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This area contains information from various sources including the Journal of Periodontology for the purposes of educating patients and fellow dentists.

Pregnancy and Periodontal Health

The test came back and it's positive – you're pregnant. Your mind is rattled with excitement, and you have created a “to-do.” While your “to-do” list and questions continue to grow, it's important to take the necessary steps to ensure an on-time and safe arrival of your most precious cargo yet.

You've probably heard a few old wives' tales about pregnancy, including “A tooth lost for every child.” While it seems far-fetched, it actually is based loosely in fact. Your teeth and gums are affected by pregnancy, just as other tissues in your body. You may not be aware that the health of your gums may also affect the health of your baby-to-be.

How does pregnancy affect your teeth and gums?
About half of women experience pregnancy gingivitis. This condition can be uncomfortable and cause swelling, bleeding, redness or tenderness in the gum tissue. Conversely, a more advanced oral health condition called periodontal disease (a serious gum infection that destroys attachment fibers and supporting bone that hold teeth in the mouth) may affect the health of your baby.

Is periodontal disease linked to preterm low birthweight babies?
Studies have shown a relationship between periodontal disease and preterm, low birthweight babies. In fact, pregnant women with periodontal disease may be seven times more likely to have a baby that's born too early and too small. The likely culprit is a labor-inducing chemical found in oral bacteria called prostaglandin. Very high levels of prostaglandin are found in women with severe cases of periodontal disease.

What if I'm diagnosed with periodontal disease during pregnancy?
If you're diagnosed with periodontal disease, your periodontist might recommend a common non-surgical procedure called scaling and root planing. During this procedure, your tooth-root surfaces are cleaned to remove plaque and tartar from deep periodontal pockets and smooth the root to remove bacterial toxins. Research suggests that scaling and root planing may reduce the risk of preterm births in pregnant women with periodontal disease. The added bonus is that the procedure should alleviate many of the uncomfortable symptoms associated with pregnancy gingivitis, such as swelling and tenderness of the gums.

As you make your way through the “to-dos,” remember to check off a visit to the dentist or periodontist. This baby step benefits you and your unborn baby.

Premature births: the answers can't come soon enough
According to the March of Dimes, premature births have soared to become the number one obstetric problem in the United States. Many premature babies come into the world with serious health problems. Those who survive may suffer life-long consequences, from cerebral palsy and mental retardation to blindness.

The March of Dimes has launched a $75 million, five-year campaign to raise public awareness and reduce rates of preterm birth and increase research to find the cause. Until all of the answers are in, the March of Dimes recommends the following to reduce the risk and/or effects of a premature birth:

  • Consume a multivitamin containing 400 micrograms of the B vitamin folic acid before and in the early months of pregnancy.
  • Stop smoking.
  • Stop drinking and/or using illicit drugs, or prescription or over-the-counter drugs (including herbal preparations) not prescribed by a doctor aware of the pregnancy.
  • Once pregnant, get early regular prenatal care, eat a balanced diet with enough calories (usually about 300 more than a woman normally eats), and gain enough weight (25 to 35 pounds is usually recommended).
  • Talk to your doctor about signs of premature labor, and what to do if you show any of the warning signs.

Find Out More

AAP News Releases

  • Infertility Treatment Affects Oral Health
  • Dental Procedure May Reduce Risk of Premature Births
  • Video News Release: Reducing the Risk of Premature Births
  • Advice for Mothers-To-Be on a Healthy Delivery
  • Severe Periodontal Disease Poses Additional Threat to Pregnant Diabetics
  • Research Provides Further Evidence on the Importance of Good Oral Health in Pregnant Women

AAP Oral Health Articles

  • Periodontal Disease and Preterm Low Birth Weight Babies
  • Protecting Oral Health Throughout Puberty, Pregnancy, Menopause and Post-Menopause
  • Find a Periodontist Near You
  • Causes and Types of Periodontal Disease
  • Warning Signs of Periodontal Disease
  • Treatments for Periodontal Disease

Other Resources

  • Information about premature births at March of Dimes Web site
  • The National Healthy Mothers, Healthy Babies Coalition
  • View a free AAP brochure sample on women and periodontal disease. (www.perio.org)

Move over bridges; dental implants preferred
Implants cost more but are permanent solution to lost teeth, keeping a healthy mouth. By Jane E. Brody
New York Times
Posted: Monday, Dec. 14, 2009
Bridges make it too hard for most people to keep their gums and underlying bone
healthy. 2007 MCT FILE PHOTO

If I have one serious regret about my age, it is that my permanent teeth developed before New York, my hometown, got fluoridated water. I first lost a permanent molar to decay in my early 20s, and the resulting bridge has had to be replaced several times in subsequent decades, ultimately as a four-part apparatus.

