Download - Gingival changes during pregnancy
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Gingival Changes During Pregnancy :
Influence of hormonal variations on clinical & immunological parameters
Presented by;Anu.A
CRRI
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Introduction
According to the currently accepted classification of periodontal diseases,
Maier & Orban studied 53 biopsies from pregnant women with gingivitis and concluded that none of their findings were exclusively characteristic of gingivitis in pregnancy
Pregnancy gingivitis is a gingival disease induced by
plaque and modified by systemic factors
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Objective
Interleukin-1β(IL-1β)
Prostaglandin-e2 (PGE2) levels.
Increased salivary hormone levels
Changes in gingival crevicular fluid (GCF)
To test whether exacerbated gingival inflammation in
pregnancy is associated with
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Mechanism Of Gingival Changes
Exacerbated inflammatory response from host parasite imbalance
Cellular changes & changes in
oral biofilms
Increased vascularity&vascular
flow
Depression of immune system
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Research Results
Reduced responsiveness of maternal T-
Lymphocytes to antigenic stimulation
Progesterone & estradiolenhanced the production
of PGE2 & suppressed the production of IL-1β
Decreased number of β-cells and macrophages in
consecutive gingival biopsies
• O’Neil• Lopatin• Polan Et Al
• Morishita Et Al• El Attar• Hugoson
• Raber-Durlacher
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48 pregnant women without periodontitis (1st,2nd,3rd trimesters &
@3 months postpartum
28 non-periodontitis non-pregnant (twice with 6 months interval)
Plaque & Gingival Indices
Salivary progesterone & Estradiol levels
GCF IL-1β & PGE2 levels
M
A
T
E
R
I
A
L
&
M
E
T
H
O
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Experimental design
Cohort Study with parallel
design
9 month follow up
Population Design
45 pregnant subjects
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Inclusion criteria
Age: 20-35 years
≥20 natural teeth
(excluding 3rd
molar)
Exclusion criteria
Diagnosis of periodontitis
Presence dental or
periodontal disease
Smoking
Systemic disease
Antibiotic treatment
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Pregnant group
1st
trimester2nd
trimester3rd
trimesterPost
partum
Non Pregnant group
1st visit 2nd visit
Measurements: Hormonal, Immunological, Clinical
Study Design
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Questionnaire
Obtain information about
socioeconomic status
Oral & periodontal
Status
Clinical Examination
Plaque index
Gingival index
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Saliva Sampling
Participants asked to rinse
mouth with water
Wait for 5 min. Allow
saliva to drip from lower lip into a sterile glass tube for
2 min
Froze @ 20 degree untill
further evaluation
Gcf Sampling
From mesiobuccal
sulcus of each upper canine
Using HarcoPeriopaper
Progesterone & Estradiol Assays
retrived from saliva by
competativeimmunoenzyma
ticcolorimetric
method
IL-1β & PGE2 Assays
Retrivedfrom GCF
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Evolution During Pregnancy & Postpartum
Gingival Reactivity to Plaque
• Increase in 2nd trimester
• Decreased @ 3 months postpartum
Steroid hormone levels
• Increased during pregnancy
• Peak in 3rd trimester
• Decreased @ 3 months post partum
Plaque Index• Decrease during
pregnancy
• Increase @ 3 months post prtum
Inflammatory Mediators levels in GCF
• Il-1 & PGE2 decreased in 3 months post partum
Gingival Index• Increased in 2nd trimester
• High levels in 3rd
trimester
• Decreased @ 3 months postpartum
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Correlation During Pregnancy
Higher the rise in PII, Higher was the increase in GI
No correlation between gingival inflammation & hormone levels
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Correlation b/w Pregnant & Non Pregnant Women
Sl No On study Pregnant Non pregnant
1 Hormone levels(progesterone & Estradiol)
Higher Normal
2 Plaque Index Higher Normal
3 Gingival Index Higher Normal
4 Gingival reactivity to Plaque
Higher Normal
5 IL-1β Higher Lower
6 PGE2 Normal Normal
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Conclusion Increased salivary
Progesterone & estradiol levels
Changes in PGE2 levels
Changes in IL-1β
levels
Gingival Inflammation
Cre
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f fa
vora
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loca
l En
viro
nm
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t
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Reference
Journal of Clinical Periodontology 2010
Vol:37
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