Abstract

This study was aimed at evaluating the occurrence and the risk factors of gingivitis among pregnant women attending the Laquantini hospital Douala. A convenience sampling technique will be used to recruit consenting pregnant women who will be continuously enrolled until the calculated sample size will be reached.

A structured, interviewer-administered questionnaire was used to obtain the socio-demographic and other relevant data. An intraoral examination was performed by the researcher to assess their oral and gingival health status.a total of 100 participants was recruited into the study.

Data was collected to determine the prevalence of gingivitis among pregnant women based on clinical presentation, oral habits, oral health status, nutritional status and gestational age. Data was entered into Microsoft excel and analyzed using SPSS version 26.0. The risk factors associated with gingivitis in pregnancy were identified in this study.

The findings were highlight the need of ANC reinforcement, oral hygiene and adequate nutrition during pregnancy among others. 63% of the respondents were presenting with active clinical gingivits. The most reported oral hygiene practice was use of tooth brush with tooth paste together. 61% of the women reported that they brushed their teeth twice a day and almost all brush in the morning.

More than half of the women did not know what causes gum disease. About 49% of the women visited a dentist, mostly for dental pain. Most of the women had received no instructions concerning either their own oral health. Gingivitis was common and associated with age, pregnancy age, oral health habits like brushing frequency, nutritional status and other risk factors among pregnant women in Douala.

CHAPTER ONE

INTRODUCTION

1.0 Background

Gingivitis is a highly prevalent periodontal disease affecting 50-90% of adults worldwide. It is reversible and the mildest form of periodontal disease that is principally-caused by lack of oral hygiene resulting in dental plaque accumulation on the surfaces of teeth adjacent to gingival. It does not affect the supporting structures of the teeth but can itself proceed to peritonitis (Trombelli et al. 2004; Pihlstrom et al. 2005).

Gingivitis is clinically defined by the presence of gingival inflammation without the loss of the connective tissue while peritonitis is defined by inflammation of the gingival with additional pathological detachment of collagen fibers from cementum, junction epithelium and finally bone resorption (Loesche & Grossman 2001; Armitage 2003; Pihlstrom et al. 2005).

Gingivitis is the most prevalent disease of the peridontum with the two most common forms being chronic marginal gingivitis and plaque-induced gingivitis. As stated above, gingivitis begins with a lack of oral hygiene, which leads to plaque increasing in both thickness and coverage eventually leading to gingival inflammation.

The gingival sulcus increases in depth (becoming a periodontal pocket) allowing more space for bacterial accumulation in the presence of nutrient-rich gingival cervical fluid. It is thought that gingivitis is caused by an imbalance among resident microbial which leads to environmental changes and alterations in gene expression.

The overall results of these changes are that the gingivitis inducing pathogens are able to out compete the health associated bacteria. However, the exact mechanism is not well characterised yet (Olsen 2006; Paster et al. 2006). Although the plaque accumulation is thought

 

to be a major causative factor for gingivitis, there are several systemic factors that can trigger or modulate gingivitis progression.

These can be divided into metabolic, environmental, genetic or other factors. The metabolic factors are usually associated with endocrine changes. Therefore, the hormonal changes that occur during puberty or pregnancy can have an impact on plaque- gingivitis relationship. Environmental factors include smoking or tobacco usage, vitamin C deficiency or excessive use of antibiotics.

The individual differences in terms of genetics and immune response to infection may also play a role. As an example, several clinical studies have associated the MMP-9, IL-1, IL-6, IL-18 polymorphism with increased susceptibility to gingivitis (Goodson et al. 2000; Trombelli et al. 2004; Moreira et al. 2007; Scapoli et al. 2007; Holla et al. 2008; Vokurka et al. 2008). However, the significance of genetic factors in modulation of the individual’s susceptibility to gingivitis remains to be established. Other factors include infections such as HIV/AIDS, physiological or emotional stress, Down’s syndrome (Trombelli et al.2004).

