The Association between Hyperemesis Gravidarum and Periodontal Disease in Pregnancy

Nurcan Altaş; Burcu Aydin Boyama; Burcu Dinçgez Çakmak

doi:10.4103/ejgd.ejgd_184_19

European Journal of General Dentistry, Table of Contents

CC BY-NC-ND 4.0 · European Journal of General Dentistry 2020; 9(03): 108-112
DOI: 10.4103/ejgd.ejgd_184_19

Original Article

The Association between Hyperemesis Gravidarum and Periodontal Disease in Pregnancy

Nurcan Altaş

Department of Periodontology, Faculty of Dentistry, Istanbul Medipol University, İstanbul, Turkey

,

Burcu Aydin Boyama

¹Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul Medipol University, İstanbul, Turkey

,

Burcu Dinçgez Çakmak

²Department of Obstetrics and Gynecology, Bursa Provincial Health Directorate Health Sciences University Bursa, Bursa, Turkey

› Author Affiliations

Abstract

Purpose: Periodontal diseases (PDs) are considered a risk factor for some systemic conditions such as cardiovascular diseases, diabetes, and adverse pregnancy outcomes. Hyperemesis gravidarum (HG) is a common health problem, and inflammation is claimed to play a vital role in its etiopathogenesis. Here, we aimed for the first time to demonstrate the relationship between PD and HG. Materials and Methods: A total of 30 pregnant with HG and 30 healthy pregnant between the age group of 18 and 40 years were enrolled in the study. HG was diagnosed if the followings were present: at least one-positive ketonuria, >5% weight loss, and severe vomiting, which is >2 times a day. Periodontal status was evaluated by the plaque index (PI), gingival index (GI), probing pocket depth (PPD), and bleeding on probing index (BOPI), and these parameters were recorded. All measurements were performed at 6 points of each tooth (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual) and compared between the groups. Results: Mean age was 29 ± 3 in HG and 28 ± 4 in the control group. There was no difference between two groups according to the age (P = 0.421), gravida (0.524), and parity, (P = 0.54). PI, GI, PPD, and BOPI were significantly higher in HG group as compared to controls. Conclusions: Gingival inflammation is more common in patients with HG, and it is possibly associated with insufficient tooth brushing because it may stimulate the gagging reflex and vomiting. Since there could be a vicious cycle between PD and HG, periodontal preventive programs are crucial for pregnant women with HG.

