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

M

A

T

E

R

I

A

L

&

M

E

T

H

O

D

S

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

Cre

atio

n o

f fa

vora

ble

loca

l En

viro

nm

en

t

Reference

Journal of Clinical Periodontology 2010

Vol:37