Epidemiology and Etiology of Gingivitis and Periodontitis in Pregnant Women

Pregnancy gingivitis has been extensively described in the literature.8-11 Previous work demonstrates a progressive increase in gingival inflammation throughout pregnancy independent of bacterial plaque accumulation and a return to baseline levels postpartum. Plaque-induced gingivitis is the most common form of periodontal disease in pregnant women affecting 36%-100% of pregnant subjects.8,12,13 Clinical characteristics show a tendency toward more severe inflammation with similar plaque levels in pregnant women than non-pregnanct controls.14-17 The severity of gingival inflammation observed has been correlated with sex steroid hormone levels, both of estrogen and progesterone, during pregnancy.8,10,18,19 This indicates a possible dose-dependent influence of female sex hormone secretions on inflammation, which increases to high levels from 16-40 weeks and then decreases parturition (delivery). Cross-sectional and cohort studies have demonstrated increased prevalence and severity of gingivitis in pregnant women compared to their non-pregnant female controls, despite similar plaque scores.20,21 Other reports have demonstrated altered immunoreactivity to putative periodontal pathogens during pregnancy.22,23. In the absence of oral hygiene measures, all individuals develop gingivitis; in healthy individuals a meticulous regimen of daily plaque removal can prevent the onset of gingivitis and effective oral hygiene can effect a cure.24