Non-Surgical Periodontal Therapy
Gum disease is an all-too-common condition that affects adults in our country. As much as 80 percent of our population has some degree of gum disease. More than the primary condition itself, there is a concern that this disease process has far-reaching effects on the body. Gum disease has been associated with numerous health conditions that are also inflammatory in nature. Some of these include heart disease, stroke, premature birth, low birth weight, diabetes, and more.
Dr. Smith and Dr. Byer of Nashua Cosmetic and Restorative Dentistry, P.L.L.C. encourage patients to visit our New Hampshire practice on a six-month basis. The frequency of visits allows us to detect minute changes to the health of gum tissue and teeth. Studies suggest that adequate screening and oral hygiene have a major impact on the prevention and management of early gum disease, often saving patients from the need for surgical repair.
Plaque is a biofilm that has no odor and no color. It adheres to teeth at the gum line, providing a home for hundreds of different types of bacteria. The byproduct of bacteria is acidic, which can weaken healthy gums and teeth, and cause irritation and inflammation. As compromised gum tissue loosens around teeth, pockets form. This allows plaque and bacteria to collect beneath the gum line, directly against teeth roots. Ultimately, the disease process can damage both soft and hard tissues, including bone. Gum disease is the leading cause of tooth loss among American adults.
Gingivitis Associated with Pregnancy Potentially Leads to Pre-Term birth and Even Fetus Death
I am Dr. Mike Milligan. We are here at the second annual American Academy for Oral Systemic Health meeting at the Cleveland Clinic, and I have Dr. Yiping Han of Case Western Reserve University here with me.
Dr. Han, thanks so much for being with us.
Thank you. It’s a pleasure to be here.
Wonderful. Well, we’re gonna talk a little bit about a tragedy, really, that can happen. But you’ve published two articles about gingivitis or periodontitis and how it affects a fetus. Why don’t you tell us a little bit about that.
The first paper was done in 2006, it was published in Journal of Clinical Microbiology. And it was a case involving a pregnant woman at the Metro Health Medical Center here in Cleveland. She came to the clinic in preterm labor at 24 weeks. The hospitals did repeated amniocentesis to rule out infection, but they couldn’t detect any infectious agents. But she clearly had signs of intrauterine infection because she had very high white blood cell counts and a very low glucose level; these are all diagnostic criteria for intrauterine infection.
So the baby was born at 24 and a half weeks and survived.
Preterm birth, but survived this one.
Right, right. So we took the mother’s amniotic fluid and used a non-culture dependent method. We call it PCR for polymerase chain reaction. So we detected actually a lot of bacteria in her amniotic fluid. It was a surprise, very much a surprise. Because it turned out to be a species that had never before been associated with intrauterine infection before. It’s a species called Ella, and it’s a very common oral bacteria.
So it’s common in the mouth, but not in the uterus or the vagina where you would normally think this infection might come from.
Right. Because the conventional belief was if the mother has intrauterine infection, the most likely source is from the vagina. So the bacteria just ascend. But in this case, Ella is not part of the vaginal flora, but it is part of the oral flora. And so using DNA fingerprinting technology, we found the exact match in the mother’s oral flora. And so this is the first case linking oral bacteria to preterm birth.
Now, tell us about the second case, which was widely publicized in the media where there was a stillborn.
Right. This case was published in 2010 in obstetrics and gynecology. The outcome was not so good because it’s a stillbirth. Yes. At term, which is very sad because the baby was at term.
And so the mother had an uneventful pregnancy all the way till 39 weeks. So, you know, 37 weeks is considered full term. She had a respiratory tract infection with a mild fever about a hundred degrees. And three days later, she felt the baby stop moving. So she went to the hospital, they did an ultrasound, and confirmed the baby had already died. So the baby was induced, and then they did an autopsy. And they found oral bacteria again, it’s a different one now. This time it’s called a fusobacterium nucleatum, which is another very common oral bacteria in the mouth. It was isolated as a pure culture from the baby’s stomach and the lung. So obviously the baby ingested the contaminated amniotic fluid of the mother, which caused the sepsis because the autopsy showed that the baby died of sepsis.
