From Healthy Gums To Healthy Babies

                                                               

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Oral Health has been associated with Pregnancy for generations. The famous saying “a loss of a tooth for every child” is still heard in many parts of the world. It has been recently suggested that periodontal disease is an associated factor for preterm birth. The delivery of preterm low birth babies (under 37 weeks of gestation  and less than 2500 g) continues to be a significant public health issue in both developed and developing countries.  Every effort is made to decrease the number of Preterm birth newborns by diminishing the effects of all traditional risk factors namely maternal age of (<17year or > 35years),low socioeconomic status, alcohol / drug abuses, smoking, multiple pregnancy,  poor general health of the pregnant woman.Other risk factors with preterm births include high maternal physical workload,maternal education, inadequate pre-and antenatal care, ethnicity, stress, parity, nutritional stats,low maternal body-mass index, previous preterm birth,  short cervical length(under 25 mm, as measured on ultrasonography), medical conditions such as hypertension  and diabetes mellitus,urogenital infections (e.g.,chorioamnionitis, asymptomatic bacteriuria and bacterial vaginosis,urinary tract infection, infections at other sites (e.g., appendicitis, pneumonia, and periodontal disease)  and genetic factors.

The hypothesis that infection remote from the fetal placental unit may influence PLBW has led to an increased awareness of the potential role of chronic bacterial infections elsewhere in the body. Periodontal diseases are a group of infectious diseases caused by predominantly Gram-negative, anaerobic, and microaerophilic bacteria that colonize the subgingival area.  Inflammed periodontal tissues produce significant amounts of pro-inflammatory cytokines, mainly interleukin 1 beta (IL-I B), IL-6, prostaglandin E2, and tumor necrosis factor alpha (TNF-µ), which may have systemic effects on the host.In the last two decades, the scientific community has demonstrated a growing interest in determining whether periodontal disease is associated with pregnancy complications.Researchers have found that certain bacteria from the mouth may be related to preterm and low birthweight (PLBW). They found that a higher salivary level of the bacteria called Actinomyces naeslundii Genospecies2is associated with low birth weight and preterm delivery, while higher levels of the bacteria Lactobacillus casei during  pregnancy positively affected  the  birth weight.The mechanisms by which periodontal disease and preterm birth are associated are not clear. It has been hypothesized that in the presence of severe periodontal disease, oral organisms can disseminate hematogenously to target the placenta, membranes, and foetus. This bacterial challenge may result in increased cytokine expression and precipitate preterm labor.Recent progress in identification and characterization of periodontal pathogens , as well as elucidation of potential systemic mechanisms of action of bacterial products and inflammatory cytokines , have opened the way for a more realistic assessment of the systemic importance of periodontal disease. Chronic oral infections have been implicated as a causative agent in a variety of systemic illness including atherosclerotic cardiovascular disease,cerebrovascular ischemia, rheumatoid arthritis,respiratory diseaseand diabetes mellitus.

The concept that Periodontal disease might influence systemic health is not a new one. Miller originally published his “Focal Infection theory” in 1891 suggesting that “microorganisms or their waste products obtain entrance to parts of the body adjacent or remote from the mouth.” In 1952, an editorial in the Journal of the American Medical Association stated that many patients with disease caused by foci of infection have not been relieved of their symptoms by removal of the foci. Many patients with these same disease have no evident focus of infection and also the focus of infection, according to some statistical studies, are as common in apparently healthy persons as in those with disease.

Complicated pregnancy imposes a risk not only to the mother but also to the offspring. The majority of preterm infants enter the neonatal intensive care unit owing to an increased risk of perinatal mortality, especially with impaired lung development and function. However, preterm infants who survive the  neonatal   period  face a higher risk of developing neurodevelopmental problems, respiratory problems, behavioral problems , learning problems, cardiovascular disease and metabolic abnormalities such as (obesity, type 2 diabetes mellitus). As a result, the obstetric complications not only are a significant health care expense (estimated at more than $5.5 billion annually), but also affect the well-being of the affected infants throughout life.

Prevalence rates of dental care use during pregnancy have been reported to range from 23°/o to 43%. Previous studies indicate not only that pregnant women underuse dental care but  poor women disproportionately fail to obtain such care. Previous studies have shown that Periodontal phase I therapy is able to reduce the incidence rate of PLBW. As a result periodontal treatment and oral hygiene instructions are thought to be essential to prevent future complications among pregnant women particularly those with periodontitis, they should begin their pregnancy without periodontal infections, and they should be educated and motivated to maintain a high level of oral hygiene prior to and throughout pregnancy.

Dentists must assume greater responsibility for the overall health of their patients, and acquire knowledge of relevant systemic conditions to interact meaningfully with medical colleague.

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