1. Gingival Changes During
Pregnancy :
Influenceofhormonalvariationsonclinical&immunological
parameters
Presented by;
Anu.A
CRRI

2. Introduction
According to the currently accepted classification of
periodontal diseases,
Maier & Orban studied 53 biopsies from
pregnant women with gingivitis and concluded that
none of their findings were exclusively
characteristic of gingivitis in pregnancy
Pregnancy gingivitis is a gingival disease induced by
plaque and modified by systemic factors

3. Objective
Interleukin-1β(IL-1β)
Prostaglandin-e2
(PGE2) levels.
Increased salivary
hormone levels
Changes in gingival
crevicular fluid (GCF)
To test whether exacerbated gingival inflammation in
pregnancy is associated with

4. Mechanism Of Gingival Changes
Exacerbated inflammatory response from host
parasite imbalance
Cellular
changes &
changes in
oral
biofilms
Increased
vascularity
&vascular
flow
Depression
of immune
system

5. Research Results
Reduced responsiveness
of maternal T-
Lymphocytes to antigenic
stimulation
Progesterone & estradiol
enhanced the production
of PGE2 & suppressed
the production of IL-1β
Decreased number of β-
cells and macrophages in
consecutive gingival
biopsies
• O’Neil
• Lopatin
• Polan Et Al
• Morishita Et Al
• El Attar
• Hugoson
• Raber-Durlacher

6. 48 pregnant women without
periodontitis (1st,2nd,3rd trimesters &
@3 months postpartum
28 non-periodontitis non-pregnant
(twice with 6 months interval)
Plaque & Gingival Indices
Salivary progesterone & Estradiol
levels
GCF IL-1β & PGE2 levels
M
A
T
E
R
I
A
L
&
M
E
T
H
O
D
S

7. Experimental
design
Cohort Study
with parallel
design
9 month
follow up
Population
Design
45 pregnant
subjects

8. Inclusion
criteria
Age: 20-35
years
≥20 natural
teeth
(excluding 3rd
molar)
Exclusion
criteria
Diagnosis of
periodontitis
Presence
dental or
periodontal
disease
Smoking
Systemic
disease
Antibiotic
treatment

9. Pregnant group
1st
trimester
2nd
trimester
3rd
trimester
Post
partum
Non Pregnant
group
1st visit 2nd visit
Measurements:
Hormonal, Immunological, Clinical
Study Design

10. Questionnaire
Obtain
information about
socioeconomic
status
Oral &
periodontal
Status
Clinical
Examination
Plaque index
Gingival index

11. Saliva Sampling
Participants
asked to rinse
mouth with
water
Wait for 5
min. Allow
saliva to drip
from lower lip
into a sterile
glass tube for
2 min
Froze @ 20
degree untill
further
evaluation
Gcf Sampling
From
mesiobuccal
sulcus of each
upper canine
Using Harco
Periopaper
Progesterone &
Estradiol Assays
retrived from
saliva by
competative
immunoenzyma
tic
colorimetric
method
IL-1β & PGE2
Assays
Retrived
from GCF

12. Evolution During Pregnancy & Postpartum
Gingival
Reactivity to
Plaque
• Increase in 2nd trimester
• Decreased @ 3 months
postpartum
Steroid
hormone levels
• Increased during
pregnancy
• Peak in 3rd trimester
• Decreased @ 3 months
post partum
Plaque Index
• Decrease during
pregnancy
• Increase @ 3 months
post prtum
Inflammatory
Mediators levels
in GCF
• Il-1 & PGE2 decreased
in 3 months post
partum
Gingival Index
• Increased in 2nd trimester
• High levels in 3rd
trimester
• Decreased @ 3 months
postpartum

13. Correlation During Pregnancy
Higher the rise in PII, Higher was
the increase in GI
No correlation between gingival
inflammation & hormone levels

14. Correlation b/w Pregnant & Non Pregnant Women
Sl No On study Pregnant Non pregnant
1 Hormone levels
(progesterone &
Estradiol)
Higher Normal
2 Plaque Index Higher Normal
3 Gingival Index Higher Normal
4 Gingival reactivity to
Plaque
Higher Normal
5 IL-1β Higher Lower
6 PGE2 Normal Normal

15. ConclusionIncreased
salivary
Progesterone &
estradiol levels
Changes in
PGE2
levels
Changes in
IL-1β
levels
Gingival
Inflammation
CreationoffavorablelocalEnvironment

16. Reference
Journal of Clinical Periodontology 2010
Vol:37