Probiotics as a Helper in the Fight Against Pregnancy Gingivitis

Pregnancy Gingivitis is Not the Same as Ordinary Gingivitis

Gingivitis affects a significant portion of pregnant women. Current studies confirm that pregnancy gingivitis is not identical to ordinary gingivitis resulting from poor hygiene. There is a significant shift in the correlation between the observed mass of bacterial plaque and the subsequent extent of gingival inflammation before and during pregnancy, where the body reacts with more severe inflammation to the same amount of plaque.

The presumed etiological explanation is attributed to the manifestation of various histological, serological, and immunological changes in the gingival tissues during pregnancy. These lead to a significant increase in the flow rate of crevicular fluid and a simultaneous increase in the concentration of pro-inflammatory cytokines and sex hormones related to pregnancy, which supports the overgrowth of microorganisms causing gingivitis.

The Role of the Microbiome

The composition of the oral microbiome also plays an important role in the development of pregnancy gingivitis. Some bacterial strains cause a more pronounced inflammatory response, while others can modulate it towards a milder manifestation. While the solution to pregnancy gingivitis through strict mechanical plaque control is well-known and proven (but unfortunately not always achievable by the patient), the effect of regular consumption of probiotics that modulate the host response to gingivitis in pregnant women has not yet been evaluated. Based on research, some strains of Limosilactobacillus reuteri commonly found in the gut and oral microbiota of healthy people and other mammals are considered beneficial to oral health. Their positive effect on general gingivitis is already known, so a similar effect is also expected for pregnancy gingivitis.

A randomized controlled trial was conducted at the University Hospital in Würzburg to determine the possible positive effect of L. reuteri on pregnancy gingivitis.

Methodology and Study Process

The study included 45 healthy women with pregnancy gingivitis in the third trimester of pregnancy, randomly divided into a group given lozenges containing L. reuteri (n = 24) and a group given a placebo (n = 21). At the beginning, the gingival index (GI) and plaque index (PI) were assessed on Ramfjord's index teeth, and venous blood was taken for analysis of tumor necrosis factor alpha (TNF-α). The participants were then randomly provided lozenges to consume twice a day until delivery (approximately 7 weeks) containing ≥ 10⁸ CFU L. reuteri ATCC PTA 5289 and ≥ 10⁸ CFU L. reuteri DSM 17938 (test) or a placebo. Within 2 days after delivery, GI, PI, and blood sampling were repeated.

Results

Initially, the average GI and PI values did not significantly differ between the two groups. In the test group, the average serum level of TNF-α was significantly higher (p < 0,02) than in the placebo group. In the subsequent evaluation post-delivery, the average GI and PI in the test group were significantly lower (p < 0.0001) than in the placebo group. The average serum TNF-α level no longer significantly differed between the groups.

The average GI in the test group decreased during probiotic use from 1.0 ± 0.6 to 0.2 ± 0.4; in the placebo group, the initial GI was 0.9 ± 0.6, and post-delivery, the GI was 0.7 ± 0.5. Similarly, the average PI in the probiotic group decreased from 0.7 ± 0.5 to 0.2 ± 0.3, while in the placebo group, the initial PI was 0.8 ± 0.6 and at the end of the study was 0.6 ± 0.6.

Conclusion

Regular consumption of preparations containing L. reuteri may have the potential to become an effective and safe supplement in the control of pregnancy gingivitis.

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Source: Schlagenhauf U., Jakob L., Eigenthaler M. et al. Regular consumption of Lactobacillus reuteri-containing lozenges reduces pregnancy gingivitis: an RCT. J Clin Periodontol 2016; 43 (11): 948−954, doi: 10.1111/jcpe.12606.