Oral health in pregnancy

Estrogen and progesterone receptors have been found in gingiva, and these hormones have been shown to increase vascular permeability and the amount of gingival crevicular fluid flow. In addition, estrogen and progesterone may alter the immune system, and progesterone can stimulate the production of an inflammatory mediator PGE2. Estrogen receptors have also been found in periosteal fibroblasts as well as in periodontal ligament fibroblasts; and thus, the sex hormones may directly affect these periodontal tissues. In addition, both estrogen and progesterone have been demonstrated to have an impact on bone metabolism.

Pregnancy does not cause gingivitis, but may worsen pre-existing disease. The prevalence and severity of gingival inflammation have been shown to increase during pregnancy, with these changes disappearing postpartum. Estrogen and progesterone affect cellular proliferation, differentiation, and growth of gingival fibroblasts. Studies have also revealed that both estrogen and progesterone have a role in bone resorption and formation. Susceptibility to infections, including periodontal disease, increases during pregnancy, and the underlying mechanisms consist of alterations in the immune system, hormonal changes, limited T-cell activity, decreased neutrophil chomotaxis and phagocytosis, and depressed antibody production. Periodontal bacteria P.i. and P.g. can use female sex hormones as a source of nutrients, and the amount of these bacteria is increased in the gingival crevicular fluid of pregnant women; this correlates positively with the severity of pregnancy gingivitis.