Periodontal Disease and Pregnancy, a New Risk

A researcher from Department of Periodontics at Case Western Reserve University School of Dental Medicine, reported the first documented link between a mother with pregnancy-associated gum disease to the death of her fetus.
The link was discovered when a friend of the mother of the stillborn baby introduced her to the researcher, Yiping Han. Han was studying the bacteria, Fusobacterium nucleatum, and it’s relationship to pre-term labor and stillbirths.

This study caught my eye because F Nucleatum is one of the known periodontal pathogens that we test for using DNA-PCR, when we find menacing bacteria from the gums when we look under the microscope.

The mother gave a history of bleeding gums during the pregnancy. Bleeding gums during pregnancy are not uncommon, indeed around 75% of pregnant women experience bleeding gums.

Postmortem microbial studies of the baby found the presence of F. nucleatum in the lungs and stomach. The baby had died from a septic infection and inflammation caused by bacteria. The bacteria was also found in the mother’s mouth.
It is now well understood that oral bacteria can make their way into the bloodstream through the bleeding gums. We are just now beginning to realize the extent of the potential for problems in other organs systems. And too many people still accept bleeding gums as normal. Bleeding gums are dangerous.

WIth the numbers of people with gum disease, 50% over age 30, and the delaying of childbirth by so many women, we need to be more diligent in our explanations of the need for good oral health to pregnant or potentially pregnant women.

And as I continue to remind all involved, the old paradigm of mechanical debridement, is just not enough to cure an existing bacterial infection. Brushing and flossing helps, but once you are infected, it is just not enough.

There is a happy ending to the story. The mother has had periodontal therapy and has now given birth to a healthy baby

The findings are discussed in the February issue of Obstetrics & Gynecology.

Risk Assesment cont.

I have seen older people who have started taking medicines for chronic illnesses that dry up the protective saliva. This has become so common that it has been called, MIX, for medicine induced xerostomia (dryness of the mouth.) When you eat, your mouth becomes acidic (low pH) as the beginning of the digestive process. The saliva buffers the pH of the mouth, so that in a normal mouth, the pH returns to normal within about a half hour of a meal. But in a person with a dry mouth, it can take hours. Indeed for the person with a dry mouth, the mouth can live in a highly acid environment from breakfast until hours after bedtime, because by time the limited saliva has had a chance to buffer the mouth from the last meal, the person has eaten again.

Type of bacteria and saliva amount (and pH) are predictors of risk for cavities. It is possible for dentists to evaluate you for that risk by testing the saliva. And it is possible to treat the saliva of those people determined to be at risk for cavities to reduce the risk, before the damage is done to the teeth. This is done with a series of mouth rinses that over a period of time lower the acidity of the saliva.

Risk for gum disease can likewise be assessed by determining the bacterial make up of the fluid next to the teeth at the deepest invaginations of the gums. The unhealthy bacteria, are anaerobes, or bacteria that prefer an environment that is without oxygen. The bacteria can be observed and generally identified as unhealthy with the use of a microscope. The exact make up of the gum disease-causing bacteria and the approximate numbers can be determined by a test called DNA-PCR, (DNA-polymerase chain reaction)

The presence of the unhealthy bacteria can be determined before the damage has started from the inflammatory process that results from gum disease. And science is finding that the damage to the body goes well beyond the teeth and gums.