Pregnancy
Pregnancy-associated gingivitis
The changes in hormone levels and to the immune response associated with pregnancy have been implicated in the development or worsening of gingivitis. In most patients this can be managed with adequate oral hygiene, but more severe cases of gingival enlargement may require further professional care. Most cases will resolve after delivery of the baby, although breastfeeding can extend the duration of the condition. Note that long periods in the prone position are not advised during pregnancy. Therefore, long periods lying flat in a dental chair should be avoided in the third trimester, where possible.
Provide personalised oral hygiene advice and instruction to assist and encourage the patient to improve their oral hygiene skills as well as their understanding of the value of good self-care routines (see Oral hygiene).
Remove supragingival plaque, calculus and subgingival deposits using an appropriate method. Highlight to the patient areas where supragingival deposits are detected.
- Patients with pregnancy gingivitis may require additional care and more frequent recall visits during pregnancy.
Strongly encourage and support smoking cessation if the patient smokes (see Smoking cessation).
Ensure that local plaque retentive factors are corrected - for example, remove overhanging restorations or alter denture design.
Explain to the patient that the condition is likely to resolve once the baby is born or following the cessation of breastfeeding, assuming the patient’s oral hygiene is adequate.
Re-assess at a future visit to determine whether the gingivitis has resolved.
Where large gingival overgrowths do not respond to non-surgical treatment, either excise the overgrowth or refer the patient to secondary care.
Periodontitis in pregnancy
Periodontal treatment during pregnancy is considered safe and should be provided when required.103
While periodontitis has been linked with adverse pregnancy outcomes, such as pre-term birth and low birth weight, the exact nature of the relationship remains unclear. Studies to determine if periodontal treatment leads to improved pregnancy outcomes have been performed but several systematic reviews have found a lack of evidence that treatment to control periodontal disease is of benefit.104, 105 The recent European Federation of Periodontology (EFP) Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline9 states that it is unclear whether treatment of periodontitis during pregnancy reduces pre-term births (<37 weeks) or reduces other adverse pregnancy outcomes. Overall, there is insufficient evidence to determine if treatment of periodontitis in patients who are pregnant improves pregnancy outcomes.
Note that long periods in the prone position are not advised during pregnancy. Therefore, long periods lying flat in a dental chair should be avoided in the third trimester, where possible.
For patients with a diagnosis of periodontitis who are planning to become pregnant, discuss with them the association between pregnancy and periodontitis.
- Encourage these patients to have periodontal treatment and to aim for periodontal stability before becoming pregnant.
- Strongly encourage and support smoking cessation if the patient smokes (see Smoking cessation).
Provide support before and during pregnancy to help the patient maintain good oral hygiene and to control oral inflammation (see Oral hygiene).
Provide non-surgical periodontal care where required, ideally during the second trimester.
- Periodontal treatment is considered safe in pregnancy and should be provided when required.
- Reassure the patient that periodontal treatment is safe for both mother and baby during pregnancy.
Once the baby is born, continue to provide periodontal care, where required.