CAMAGUEY.- Oral health is decisive in the lives of individuals. In pregnant women it is vital, not only for them but also for the proper transit of their state and when it comes to achieving delivery in the appropriate term.

As a student of the subject, we turned to Dr. Alain Ramírez López, Comprehensive General Dentist (EGI) and director of the José Espiridón Santiesteban Báez hospital, in the Santa Cruz del Sur municipality of Camagüey.

Dr. Alain said that polymicrobial infections in the oral cavity are generally produced by an imbalance between the immune system that is usually deficient in the pregnant woman and the microorganisms in dental plaque, which triggers inflammation of the gum and can cause even the loss of teeth.

"Like any health-disease process, the biological cannot be isolated from the social," he expressed, and it is known that the gestational stage can cause changes in the ways and lifestyles from which the deficiency in tooth brushing does not escape due to two reasons: the nausea produced by this practice and the clinical picture of the so-called “bad pregnancy”.

- What would be the result in the face of such difficulties?

—Undoubtedly, they contribute to the accumulation of bacterial plaque in the teeth, and it is suggested that they are the determining cause of periodontal affections, and beyond this concept, periodontal infection, through the blood microcirculation of the gingiva it constitutes one of the multiple routes of hematogenous dissemination (produced in the blood or derived from it), which can cause, among others, intrauterine infections, generally bacterial.

“In this sense, it has been shown that periodontal and oral pathogens in general are capable of crossing the blood vessels of the gum and being detected in the cardiovascular system; the oral cavity can constitute an important reservoir of microbes with the possibility of affecting the intrauterine environment ”.

– How should such evidence be assumed?

—Warning about the possibility of a relationship between periodontal disease and the risk of remote infection of the placenta or of the amniotic fluid, which would end in a serious gestational disease called chorioamnionitis (infection of the amniotic fluid and the membranes that contain it) and from this infect with serious consequences both the fetus and the mother.

“It is good to know that throughout pregnancy, deep physical and mental adaptations occur in healthy women that involve marked changes in her anatomy and in the functioning of her entire organism. One of these striking and frequent changes is gravid gingivitis (increased thickness of the gums, redness and also bleeding) and is basically due to the physiological increase in vascularization and the accumulation of fluid (edema) in the mucous membranes. of the pregnant woman.

“This physiological state that occurs normally in pregnancy is characterized by the appearance of hyperemic gums that can be accompanied by gingivorrhagia (spontaneous bleeding in the gums) and hypertrophic gingivitis, where the hormonal action of estrogens and progesterone plays a key role. In pregnant women, the most frequent and marked changes lie in the gingival tissue, which produce the so-called pregnancy gingivitis ”.

— What are the types of gingivitis?

—There are different types with clinical and microbiological characteristics such as: chronic, necrotizing ulcerative (more frequent in adolescents than in adults), hormonal (in puberty and pregnancy), pharmacological (due to phenytoin, nifedipine, among other drugs) and associated with systemic diseases (blood dyscrasias, autoimmune diseases, systemic disorders), just to mention a few.

- Does the gum behave in a special way during pregnancy?

—The gingiva of the pregnant woman favors any colonizing agent, as well as infectious spread, given its extreme permeability. Sialorrhea (excessive production of saliva and the inability to keep it in the mouth) and increased glycogen concentrations create a breeding ground and environment favorable to oral infections during this stage in a woman's life, and consequently various changes occur.

“Specifically, in cases of gingival inflammation, transient bacteremia (it is the presence of bacteria in the blood) frequently occurs that reach the placental tissues through the to

blood stream and thus provide the inflammatory drive for induction of labor.

“The possibility and negative influence on the prognosis of preterm labor caused by periodontal infections was first raised in the late 1980s and the most accepted hypothesis is that periodontal bacteria act as a chronic reservoir of endotoxins (a structure composed of complexes of lipids and sugars) and lipolysaccharides (most important components of the cell wall of gram-negative bacteria), which would stimulate the constant release of inflammatory mediators and cytokines (small proteins that regulate the function of the cells that produce them on other cell types), that by hematogenous route would trigger preterm delivery ”.

— Currently, what criteria predominate?

—Inquiry currents are directed, among other issues, to determine whether periodontal disease is a first-order risk factor for the onset of preterm labor and, therefore, whether it should be adequately treated or prevented before and during pregnancy.

“Periodontal diseases have a high prevalence in pregnancy, since, to the systemic changes, induced by the peculiar inflammatory and immune response of the pregnant woman, other factors favoring the infection are added.

“During pregnancy, the hormonal secretion of estrogens increases 30 times due to the large amount of surface of the ulcerated epithelium of the bags that allows the passage of bacteria and their products into the body through mechanisms; and that of progesterone, it rises 10 times compared to what occurs in the normal sexual cycle of women.

"It should not be forgotten that to enable the acceptance of the fetus as a host, the pregnant woman creates an immunosuppressed environment, which thus avoids rejection of her and, collaterally, is more susceptible and vulnerable to infections of all kinds."

—Are the efforts in prevention and guidance sufficient?

—Despite the efforts made in the control of pregnancy, childbirth and the advancement of new technologies in gestational surveillance, the incidence of premature or preterm births has not decreased in the last two decades. Preterm delivery poses a serious threat to the health of the newborn, with a very important percentage of costs being added to those for perinatal health care.

"Research lines have revealed various mechanisms by which remote infections, including periodontal disease, can be involved in the triggering of preterm labor, so they should be included as an important etiological factor and not overlooked within of the plans for the prevention of fetal prematurity ”.

—Tips that cannot be missed?

—Brushing four times a day, with a technique that is not rough, try to place the brush in dry and angry places, and change it, if possible, every three months.

“Eliminate deforming habits such as smoking, alcoholism, of a dietary nature, especially those rich in sugars and carbohydrates; maintain an adequate and balanced diet, and incorporate vegetables, fruits, reduce citrus fruits, chemicals, sausages and fibrous to avoid interproximal clogging, that is, meat residues inside the teeth, through the use of dental floss.

“In our health system through the Maternal and Child Care Program (PAMI), pregnant women are cared for according to their risk factors. Its uptake at the beginning of pregnancy is established and it is treated until discharge, which is established in the shortest possible time ”.