After I had my first child, my dentist complained that I hadn't been looking after my teeth and gums. I was sure that I hadn't been doing anything different from usual. He then went on to complain that all pregnant women and new mothers neglected their teeth and gums. I believe that he was wrong when he suggested that pregnant women suddenly change their oral hygiene habits. But he was correct that the dramatic hormonal changes during pregnancy can greatly affect the gums. If the gums aren't healthy to start with then this seemingly irrelevant problem can seriously baby's growth and health in the womb.
It is now shown beyond any doubt that maternal gum disease causes premature labor. One study performed prospectively in North Carolina looked at the effect of dental health in 812 women. Each woman's dental health was assessed at 26 weeks and then within 48 hours after delivery. The researchers examined both the rate of premature births (less than 28 weeks) and low birth weight (less than 1,000 gms). Their data was adjusted for race, parity and gender. 1.1% of the group with healthy gums (201 women) had premature births. This rate greatly increased in the 566 rated as having mild gum disease to 3.5% and was 11.1% in the 45 women with moderate to severe gum disease. The rates were slightly more dramatic for birth weight. No women with healthy gums had a baby that weighed less than 1,000 gm. Six per cent of the women with mild disease had a baby with low birth weight and 11.4% of those with moderate to severe disease had a low birth weight baby. Studies from Poland, France and Brazil showed similar results.
This research applies equally to second trimester and later miscarriages as well as prematurity at term.
Gum disease might cause low birth weight and prematurity in more than one way. Gum disease allows oral bacteria to move from the mouth into the blood stream. These oral bacteria can cause clotting and are known to be a major factor in strokes. They are also cause endocarditis, a potentially lethal infection of heart valves and inner lining of the heart. Periodontitis, serious gum disease in pregnancy might act through clotting or infection itself.
The great news is that early attention to periodontal (gum) health can reduce these risks.
A study from Chile examined the oral health of 400 pregnant women, aged between 18 and 35, before 28 weeks gestation. Dentists immediately treated periodontal disease in 200 of the women. They treated the other 200 (the controls) only after delivery. The rate of pre-term, low birth weight delivery was 1.8% (3/163) in the treated group and 10.1% (19/188) in the untreated group. Low birth weight and prematurity was 5.5 times more likely in the untreated group.
Prematurity and low birth weight together greatly increase the risk of a baby's death. There are also a large number of other important problems that occur as a result of prematurity. It is sad that it has taken so long to recognize this easily preventable cause of problems.
Let us hope that doctors and dentists will soon work together to prevent the problems in the future. In the meantime, inform every pregnant woman that you know.