Periodoncia En Mujeres Embarazadas

Periodontal disease in pregnant women

Bacteria and Environment as a trigger for EP

Periodontal Disease The term brings together a number of pathological conditions affecting the structures that protect and support the teeth (gingivitis and periodontitis) which are rated among the most common afflictions of mankind. The phenomena involved in the pathogenesis of different forms of the disease have been the focus of much research for many years.

Currently accepted that dental plaque and the microbiological component present in the gingival sulcus, also called Groove microbiota, are strongly related to the origin and subsequent development of disease. Bacteria are the initiating trigger condition and response of the host, which in turn is responsible that defensive injuries which occur in tissues, but is also known that bacteria are necessary but not sufficient agent which both the host response, such as bacterial aggression are conditioned by various environmental, socio-cultural, behavioral, genetic factors that may modify the clinical expression of the disease, and are called risk factors.Currently accepted that dental plaque and the microbiological component present in the gingival sulcus, also called Groove microbiota, are strongly related to the origin and subsequent development of disease. Bacteria are the initiating trigger condition and response of the host, which in turn is responsible that defensive injuries which occur in tissues, but is also known that bacteria are necessary but not sufficient agent which both the host response, such as bacterial aggression are conditioned by various environmental, socio-cultural, behavioral, genetic factors that may modify the clinical expression of the disease, and are called risk factors.

Hormone triggers of Periodontal Disease

The female sex hormones are a determining factor in periodontal disease; its increase in pregnancy causes vascular, cellular, microbiological and immunological alterations that condition different from the rest of the patients clinical response. Periodontal disease is a permanent deposit of microorganisms and bacterial products that can cause systemic risk. The periodontal infection causes an increase in the concentration of intra-amniotic PGE 2 and TNF-alpha, physiological mediators of labor, so that the work could rush delivery. Longitudinal studies in humans are needed to establish the association between periodontal infection and pregnancy risk, if this hypothesis could be confirmed should be considered periodontal disease a risk factor for low birth weight and preterm birth.

Pregnancy is a time of great hormonal changes in the production of estrogen and progesterone increases significantly, so that the end of the third quarter to reach plasma concentrations increase tenfold the levels during the menstrual cycle.

Numerous studies have raised the modifying role of these hormones in the periodontal disease, gingival tissue receptors for estrogen and progesterone, by which the female sex hormones may exert different effects on the same either on the epithelium, connective or blood vessels. Progesterone produces a dilation of the capillaries gingival, which is the usual cause of clinical pregnancy gingivitis erythema and edema, and is also responsible for the increase of gingival exudate and capillary permeability.

Numerous studies have also described a change attributed to the high levels of active progesterone present in the gingival fluid subgingival microflora which favor the growth of anaerobic microorganisms considered periodontal pathogens, such as bacteria of Prevotella intermedia, which influences the development gingival alterations in the mother. From the immunological point of view a decrease in functional migration of inflammatory cells and phagocytosis described, considerably decreasing the body's defense capacity during this period.

We know that pregnancy itself is not only capable of producing the disease, however, the presence of risk factors during this period be conditioned to an exaggerated response of the body which would result in the onset of gingivitis or aggravation of pre-existing disease.

Periodontal disease associated with hormonal changes occur during puberty, pregnancy, and in connection with the use of oral contraceptives. The secretion of female sex hormones is cyclical, with certain peaks during the menstrual cycle; during pregnancy, at the end of the third quarter, the plasma concentrations of estrogen and progesterone levels exceeded in 10 of the menstrual cycle, so that potentially the biological impact of these hormones increases during pregnancy.

The major impact of female sex hormones during pregnancy on the development and progression of periodontal disease and in light of recent reports that controversial results related periodontal disease premature birth and low birth weight raises reviewing objectives periodontal changes in pregnancy and the possible influence of periodontal infection with low weight and prematurity.

Ratio of female sex hormones on the periodontium

Estrogens are metabolized in the gingival tissues by enzymatic action that converts estrone to estradiol; this conversion is three times higher in the presence of inflammation, being indicative of the degree of clinical inflammation present. In the gingival tissue receptors for estrogen and progesterone, which thanks to these hormones have various effects on them, either in the epithelium, connective or blood vessels.

Progesterone produces a dilation of the capillaries gingival, which is the usual cause of clinical gingivitis of pregnancy, it is also responsible for the increase of gingival exudate and vascular permeability. Progesterone also stimulates endothelial cells and decreases collagen production, estrogens act by decreasing the keratinization of gingival epithelium, induce the proliferation of fibroblasts and collagen

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