23 May 2024

---

What changes orally in pregnant women

Lara Figini

---

The etiology of some of the possible oral manifestations typical of a woman's pregnancy period lies in hormonal changes. During pregnancy, the production of progesterone and estrogen increases, causing greater dilation of the blood vessels in the gums. This hormonal alteration, together with oral changes due to the oral microflora or oral hygiene of the individual pregnant woman, can lead to the appearance of bleeding and gum inflammation, can influence the appearance or exacerbation of temporomandibular disorders and more. Furthermore, a good part of pregnant women suffer from nausea and vomiting and their frequency of snacks, mainly based on sugars, increases. All this, together with a more acidic oral condition (also responsible for the appearance of enamel erosions), changes in saliva and inefficient hygiene care leads to an increased risk of tooth decay. Recognizing the risk factors helps to improve the patient's quality of life in this particular period in the shortest possible time. For this reason, healthcare professionals should establish measures to prevent oral diseases and treat them promptly, while in past years dentists had mistakenly developed the mistaken belief that dental treatments should be avoided on pregnant women.

Many patients find that going to the dentist after giving birth is a protective measure for both them and their baby. However, timely visits allow for early diagnosis and treatment, while improving well-being during pregnancy, avoiding necessarily having to resort to emergency visits and treatments for acute pain or swelling.

Materials and methods

In a recent systematic review, published in the Journal of Clincal Medicine, the authors performed a detailed analysis of bibliography studies regarding oral manifestations observed in pregnant women. The literature search was conducted through the Medline, Scopus and Scielo databases using the following keywords: ((pregnant OR pregnancy)) AND (“oral manifestation*”) OR (“oral health”) Articles published between 2013 and 2023, written in English or Spanish, regarding oral manifestations in pregnant women and which included a diagnosis conducted by a selected qualified dentist, were analyzed; Articles published before 2013, articles of which it was not possible to access the full text, studies in which the patients were not pregnant women at the time of the study, studies in which the patients were suffering from a specific oral or systemic. The risk of bias of the studies included in the review was also assessed, according to the Scale of Observational Studies in Epidemiology (STROBE).

Results

20 studies were included in the analysis, following the exclusion and inclusion criteria. These studies were classified as cross-sectional, cohort, longitudinal, or case-control.

Various oral manifestations in pregnant women have been examined. Five studies compared these manifestations with those observed in non-pregnant women. The most widespread oral manifestations, listed in decreasing order of frequency, were found to be: caries, identified in 13 studies, followed by periodontitis in 10 studies and gingivitis in 7 studies. Furthermore, the appearance of pyogenic granulomas and candidiasis in two studies was observed in four studies. Finally, some studies have reported a number of less common oral conditions including: ptyalism, dental erosion, abscesses, leukoplakia, erythroplakia, saburral tongue, exostosis, geographic tongue, benign brown pigmentation, and tooth mobility.

Five studies analyzed the prevalence of oral manifestations present in pregnant women compared to non-pregnant women; the remaining 15 studies studied pregnant women only. The prevalence of caries was observed in four of them and was higher in the group of pregnant women in three studies and higher in non-pregnant women in one study. Gingivitis was analyzed in two studies and was found to be more common among pregnant women in both studies. Periodontitis was studied in two studies and the result was a higher prevalence in the group of non-pregnant women in the first and in pregnant women in the second.

Finally, the presence of candidiasis was reported in one study, which however did not detect any difference between pregnant and non-pregnant women. The appearance of pyogenic granulomas, ptyalism and dental erosion was more common among pregnant women.

Conclusions

From the data of this review, which must be confirmed in other similar studies and reviews, it can be concluded that the most widespread oral manifestations associated with pregnancy include dental caries, periodontitis, gingivitis, pyogenic granulomas and candidiasis.