So it appears, again, this came from the mouth, a different bacteria from the mouth.
Right. And you were telling me that afterwards you think it was a pregnancy gingivitis that caused this. The gums appeared fairly healthy.
Right. This is what’s so surprising to us, especially when we saw it the first time in 2006. With such a traumatic case, we thought the mother must have very terrible gum disease. But when we examined her postpartum, she had perfect gums—like no inflammation, no bleeding. But what she told us was that her gums bled excessively while she was pregnant. So we concluded that she must have had what’s called pregnancy-associated gingivitis. Because of the hormonal changes during pregnancy, the gums can become more inflamed. But it’s pregnancy-associated, so it means after birth the gums get better.
So when you examine her postpartum, you’re not gonna find anything.
Right. And this is quite common. It affects anywhere between 30 to 75% of the pregnant population.
This, the pregnancy gingivitis.
Right. And for the second, the stillbirth case, it’s the same. When we examined the mother three weeks postpartum, she had no gingival inflammation. But she said that she had excessive gum bleeding during pregnancy. So in both cases, I think these women had pregnancy-associated gingivitis, which is a very mild form of periodontal disease. Normally, people don’t worry about it. They just say, “Oh, it’s mild and temporary, it will go away, don’t worry about it.” But here we are showing that even these mild forms can cause severe damage to the fetus.
Might be an indication that some of the newer tests would be indicated more frequently, like the oral DNA, where you can actually see the bacteria that are present in the mouth, the actual ones, as opposed to just looking at bleeding and not really knowing what is there. So that even in a mouth that doesn’t look that bad periodontally.
Exactly. It actually tells you if there are certain bacteria, and there are only about 13 or 14 bacteria out of the several hundred in the mouth that are the causative problems, the bad bacteria. And some of these newer tests will tell you which ones they are and if you have them in your mouth.
Right. I think with the technology we can detect so many more bacteria. The profile of periodontal bacteria is shifting. So we should definitely take a look at the oral bacteria load of certain species in pregnant women and see if they correlate with the birth outcome.
So what would you recommend for all pregnant women? Would you recommend that they definitely have their gums evaluated by their dentist?
Absolutely. I always say that for women, even before they think about getting pregnant, they should see their dentist to get their gums in shape. In fact, in the case of the stillbirth, the mother contacted me after this happened and asked me what to do. My advice to her was to see her dentist, get her gums in shape. The good news is that she later had another pregnancy, delivered a healthy baby boy, and her gums bled a lot less during the second pregnancy.
Wonderful. Well, Dr. Han, where would we get more information about this? Is there a website or where would your papers be located? Where could we learn more about this?
I published a paper in Women’s Health magazine. I think it was in July 2011. The title is “Oral Bacteria Cause Pregnancy Complications.” It describes much of what we talked about today.
Wonderful. Are there any last things you’d like to say before we close, Dr. Han?
Just get your gums in shape, brush and floss regularly, and see your dentist regularly, especially if you’re thinking about becoming pregnant.
Treating gum disease conservatively in New Hampshire
Our dentists and hygienist have years of experience in the diagnosis and treatment of all stages of gum disease. Ideally, we can begin treatment very early in the disease process. Treating gingivitis, we can reverse infection and better manage oral health with routine cleanings and support for adequate home care. In some cases, we may perform a deep cleaning in which pockets around teeth are gently cleaned of plaque and roots are smoothed to encourage attachment of healthier gum tissue. Scaling and root planing may be combined with medication to manage oral bacteria.
Signs of gum disease can be easy to miss. Often, irritation produces only a slight change in color, from shiny pink to rough red. Two of the most prominent signs that gums are in trouble are chronic bad breath and bleeding when brushing and flossing. If you notice any of the signs of gum disease, or it has been more than six months since your last check-up, we encourage you to schedule your visit with Dr. Smith or Dr. Byer at Nashua Cosmetic and Restorative Dentistry, P.L.L.C.
