Oral health, what is it?

According to the World Health Organization, oral health refers to “the absence of chronic oral or facial pain, oral or pharyngeal cancer, oral lesion, congenital anomaly such as cleft lip or lip. -hare, periodontal disease (disease affecting the gums), decay and loosening of the teeth, as well as other pathologies and disorders affecting the mouth and oral cavity. »In France, according to a study carried out by the French Dental Association, more than 80% of adults between 35 and 44 years old suffer from periodontal disease¹ while according to the High Authority of Health, 33 to 50% of adults have a decayed tooth to be treated at least².

Physiological changes in pregnancy and their consequences on oral health

Hormonal and immunological changes

The increased levels of progesterone and estrogen, leading to greater fluidity of the connective tissue matrix, in turn increases the prevalence of gingivitis. Progesterone also promotes the proliferation of several germs through its immunosuppressive action^3-4 . This gingivitis, here called “pregnancy” (related to pregnancy) most often results in inflammation of the gum accompanied by redness and bleeding.

Salivary changes

During pregnancy, saliva is modified both qualitatively and quantitatively: for example, there is a lowering of the pH which promotes the development of a pathogenic flora as well as an increased salivary flow during the last three months. . The latter gradually decreases over the course of pregnancy and does not cause any particular pathologies.⁴. On the other hand, oral acidification, in addition to frequent nausea, will lead to erosion of the enamel which will increase the risk of cavities occurring.

Their impact on oral health

These physiological upheavals are expressed mainly by periodontal disease, which are polymicrobial infectious diseases. They are explained by the alteration of tissues due to hormonal disturbances, but also by changes in eating habits. Seemingly harmless, periodontal disease is, however, risk factors for prematurity, stroke, pulmonary pathologies or the lower birth weight of the baby.⁵.

Changes in the body can also increase the occurrence of caries. It is a gradual destruction of the tissues of the tooth (which forms a cavity) due to the attack of the enamel by the waste of bacteria. The drop in salivary pH and frequent gastroesophageal reflux weaken teeth during pregnancy while frequent bleeding and fatigue can lead pregnant women to neglect their oral hygiene, which leads to the accumulation of bacterial plaque, ideal breeding ground for the development of cavities.

Pregnant women may also see a benign tumor called pregnant woman at the level of the gums. It usually occurs during the 3^st months of pregnancy but only concerns about 5% of women. It is typically a small ball of tissue, red in color that rarely exceeds 2 cm, and which grows between two teeth.

The consequences of oral diseases on pregnancy

Several studies^6-9 showed the link between periodontal disease and obstetric complications. In 2002, the Haute Autorité de Santé noted in particular that “ periodontal disease in pregnancy appears to be significantly associated with a risk of prematurity and low birth weight “. This can be explained by the release of toxins by bacteria into the mother’s bloodstream: their presence is likely to lead to an inflammatory response, which in turn can cause uterine contractions to occur.¹⁰.

More importantly, the most severe periodontitis can significantly increase the risk of pre-eclampsia, a gestational hypertension that sometimes appears during the second half of pregnancy and which can progress to eclampsia, which clearly constitutes a situation of pregnancy. emergency.

These consequences on pregnancy and on the health of the mother-to-be explain why the HAS recommends 2 dental consultations during pregnancy. Currently, only 23 to 25% of pregnant women seek dental treatment during the latter.