Vol.14, No 1, 2007 pp. 10 - 14
UC
618.2:616.31
RELATIONSHIP BETWEEN PREGNANCY AND PERIODONTAL DISEASE
Ruben Ovadia, Rafael Zirdok, Rosa Maria Diaz-Romero
Subdirection of Public Health Research at the National Institute of Perinatology (Instituto Nacional de Perinatología)
Mexico City, Mexico
E-mail: ovadent@yahoo.com
Summary.
The gingivitis associated with pregnancy has been attributed to increased concentrations of circulating estrogen and/or progesterone. However, the mechanism by which these steroids increase gingival inflammation is not known. Female steroid hormones may have dual effects on the pathogenesis of pyogenic granuloma in pregnancy. The hormones not only enhance the expression of angiogenic factors in inflamed tissue, but also decrease apoptosis of granuloma cells to extend angiogenic effect. The bacteria known as Fusobacterium nucleatum, has been linked with adverse pregnancy outcomes. Since F. nucleatum is associated with periodontal infections rather than genital or uterine infections, it is supposed that the infection doesn't enter the womb by an ascendant route coming up through the genital tract; rather it enters the mother's bloodstream making its way down from the oral cavity. Systemic inflammation and its chemical mediators play a major role in the pathogenesis of preterm delivery, including pre-eclampsia, intrauterine growth restriction, and preterm delivery. Chronic infections like intrauterine infection and chorioamnionitis are linked to both preterm birth and elevated CRP levels. Furthermore, periodontal disease has been associated with increased risk of preterm low birth weight, low birth weight, and preterm birth. Therefore, chemical mediators, principally CRP, might be a plausible mediator of the association between periodontitis and adverse pregnancy outcomes. Periodontal intervention results in a significantly decreased incidence for preterm delivery. Pregnancy without periodontal treatment is associated with significant increases in probing depths, plaque scores, GCF IL-1ß, and GCF IL-6 levels.
Key words:
Periodontal disease, pregnancy, preterm, low birth weight
TRUDNOĆA I PERIODONTALNA BOLEST
Kratak sadržaj:
Gingivitis kao posledica trudnoće pripisuje se povećanoj koncetraciji estrogena i/ili progesterona. Međutim, nije poznat mehanizam po kom ovi steroidi povećavaju upalu gingive. Ženski steroidni hormoni mogu da imaju dvojak efekat na patogenezu piogenog granuloma u trudnoći. Hormoni ne samo da povećavaju ekspresiju faktora angiogeneze upaljenog tkiva, već i smanjuju apoptozu ćelija granuloma da bi produžili efekat angiogeneze. Bakterija poznata pod imenom Fusobacterium nucleatum povezuje se sa negativnim ishodima trudnoće. S ozbirom na to da se Fusobacterium nucleatum više povezuje sa periodontalnom infekcijom nego sa genitalnom infekcijom ili sa infekcijom uterusa, pretpostavlja se da ova infekcija ne dolazi do materice ascedentalnim putem kroz genitalni trakt, već da u krv majke ulazi spuštajući se iz usne šupljine. Sistematična infekcija i njeni hemijski medijatori igraju glavnu ulogu u patogenezi prevremenog porođaja, uključujući i pre-eklampsiju, intrauterino ograničenje rasta ploda, i prevremeni porođaj. Hronične infekcije kao što su intrauterina infekcija i horioamnionitis povezane su i sa prevremenim rođenjem i povećanim nivoima CPR-a (C-reaktivni protein). Štaviše, periodontalna bolest povezuje se sa povećanim rizikom od male težine ploda kod prevemenog porođaja, od male težine ploda kod porođaja, i od prevremenog porođaja. Zbog toga, hemijski medijatori, naročito CPR, mogu biti verodostojni medijatori veze između periodontitisa i negativnih ishoda trudnoće. Periodontalna intervencija rezultira u značajno smanjenoj incidenci za prevremeni porođaj. Trudnoća bez periodontalnog tretmana povezuje se sa značajno povećanim dubinama džepa, naslagama plaka, GCF IL-1βi GCF IL- 6 nivoima..
Ključne reči:
Periodontalna bolest, trudnoća, prevremeni, mala teina ploda
