- The ideal scenario is to carry out periodontal therapy and achieve periodontal health prior to conception. For this reason, dental healthcare professionals should communicate the benefits of pre-pregnancy treatment to women of childbearing age.
- When assessing a patient who is pregnant always: identify the stage of pregnancy, ensure a full medical history has been taken with any notes on previous adverse pregnancy outcomes and perform a comprehensive periodontal examination.
- If the periodontium is healthy, provide oral hygiene advice and educate the patient on the potential changes that may occur to the periodontium.
- During pregnancy, hormonal changes result in increased vascular permeability of the gingival tissues. Therefore, in the presence of plaque, gingival inflammation is exacerbated and existing periodontitis may worsen. Inflammatory changes may be oedematous and/or proliferative (pregnancy epulis).
- If the patient has gingivitis, oral hygiene instructions should also be provided and professional intervention carried out, aiming to remove the biofilm/plaque retentive factors. Adjunctive chemical plaque-control agents in the form of dentifrices and mouthrinses have been shown to be safe and effective in reducing gingival inflammation when combined with mechanical plaque control. Close monitoring throughout pregnancy is thereafter important and further intervention should be provided as necessary.
- For patients with periodontitis, as well as oral hygiene instructions, standard non-surgical periodontal therapy is indicated i.e. subgingival scaling/root surface debridement. This is safe and effective. Local anaesthetic can be delivered safely. If antibiotics are required, tetracyclines should be avoided.
- Any surgical intervention (including possible excision of an epulis) should be delayed until postpartum.
- The evidence of periodontitis being associated with a higher risk of low birth weight, pre-term birth and pre-eclampsia is inconclusive.
Fantastic resource by the EFP highlighting guidelines for health professionals and patients: https://www.efp.org/publications/projects/oralhealthandpregnancy/guidelines/index.html