Mayra (New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, 2011), 115.
        6. A. C. Ellershaw and A. J. Spencer, Dental attendance patterns and oral health status (Canberra: Australian Institute of Health and Welfare, 2011), 36.
        7. Kachlany et al., Deadly diseases and epidemics, 40.
        8. Nield-Gehrig and Villmann, Foundations of periodontics, 41.
        9. Nkem Obiechina, Understanding periodontitis: a comprehensive guide to periodontal disease for dentists, dental hygienists and dental patients (Bloomington: Author House, 2011), 8.
        10. Sudeep Kothai et al., “Periodontal chip: an adjunct to conventional surgical treatment”, International Journal of Drug Research and Technology 2, no.6. (2012): 411.
        11. Ellershaw and Spencer, Dental attendance patterns, 36
        12. Nield-Gehrig and Villmann, Foundations of periodontics, 44.
        13. Jeffcoat et al., Periodontal infection, 254.
        14. N.J. Lopez, I. Da Silva, J. Ipinza, J. Gutierrez, “Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis,” J Periodontol 75, No. 11 (2005): 2144-2153.

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The content on the LifeCare Dental website is provided for education and information purposes only. Information about therapy, service, product or treatment does not imply endorsement and is not intended to replace advice received from your dentist, doctor or other registered health professionals. LifeCare Dental makes no claim as to the accuracy or authenticity of this content.

Additionally, LifeCare Dental does not accept liability to any person for the information or advice provided on this website or incorporated into it by reference. Content has been prepared for Western Australian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.

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