Download - Gingival changes during pregnancy
Gingival Changes During Pregnancy :
Influence of hormonal variations on clinical & immunological parameters
Presented by;Anu.A
CRRI
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
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
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
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
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
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Experimental design
Cohort Study with parallel
design
9 month follow up
Population Design
45 pregnant subjects
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
Pregnant group
1st
trimester2nd
trimester3rd
trimesterPost
partum
Non Pregnant group
1st visit 2nd visit
Measurements: Hormonal, Immunological, Clinical
Study Design
Questionnaire
Obtain information about
socioeconomic status
Oral & periodontal
Status
Clinical Examination
Plaque index
Gingival index
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
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
Correlation During Pregnancy
Higher the rise in PII, Higher was the increase in GI
No correlation between gingival inflammation & hormone levels
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
Conclusion Increased salivary
Progesterone & estradiol levels
Changes in PGE2 levels
Changes in IL-1β
levels
Gingival Inflammation
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Reference
Journal of Clinical Periodontology 2010
Vol:37