Dr. Rupali Kalsi, MDS (Periodontics).
Oral Health and Pregnancy: Pregnancy Outcomes and Dental Health of the Offspring.
Oral Hygiene Day is celebrated on 1st August every year to commemorate the birth anniversary of Late Dr. G.B. Shankwalkar. Dr. Shankwalkar was one of the pioneer periodontists of India and the founder member of the Indian Society of Periodontology.
Ironically, we are celebrating oral hygiene day every year from past many decades but we fail to convey enough patients and pre-natal care practitioners that oral health is important and integral aspect of general health in pregnant women. Incidentally the theme for oral health 2024 focuses on intricate relationship between oral health and systemic health (WHO, 2024). The two way relationship between oral and systemic health was discussed long back by Offenbacher and was termed as Periodontal medicine in 1995 (Offenbacher et al., 2004).
Oral hygiene is the least discussed and addressed health care needs in pregnant women worldwide. Hormonal changes in pregnancy make gingival tissues more vulnerable to inflammation owing to change in microbiota, hyper vascularization and alteration in collagen production (Kessler et al.,2017). In developing countries like India with so many myths associated with oral health practices in pregnancy the situation is gruesome (Jain et al., 2021).
Poor oral hygiene is herald of gingivitis and periodontitis. According to recent reports it has been stated that periodontitis has a notable influence on the structure of the placental microbiota. A recent meta-analysis has reported that prevalence of periodontitis in pregnancy is around 40%. Ample evidence is available stating the association between maternal periodontitis and adverse pregnancy outcomes, specifically low birth weight infants (Wu et al., 2015). It has been postulated that translocation of oral microbes associated with periodontal diseases to the feto-placental unit marks the onset of metastatic inflammation which possibly a contributing factor for preterm labor and low birth weight infants (Chen et al.,2022). It is noteworthy that with current evidence we can conclude that there is some association between poor oral health and adverse pregnancy outcomes but the magnitude of this link is yet to be explored by research with some robust study designs (Miranda-Rius et al., 2023).
Unfortunately India has reported the highest number of preterm births globally in the year 2020 which is thought provoking. This can be attributed to several factors in developing nations like India but a holistic approach may be the solution (Bobetsis et al.,2020). It is altogether more important in India wherein oral health practices are forbidden in pregnancy due to prevailing myths and misconceptions during pregnancy and postpartum (Prabhudessai et al., 2023).
Talking to pregnant women about oral health and why it matters?
Pregnancy may make women more prone to periodontal (gum) disease and cavities. Oral health is important part of prenatal care, given that poor oral health during pregnancy can lead to poor health outcomes for the mother and baby.
This is high time to raise awareness from grass root level about the negative impact of poor oral health in pregnancy. Evidence based research suggests that interventions during the preconception period may be more meaningful but referrals from prenatal care practitioners as well will not go in vain. As it is always advised, ‘Prevention of better Than Cure’.
Author:
Dr. Rupali Kalsi, MDS (Periodontics)
Associate Professor, Department of dentistry at Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India.
Edited by:
Sunanda Kulshrestha, Ph.D (Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India).
References:
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