THE FUTURE OF THE BRITISH THRONE, PERIODONTITIS (GUM DISEASE) AND PREGNANCY OUTCOMES Following the arrival of His Royal Highness Prince George of Cambridge – arguably the world’s most famous baby - the South African Dental Association (SADA) today released information regarding the association between periodontitis (gum disease), preterm births and preterm low birth weight (PTLBW). Maretha Smit, Chief Executive Officer of SADA says that PTLBW contributes significantly to both public and private healthcare costs. “By attending to the factors that put pregnant women at risk for PTLBW we can so easily avoid the enormous financial burden which is imposed on the state, communities and families involved. “ “According to the global action report on pre-term birth, there are approximately 15 million preterm births annually. Global statistics published by the WHO indicate over 60% of pre-term births occurring in Africa and South Asia. Some regions within sub-Saharan Africa record pre-term birth rates as high as over 15%. Despite improvement in prenatal, antenatal, postnatal and material care including public awareness, adverse pregnancy outcomes present a major public health problem worldwide.” According to Professor Londi Shangase, Head of Oral Medicine and Periodontology at the Wits School of Oral Health Sciences – and also spokesperson for SADA’s 2013 public education theme of Periodontotis and Systemic Disease - infections during pregnancy have been strongly associated with PTLBW. “Maternal genito-urinary tract infections have most frequently been associated with such pregnancy outcomes. However, incidences of such outcomes have been reported in the absence of maternal genito-urinary infections, which is therefore suggestive of the presence of infections elsewhere in the body.” Periodontitis is a chronic inflammatory disease, caused by bacteria and can be modified by the host’s protective response to infection as well as environmental, genetic and systemic factors. Prof Shangase adds, “Destruction of soft tissues and bone housing the teeth is the hallmark of the disease. This tissue destruction is related to the inflammatory (protective response) which, in an attempt to combat infection, damages tissue.” A number of bodily immune response substances (inflammatory mediators) are role players in the inflammatory process and, therefore, serve as markers of the process. These inflammatory mediators can be detected in the fluid between the tooth and the gingival (gums) and, systemically, following exposure of the bacterial substances. Prof Shangase points out that the association between pregnancy and periodontitis is bidirectional with each having an effect on the other. “Pregnancy impacts the gums, the amount of bacteria present in the mouth during pregnancy, the immune response and collagen repair (the healing potential).” “The effect of pregnancy on periodontitis is related to the increased levels of estrogen and progesterone which starts from the second month of pregnancy and continues until the eighth month, after which it declines. This rise and fall of the hormonal levels coincides with a similar pattern of gingival (gum) inflammation during pregnancy, which clears after the eighth month when the hormonal levels drop rapidly. The hormones are known to increase capillary dilation and permeability which are key to gingival (gum) inflammation. Untreated gingivitis may progress to periodontitis.” The effects that periodontitis has on pregnancy outcomes can come about in a number of ways. “Firstly, through bacteraemia and inflammation. Bacteraemia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal.” ‘Secondly, bacteria that cause periodontitis (gum disease) may cause programmed death of placental cells. This, in turn, may lead to reduced nutrient delivery to the fetus, compromised fetal growth. Increased levels of inflammatory mediators cause pre-mature rupture of membranes and contraction of uterus thus resulting in pre-term delivery/ miscarriage. Inflammation in the fetus, may lead to structural damage of fetal tissue and organ systems.” Professor Shangase says that there can be little doubt that periodontal therapy has at the very least some positive impact on pregnancy outcomes. “While different studies have yielded contradictory results, most studies showed a positive effect of periodontal therapy with a reduction in the incidence of PTLBW in women who received periodontal therapy.” Maretha Smit concludes: “Both the Duke and Duchess of Cambridge have perfect teeth and there is little doubt that the young prince, who is likely to reign one day, ever will be affected by the vagaries of gum disease. But, every child in the world deserves also to be a royal baby and given the bulk of the research results, SADA recommends that oral health care be incorporated into maternal and child healthcare programs in the private and public sector.” “Taking into consideration the impact of PTLBW on the mother, the live births that survive, families and communities, it would be unwise not to place the focus on the prevention of the onset of gum disease.” Johannesburg, Tuesday, 30th July 2013 NOTES TO EDITORS 1. Preterm birth refers to all births before 37 weeks of completed gestation as defined by WHO. Preterm birth may be further classified according to gestational period of age: extremely preterm (< 28 weeks) very preterm (7, 28 32; < 37 weeks) as determined, by the last menstrual day and by ultrasound. 2. Low birth weight is defined as less than 2500 grams and is believed to reflect the health status of the immediate community into which the infant is born. A very low birth weight refers to a weight below 1500 grams. In developing countries low birth weight is usually caused by intrauterine growth restriction whilst in developed countries it is often as a result of the preterm birth. FOR FURTHER INFORMATION: 1. Maretha Smit Tel: +27 (0)11 484 5288, Mobile: 084 627 3842, Fax: +27 (0)11 642 5718 e-mail: [email protected] 2. Prof Londi Shangase Tel: 011 488 4887, Mobile: 072 395 2335, Fax: 011 488 4902 /0862074358 e-mail: [email protected] 3. Mixael de Kock Tel: 011 646 8501, Mobile: 083 651 4424 e-mail: [email protected]
Posted on: Tue, 30 Jul 2013 11:29:52 +0000
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