LAUSR

Oral diseases affect over 3.5 billion people worldwide and entail substantial expenses for individuals and society. Periodontal diseases (gingivitis and periodontitis) are frequently neglected, and yet represent the sixth most prevalent noncommunicable oral diseases affecting 796 million people worldwide according to the Global Burden of Disease study.1 These diseases are typically initiated by the accumulation of dental plaque on the tooth and root surfaces.2 Evidently, there are many connections between systemic and periodontal health. Changes in hormones such as those that occur during puberty, menstruation, pregnancy, and menopause, or with the intake of hormonal supplements, can all alter the periodontal health of women.3 In the current issue, Thomas et al. demonstrate that almost half of the pregnant women in their first trimester exhibited poor periodontal health, while those who developed periodontitis were more prone to develop gestational diabetes during their pregnancy.4 These findings are in line with existing evidence alluding to periodontal diseases as systemic stressors during pregnancy, that are also associated with adverse pregnancy outcomes (APOs). Such considerations have nonetheless received little attention thus far in everyday clinical practice, due to several existing barriers. Importantly, up to one third of the pregnant women were unaware of their existing periodontal condition, as symptoms of gingival inflammation remained concealed. This seems to be a common pattern across the world as periodontitis is considered a “silent epidemic”, that may start and worsen with little or no pain. If left untreated, not only will periodontal diseases destroy the tooth supporting tissues, but they may further constitute a risk factor to several lifethreatening affections such as cardiovascular diseases, diabetes mellitus II, as well as to APOs. “Periodontal Health for a Better Life” has been emphasized by several health associations including the European Federation of Periodontology and World Health Organization among the few. The progesterone and estrogen levels are known to peak during the second and third trimester of pregnancy, when one half of women with preexisting gingival inflammation are documented to exhibit significant exacerbation of bleeding in their gums in combination with changes in specific oral taxa, such as Porphyromonas gingivalis and Prevotella melaninogenica.5 Driven by these findings, the current body of literature is mainly focused on the second and third pregnancy trimesters, somewhat overlooking the first trimester, which now appears to be the tipping point to implement efficient prevention strategies. The systematic reviews show that the percentage of pregnant women with periodontitis varies significantly from 16% to 67% and seems to be dependent on the time of the clinical examination, the type of periodontal examination performed (partialmouth vs fullmouth) as well as on the case definition of periodontitis.6