Ask the Expert: Dr. Mia Geisinger

There are several factors that make oral care an important component of overall health care for women, particularly during pregnancy. Mia L. Geisinger, DDS, MS – a professor in the UAB School of Dentistry Department of Periodontology and director of the Advanced Education Program in Periodontology – discusses this connection.

Q: The link between oral care and overall health has been well established. What makes this especially important for women?

Dr. Geisinger: It relates to sex-steroid hormones, particularly estrogen and progesterone. There are separate concerns with regards to testosterone in men and oral health. But in women, when we see large fluctuations in those female sex-steroid hormones, we also see an increase in clinical gingival inflammation, like bleeding of the gums or lesions in the mouth that occur in response to bacterial plaque.

Changes in sex-steroid hormones can occur during menarche (early menstruation), during pregnancy or at menopause. They can also occur in relation to some higher-dose oral contraception medication or hormone replacement therapy. The good news is, it’s not the sex-therapy hormones that are making your gums bleed! But they can increase the body’s response to bacteria and bacterial toxins. So excellent oral hygiene and visiting your dentist can allow you to control those diseases.

Q: How can pregnancy impact oral health?

Dr. Geisinger: Each year, about 15 million babies globally are born pre-term, which is defined as before 37 weeks of gestation. About 30 percent of those births are due to a physician or a perinatal health care provider saying it’s time to induce labor because there’s something going wrong with mom or baby. But the other 70 percent are spontaneous pre-term births, and they are associated with a whole host of things, including infection and inflammation.

A source of infection and inflammation that may impact pregnancy outcomes could include periodontitis or gingivitis. There have been a number of studies that have correlated pre-term births and low birth weight, with periodontitis during pregnancy. Patients who have severe gum disease may be more likely to have pre-term births and low birth weight.

Another oral health related concern during pregnancy is that the amount of carbohydrate consumption for pregnant patients generally goes up. And patients who have severe morning sickness also have an increase in stomach acid. So there can be risks for tooth decay associated with both those things that should be monitored by a dentist as well.

Q: So women should continue seeing their dentist regularly even during pregnancy?

Dr. Geisinger: For a long time, one of the conventional pieces of wisdom was that you don’t necessarily want to provide non-emergency dental care to a pregnant woman. It turns out that is not the case. Routine dental care in the vast majority of cases is safe and effective for pregnant women. In fact, The American College of Obstetricians and Gynecologists recommends that women who are pregnant or plan to become pregnant within six months find a dental home in order for them to have ongoing routine care. Maintaining your oral health prior to pregnancy is ideal, but certainly patients who are pregnant should have a comprehensive oral exam and understand what their oral health risks are.

Q: What is the UAB School of Dentistry doing to help research this issue?

Dr. Geisinger: Our department has been involved with several studies that looked at the connection between significant levels of gingivitis and the rate of pre-term births and low birth weight. Those studies were conducted in conjunction with the UAB Center for Women’s Reproductive Health. The principal investigator was the Chair of the Department of Periodontology, Dr. Nico Geurs. They found that if we did intensive oral hygiene training for pregnant women with severe gingivitis – delivered by a nursing staff in conjunction with their monthly OB visit – that we were able to improve their oral health and potentially impact rates of pre-term births and low birth weight.

That was really exciting, because that is a very scalable intervention. Patient-delivered oral hygiene is a skill that can be taught! And it’s a very low-cost intervention, especially when compared to the cost of caring for a pre-term baby, which is about 10 times more than the cost of an uncomplicated birth. Also, if you do something regularly for nine months, there is a good chance it will becomes a habit.

One of the other things that we found is that maternal oral health is correlated with children’s oral health. In other words, if mom is able to take better care of her mouth and oral health is important to her, then the likelihood of her child having early childhood caries is much lower. So if we can help moms get healthier, we can also have an impact on the oral health of the next generation. That is really exciting for dentistry as a whole!

For more on Dr. Mia Geisinger and our other experts, visit UAB News Experts in Dentistry.