Keywords

Periodontal-systemic disease interactions - pregnancy - pregnancy complications

Full Text

References

References
1 Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Borgnakke WS, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J Periodontol 2015;86:611-22.
2 Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: Pathogenic mechanisms. J Periodontol 2013;84:S170-80.
3 Daalderop LA, Wieland BV, Tomsin K, Reyes L, Kramer BW, Vanterpool SF, et al. Periodontal disease and pregnancy outcomes: Overview of systematic reviews. JDR Clin Trans Res 2018;3:10-27.
4 Bui FQ, Almeida-da-Silva CL, Huynh B, Trinh A, Liu J, Woodward J, et al. Association between periodontal pathogens and systemic disease. Biomed J 2019;42:27-35.
5 Sanz M, Kornman K; Working Group 3 of the joint EFP/AAP Workshop. Periodontitis and adverse pregnancy outcomes: Consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 2013;84:S164-9.
6 Toygar HU, Seydaoglu G, Kurklu S, Guzeldemir E, Arpak N. Periodontal health and adverse pregnancy outcome in 3,576 Turkish women. J Periodontol 2007;78:2081-94.
7 Márquez-Corona ML, Tellez-Girón-Valdez A, Pontigo-Loyola AP, Islas-Zarazúa R, Robles-Bermeo NL, Gonzalez-López BS, et al. Preterm birth associated with periodontal and dental indicators: A pilot case-control study in a developing country. J Matern Fetal Neonatal Med 2019;7:1-6.
8 Tilakaratne A, Soory M, Ranasinghe AW, Corea SM, Ekanayake SL, de Silva M. Periodontal disease status during pregnancy and 3 months post-partum, in a rural population of Sri-Lankan women. J Clin Periodontol 2000;27:787-92.
9 Taani DQ, Habashneh R, Hammad MM, Batieha A. The periodontal status of pregnant women and its relationship with socio-demographic and clinical variables. J Oral Rehabil 2003;30:440-5.
10 Gürsoy M, Pajukanta R, Sorsa T, Könönen E. Clinical changes in periodontium during pregnancy and post-partum. J Clin Periodontol 2008;35:576-83.
11 Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum: A multimodal challenge. BMC Med 2010;8:46.
12 Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11:527-39.
13 Sutamnartpong P, Muengtaweepongsa S, Kulkantrakorn K. Wernicke’s encephalopathy and central pontine myelinolysis in hyperemesis gravidarum. J Neurosci Rural Pract 2013;4:39-41.
14 Lassey SC, Robinson JN. Rhabdomyolysis after hyperemesis gravidarum. Obstet Gynecol 2016;128:195-6.
15 Nagarajan E, Rupareliya C, Bollu PC. Wernicke’s Encephalopathy as a rare complication of hyperemesis gravidarum: A case report and review of literature. Cureus 2018;10:e2597.
16 Dinberu MT, Mohammed MA, Tekelab T, Yimer NB, Desta M, Habtewold TD. Burden, risk factors and outcomes of hyperemesis gravidarum in low-income and middle-income countries (LMICs): Systematic review and meta-analysis protocol. BMJ Open 2019;9:e025841.
17 Grooten IJ, Roseboom TJ, Painter RC. Barriers and challenges in hyperemesis gravidarum research. Nutr Metab Insights 2015;8:33-9.
18 Kaplan PB, Gücer F, Sayin NC, Yüksel M, Yüce MA, Yardim T. Maternal serum cytokine levels in women with hyperemesis gravidarum in the first trimester of pregnancy. Fertil Steril 2003;79:498-502.
19 Kuscu NK, Yildirim Y, Koyuncu F, Var A, Uyanik BS. Interleukin-6 levels in hyperemesis gravidarum. Arch Gynecol Obstet 2003;269:13-5.
20 Leylek OA, Toyaksi M, Erselcan T, Dokmetas S. Immunologic and biochemical factors in hyperemesis gravidarum with or without hyperthyroxinemia. Gynecol Obstet Invest 1999;47:229-34.
21 Moran P, Taylor R. Management of hyperemesis gravidarum: The importance of weight loss as a criterion for steroid therapy. QJM 2002;95:153-8.
22 Sılness J, Loe H. Perıodontal dısease ın pregnancy. II. Correlatıon between oral hygıene and perıodontal condtıon. Acta Odontol Scand 1964;22:121-35.
23 Loe H, Sılness J. Perıodontal dısease ın pregnancy. I. Prevalence and severıty. Acta Odontol Scand 1963;21:533-51.
24 Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975;25:229-35.
25 Pavlatou A, Tsami A, Vlahos N, Mantzavinos T, Vrotsos I. The effect of in vitro fertilization on gingival inflammation according to women’s periodontal status: Clinical data. J Int Acad Periodontol 2013;15:36-42.
26 Kobayashi T, Okada M, Ito S, Kobayashi D, Ishida K, Kojima A, et al. Assessment of interleukin-6 receptor inhibition therapy on periodontal condition in patients with rheumatoid arthritis and chronic periodontitis. J Periodontol 2014;85:57-67.
27 Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract 1993;43:245-8.
28 Austin K, Wilson K, Saha S. Hyperemesis gravidarum. Nutr Clin Pract 2019;34:226-41.
29 Tan A, Lowe S, Henry A. Nausea and vomiting of pregnancy: Effects on quality of life and day-to-day function. Aust N Z J Obstet Gynaecol 2018;58:278-90.
30 Togoo RA, Al-Almai B, Al-Hamdi F, Huaylah SH, Althobati M, Alqarni S. Knowledge of pregnant women about pregnancy gingivitis and children oral health. Eur J Dent 2019;13:261-70.