The clinical assessment of gingival inflammation is based on several clinical parameters. A visual assessment includes observing the physical status of gingival by assessing the colour change, surface anatomy and bleeding tendency. To aid the process several indices have been introduced for the clinical evaluation of gingival inflammation. These include papilla, marginal, attached index (PMA), the papillary bleeding index (PBI) and the gingival index (GI) introduced by Loe & Silness (1963).

The use of the above mentioned indices have demonstrated the extent of severity between plaque deposits and the severity of gingivitis (Tatakis & Trombelli 2004). The main therapy for gingivitis patients is aimed at removing the aetiological factors to reduce or eliminate the inflammation and then subsequently allow the gingival tissues to heal (He & Shi 2009).

As dental plaque is the primary aetiological factor for disease progression, mechanical or chemical plaque removal techniques can be successfully used as a preventative approach (Lamster 2006). The removal of dental plaque and calculus can be performed by regular daily hygiene applied by hand, sonic, ultrasonic instrument, and supplemented by professional cleaning and supra-gingival scaling (Van Der Weijden et al. 2002; Santos 2003).

The addition of topical anti-plaque agents in the form of dentifrices or mouthwashes to a gingivitis-treatment programme for patients with inadequate plaque control can help reduce the problem (Allaker & Douglas 2009) (Santos 2003). These active substances include thymol, menthol, eucalyptol, methyl salicylate, triclosan and chlorhexidine digluconate (Santos 2003; Allaker & Douglas, 2009)

Gingivitis is essentially a prudent attempt of the human body to wall-off the destructive aspects of the immunologically mediated mechanisms in response to the presence of a biofilm, which enhances the body to cease such perturbing consequences.

Periodontal disease in pregnancy has been associated with an increase in preterm birth and adverse pregnancy outcomes. (Bobetsis YA et al, 2006). However, treatment of periodontal disease in pregnancy has not been shown to improve pregnancy outcomes. (Baccaglini L et al, 2011). An increase in the prevalence and severity of gingival inflammation during pregnancy without plaque association has been reported (Hugoson, A 2017).

Clinically, preexisting gingivitis or peritonitis in pregnant women would be worsening dramatically. The periodontal changes are characterized by increasing periodontal probing depths, bleeding upon probing or mechanical stimulation, and gingival cervical fluid flow, which disappears postpartum (Mariotti A. et al, 2014).

In previous studies, it appears that gingival inflammation shows prevalence from 30% to 100% when pregnancy occurs (Mealey B, et al, 2013). Meanwhile, some cross-sectional research showed that the percentage of pregnant women with gingivitis was 89% in Ghana, 86.2% in Thailand, and 47% in Brazil (Rakchanok N et al, 2010). This variation may reflect the different populations studied and their characteristics, as well as the differences in definitions of periodontal disease between studies. (Vogt M et al, 2012).

1.2 Statement of the Problem

Gingivitis is a highly prevalent periodontal disease affecting 50-90% of adults worldwide. Gingivitis if left untreated, can lead to dental abscess which is linked to preterm delivery and low birth weight. Inflammation as a result of gingivitis causes your gums to pull away from your teeth, leaving pockets that can become infected. Eventually, this can lead to tooth loss.

Research suggests that the bacteria that cause inflammation in the gums can actually get into the bloodstream and target the fetus, potentially leading to PLBW babies. Most gravid women begin antenatal visits by the second trimester of pregnancy, which makes it very difficult to diagnose gingivitis early enough. With pregnancy the mother’s immunity is reduced, hence pregnant women are more prone to infection. This study is focused on assessing the causes, risk factors and management of gingivitis among patients in Laquintini hospital Douala.

1.4 Research Questions

1. What are the causes of gingivitis among pregnant women attending the Laquintini Hospital Douala.?
2. What are the effects of gingivitis infection among pregnant women at the Laquintini Hospital Douala.?
3. What are the possible preventive measures against gingivitis infection during pregnancy?

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