Now that has to go as well. Because I could not floss and clean properly under the bridge and between the supporting crowns, I developed a severe periodontal infection.

Dr. Michael Zidile, the young periodontist I consulted, took one look at my mouth and said: "This is not how we do restorations nowadays. A bridge is not a permanent solution and makes it too hard for most people to keep their gums and underlying bone healthy. Now we do implants and individual crowns where needed."

I did my own homework and got a second opinion. Zidile, I learned, is correct. In an overwhelming majority of cases, implants to replace lost teeth are by far the best long-term solution for maintaining a healthy mouth. Also, because they rarely need to be replaced, in the long run they are more economical than bridges.

A growing option

Implants for replacing lost teeth have come a long way. Better materials, procedures and professional experience result in far fewer problems.

Critical to their success, however, is proper selection of both patients and practitioners - and, after the implant, a commitment to good oral hygiene. Dental implants must be treated like natural teeth: kept clean and free of plaque through proper brushing, flossing and periodic professional cleanings.

"Bridges are not the standard of care anymore," Dr. Lawrence J. Kessler, a periodontist and associate professor of surgery at the University of Miami School of Medicine, told me. "For most people who lose teeth, implants are the treatment of choice."

Implants do not decay, and adjacent healthy teeth do not require crowns to support them. And because it is easy to clean and floss between implants, the gum tissue and underlying bone are more likely to remain healthy.

With a bridge, if one of the supporting crowned teeth breaks or develops decay or nerve damage, the bridge and its three or more crowns must be removed and replaced.

Implants can replace individual lost teeth or many teeth in a row. For those who have lost most of their teeth, implants can be used to anchor a full or partial denture.

On average, the total cost of an implant to replace a single tooth is $3,500 to $4,000 (more if other procedures are required), or about one-third more than the cost of a bridge. But while bridges have an average life span of 10 years, an implant can last a lifetime.

Many insurance companies now cover implants, but most people do not have dental insurance and must pay out of pocket. If cost is an issue, consider treatment at a dental college, where implants may be available at reduced rates as part of the teaching process.

Not a quick procedure

The basic technique involves surgically inserting a titanium screw - the implant - into the supporting bone, which can be done under local anesthesia in less than an hour, and attaching a small fake tooth called an abutment, followed by a crown. The resulting tooth looks and feels like a natural one.

The procedure is a lengthy one. Unlike a bridge, which can be completed in two weeks, implants usually take about eight weeks for the screw to become firmly attached to bone before the final crown can be placed. "A patient's health, not age, determines suitability for an implant," Kessler said. "If cases are chosen well, implants are very successful - 96 to 97 percent successful. And they rarely fail down the road."

A most important element is having enough bone in the jaw to support the implant, although in some cases bone cells removed during drilling for the implant or taken from elsewhere in the mouth can be used to fill in gaps.

"If someone has diabetes or is a smoker," Kessler said, "the chances of success are reduced because a poorer blood supply diminishes the fusion of bone cells to the implant."

Also important is healthy gum tissue, free of periodontal disease. Before I could undergo an implant procedure, I had to have periodontal treatment to get rid of the plaque, tartar and infection on the tooth roots and gum tissue around my bridge and supporting crowns.

In some cases when a tooth must be pulled, an implant can be placed right after the extraction, with the advantage of limiting bone loss in the area. When bone is not being stimulated, it tends to break down.

Choosing a doctor

Just as any physician can legally perform surgery, any dentist can legally do implants. Be sure to choose someone thoroughly trained in the technique. Taking a weekend course in implantology is rarely adequate. Implants were once done mainly by oral and maxillofacial surgeons, most of whom operated independently of dentists. Now at least as many implants are placed by periodontists who are schooled in the technique and who coordinate their work closely with the patient's dentist. Ideally, the periodontist should be board-certified.

Just as you might ask for referrals for a prospective nanny or house cleaner, consider asking to speak with other patients of the practitioner before deciding to proceed with an implant. Though every case is different, at the least you can determine how well you are likely to be cared for.