The Japanese Journal of Conservative Dentistry
Online ISSN : 2188-0808
Print ISSN : 0387-2343
ISSN-L : 0387-2343
Case Reports
Pathophysiologic Consideration for a Patient with Aggressive Periodontitis Suggesting a Relationship between Periodontal Inflammation and Infertility
OMORI KazuhiroKONO TakayukiKOBAYASHI HiroyaARAI HideoYAMAMOTO TadashiTAKASHIBA Shogo
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JOURNAL FREE ACCESS

2020 Volume 63 Issue 5 Pages 451-460

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Abstract

 Background: Infection by periodontopathic bacteria and inflammation of periodontal tissue may affect conception. In this case report, we describe a specialized periodontal treatment focusing on removing the source of infection for a patient with aggressive periodontitis during infertility treatment. After the periodontal treatment, the patient had a natural pregnancy and a normal delivery.

 Case: The patient was a 33-year-old married female undergoing infertility treatment. In September 2016, she became aware of looseness of tooth 26 and spontaneous pain, and visited a dental clinic. An X-ray examination indicated that severe alveolar bone resorption was progressing, and she requested specialized periodontal treatment at the University Hospital. There was no special medical history, and there were no abnormal findings in both the patient and her husband on infertility examinations. Periodontal examination revealed that the proportion of periodontal pockets of 4 mm or more was 49.5%, bleeding on probing was 47.9%, plaque control record was 3.1%, and periodontal inflamed surface area (PISA) was 2,392 mm2. On X-ray imaging, there were many images showing bone resorption extending to the apex, including tooth 26. Infection by Porphyromonas gingivalis was high in both serum immunoglobulin G antibody titers test and DNA tests for periodontal pathogens in periodontal pockets. The diagnosis was aggressive periodontitis (Stage IV, Grade C) and secondary traumatic occlusion. The treatment policy was to improve the periodontal environment as early as possible (within one year), taking into consideration the patient’s desire for pregnancy. In addition, we explained and obtained consent for the necessity of refraining from pregnancy activities including infertility treatment until periodontal surgery was completed. The treatment plan was: (1) Initial periodontal treatment (patient education, tooth extraction, scaling and root planing with topical antibacterial therapy, temporary fixation), (2) Periodontal tissue regeneration therapy, (3) Oral function recovery treatment, and (4) Supportive periodontal therapy. The host response to periodontal treatment was very good, and improvement of inflammation and regeneration of alveolar bone were confirmed (PISA after periodontal surgery: 43 mm2). She had a spontaneous pregnancy during oral function recovery treatment, and gave birth to a normal boy (3,240 g, birth week: 38 weeks+5 days) at the age of 35.

 Conclusion: It is suggested that severe P. gingivalis infection and periodontal inflammation may affect pregnancy. If the course of infertility treatment is not good, it is desirable to examine the oral condition including periodontal tissue.

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© 2020 The Japanese Journal of Conservative Dentistry
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