Periodontal Treatment for an Early Onset Periodontitis Patient During Pregnancy. A Case Report

Abstract

Although dentists tend to hesitate to treat pregnant patients, the initiation and progression of periodontal disease really should be controlled during pregnancy. This case report deals with an early onset periodontitis patient who became pregnant during periodontal treatment. We conducted intensive nonsurgical periodontal therapy using local drug delivery to prevent her periodontal disease from progressing while avoiding pregnancy complications such as preterm labor or preterm low birth weight.
A 34-year-old woman with severe alveolar bone loss was referred to our clinic for gingival pain and mobility of the left mandibular molars. After initial periodontal treatment, we conducted flap operations, but had to change the treatment plan to nonsurgical periodontal therapy when she entered her fourth pregnancy. Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Prevotella intermedia (Pi) were detected from many periodontal pockets by PCR analysis early on in pregnancy, and her serum IgG antibody titers to Pg, Campylobacter rectus, Treponema denticola, and Eikenella corrodens were 2 SD higher than that of healthy controls. Since gingival bleeding and tooth mobility worsened markedly despite supportive periodontal therapy, we attempted subgingival plaque control by ultrasonic scaler under irrigation with 0.002% chlorhexidine gluconate and local drug delivery using 2% minocycline hydrochloride ointment. After such periodontal treatment, Aa, Pg, and Pi were no longer detected from periodontal pockets we tested and gingival bleeding lessened. We thus succeeded in improving microflora qualitatively. We must conduct similar clinical trials to build up safer, more effective periodontal treatment for pregnant women. J Jpn Soc Periodontol, 44: 37-45, 2002.