Oral health considerations in pregnancy
Maria Papavergos explores the changing oral health during pregnancy as well as how improving oral health can improve fertility.
Oral health is an important component of general health and wellbeing. There are several well-established links between our mouths and the rest of our bodies.
Research now indicates that maternal oral microbiota pass from the oral cavity to the placenta, transmitting to the baby during pregnancy.
Hormones progesterone and oestrogen increase in levels over the course of pregnancy. They are key to orchestrating the immunological and physiological changes that occur during pregnancy.
These chemical messengers can directly bind to many of our different types of immune cells and modulate their function.
Due to these hormonal changes during pregnancy, the function of the immune system is shifted. It’s not as simple as just suppressing the immune system; some parts of the immune system are enhanced whilst others are suppressed.
This creates a balance that can prevent infection in the baby, without compromising the health of the mother and child.
Oral health changes during pregnancy
We can also see alterations to the microbiome during pregnancy, helping to maintain this delicate balance.
The oral microbiome, a key feature of immunity, is receptive to change in terms of saliva and microbial composition. As well as the periodontium being responsive to hormonal and immunological change.
These microbial and immunological changes mean the body, extending to the oral cavity, will react differently in terms of susceptibility to disease.
Pregnancy renders the body potentially less able to fight infections. But in terms of chronic disease, studies show mixed data. Some chronic inflammatory diseases improve, whilst others worsen.
What evidence does show is that certain chronic inflammatory diseases are linked to adverse pregnancy outcomes; ie pre-eclampsia, premature birth and low birthweight babies.
Periodontal disease is one of these conditions.
In terms of the oral microbiome, periodontal pathogens have demonstrated a higher presence in pregnant women. They have been found to pass from the oral cavity to the placenta, increasing the risks of pregnancy complications.
Inflammatory changes in the mouth that exacerbate existing gingivitis (pregnancy gingivitis) along with the increased pathogenic load, means the periodontal condition must be closely monitored in pregnant patients. The importance of oral hygiene, as well as nutrition and lifestyle, cannot be understated.
Babies’ oral health
The importance of expectant mothers nurturing their oral microbiome does not stop at the foetal stage.
A newborn baby’s oral microbiome is shaped from the moment of delivery.
Early colonisation differs between vaginally delivered and C-section babies. With the infant oral microbiome resembling that of the mother’s gut and vagina. With increased bacterial diversity in those delivered vaginally over babies born by C-section.
One study suggests that C-section delivered babies colonise Streptococcus Mutans almost a year earlier that vaginally-delivered infants.
Not only does the mode of delivery shape the infant oral microbiome, but in the subsequent hours, the baby’s mouth will become exposed to a large number of microorganisms by contact with the outside world through breathing, breastfeeding, parents and medical staff.
In 24 hours, the establishment of the ‘pioneer’ species in the baby’s oral cavity has already begun.
Breastfed infants demonstrate higher diversity of oral bacterial species. And therefore potentially more health-associated species than formula-fed infants.
Breastmilk has also shown to inhibit growth and attachment of certain cariogenic bacteria, including Streptococcus Mutans.
Often mothers do not have a choice when it comes to mode of delivery or method of feeding – so much of this is out of their control.
Nonetheless, we still have a role and responsibility to new parents to help guide and shape a healthy oral microbiome in their children as they grow. Take into account factors such as introduction of solid foods, practising good oral hygiene habits, teaching positive lifestyle choices and encouraging parents to lead by example of eating a healthy, balanced diet.
These positive choices and good habits will serve their oral health throughout our lifetime. Along with their children’s.
Emerging research also suggests oral health can improve fertility. In particular with regard to length of time to conception in women and sperm quality in men.
One study shows that women with periodontal disease took longer to conceive. Especially those from ethnic minorities.
A plausible explanation is that the spread of bacterial toxins in the blood circulation that results from periodontal disease can activate the immune system and thus hinder reproductive function.
Men with excessive and untreated cavities or periodontal disease display a lower sperm count, poor sperm motility and abnormal sperm morphology.
With all this in mind, here we have several motivating factors to encourage patients who are soon to plan or become parents, to make well-directed efforts to reduce their risk of dental disease.
This is where we, the dental profession, can make a difference.
The pregnant patient needs careful consideration. Not only when it comes to radiograph justification and antibiotic prescriptions, but to their oral hygiene practices, nutritional needs and lifestyle choices.
Congratulations are just the beginning…
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